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ENDOMETRIOSIS . . . CONT.

Treatment medical p s e u d o p r e g n a n c y c y c l i c e s t r o g e n - p r o g e s t e r o n e ( O C P ) o r m e d r o x y p r o g e s t e r o n e ( P r o v e r a ) p s e u d o m e n o p a u s e d a n a z o l ( D a n o c r i n e ) = w e a k a n d r o g e n , s / e : w e i g h t g a i n , f l u i d r e t e n t i o n , a c n e , o r h i r s u t i s m l e u p r o l i d e ( L u p r o n ) = G n R H a g o n i s t ( s u p p r e s s e s p i t u i t a r y G n R H ) s / e : h o t f l a s h e s , v a g i n a l d r y n e s s , r e d u c e d l i b i d o , a n d o s t e o p o r o s i s w i t h p r o l o n g e d u s e t h e s e c a n o n l y b e u s e d s h o r t t e r m b e c a u s e o f o s t e o p o r o t i c p o t e n t i a l s u r g i c a l l a p a r o s c o p i c r e s e c t i o n a n d l a s e r i n g o f i m p l a n t s l y s i s o f a d h e s i o n s u s e o f e l e c t r o c a u t e r y u n i l a t e r a l s a l p i n g o - o o p h o r e c t o m y u t e r i n e s u s p e n s i o n r a r e l y t o t a l p e l v i c c l e a n - o u t + / f o l l o w - u p w i t h 3 m o n t h s o f m e d i c a l t r e a t m e n t

ADENOMYOSIS

Definition extension of areas of endometrial glands and stroma into the myometrium also known as “endometriosis interna” endometrium often remains unresponsive to ovarian hormones uterine wall may be diffusely involved

Incidence 15% of females > 35 years old 20-40% of hysterectomy specimens older parous age group 40-50 years (in contrast to endometriosis)

Symptoms menorrhagia dysmenorrhea (secondary) pelvic discomfort dyspareunia dyschezia

Diagnosis (see Colour Atlas D4) uterus symmetrically bulky uterus size is rarely greater than 2-3 times normal Halban sign: tender, softened uterus on premenstrual bimanual definitive diagnosis made at time of pathological examination

Treatment iron supplements as necessary D&C to rule out other pathology analgesics/NSAIDs low dose danazol 100-200 mg daily for 4 months GnRH agonists hysterectomy

MCCQE 2000 Review Notes and Lecture Series

Notes

Gynecology 21

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