4/12/2019

ENDOMETRIOSIS It’s a pain in the ?????

CONTENT

• ‐ WHAT EXACTLY IS IT?

• THE WHO, WHAT , WHERE, WHY AND HOW’S

• • IF IT WALKS LIKE A DUCK

• TREATMENT OPTIONS • MEDICAL • SURGICAL • EMOTIONAL

SURGICAL TREATMENT

• Laparoscopy • Laser • TAH/BSO

1 4/12/2019

EMOTIONAL TREATMENT

• Chronic pain • Sexuality • Job performance • • Counseling • Medication

WHAT IS ENDOMETRIOSIS

Endometriosis is a condition in which endometrial tissue normally lining the inside of the is found outside of the uterus. This tissue can implant anywhere in the and are called lesions. These lesions are fueled by and the result is pain.

WHO

• ANYONE – AS LONG AS THEY ARE MENSTRUATING • MENARCHE TO • AGE 9 TO 55 • FREQUENCY OF MENSES • 21‐35 DAYS • 10 vs 17 per year • LENGTH OF MENSES • NULLIPAROUS • FAMILY HISTORY

2 4/12/2019

WHAT

• Abnormal growth of endometrial tissue outside of the uterus.

• These lesions are responsive to estrogen and the response is PAIN.

• No correlation between the number of lesions and degree of pain.

WHERE

• Endometrial tissue can spill out anywhere in the pelvis.

• Ovaries, tubes, uterus, bladder and colon.

• Lesions may be visible or hidden.

WHY

• We don’t know. • The EXACT cause is unknown. • Can affect anyone regardless of socioeconomic class or race. • May be inherited. • Why is it so hard to diagnose?

3 4/12/2019

HOW

• Retrograde menstruation. • responds to estrogen no matter where it is. • How to we diagnose it? ‐Typically years for diagnosis. • How do we treat it?

SIGNS AND SYMPTOMS

• Pain is number one. • ‐Menstrual cramps • ‐ • ‐Back pain • ‐Pelvic pressure • ‐GI issues‐ nausea, constipation, diarrhea, bloating, dyschezia • ‐

IF IT WALKS LIKE A DUCK

• ALTHOUGH THE SYMPTOMS ARE FAIRLY CLASSIC IT IS IMPORTANT TO R/O OTHER SOURCES OF PAIN. • STD’s • UTI’S • Constipation/IBS • Ovarian cysts • atrophic • back/spinal issues

4 4/12/2019

TREATMENT OPTIONS

• Treatment options are varied and no one shoe fits all. • They must be tailored to the individual. • May include concurrent therapy. • Combination of medical and surgical.

MEDICAL TREATMENT OPTIONS

• Non Hormonal • NSAIDS ‐adequate dosing ‐early dosing to reduce the prostaglandin effect

MEDICAL TREATMENT OPTIONS

• PROGESTIN ONLY or COMBINATION

‐ Depo Provera ‐Nexplanon ‐IUD’s Mirena, Skyla, Kyleena ‐Progestin only pill (POP) ‐ OC’S, Nuva Ring, Contraceptive patch (Xulane)

5 4/12/2019

THE OTHER WHITE MEAT

• GnRH ANTAGONISTS • LUPRON • LUPRON WITH ADD‐BACK THERAPY

‐Monthly injection ‐Every 3 month injection ‐Aygestin 5 mg daily for add back

THE NEW KID ON THE BLOCK

• ORLISSIA ‐Oral ‐Daily dosing ‐2 dosing options

Dysmenorrhea ‐150 mg QD for up to 24 months Dyspareunia ‐200 mg BID

SO IS THERE ANY COMMON DENOMINATOR

• MENARCHE • MENSTRAUTION • MENORRHAGIA • MENOPAUSE • MENTAL ILLNESS • HYSTERECTOMY

6 4/12/2019

MEN

7