endometriosis power points

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ENDOMETRIOSIS Endometrium cells normally line the uterus Endometriosis is the presence of endometrial tissue outside the endometrial cavity (Youngkin, Davis, 2004) The growth of seeds or nodules are lodged in areas outside the uterus It is seen during the reproductive years The inflammatory process produces inflammatory mediators that cause pain and inflammation Pelvic pain is the most common symptom which correlates with the menstrual cycle The pelvic pain can be caused by a build up of scar tissue or adhesions


ENDOMETRIOSIS Benign disease Affects women mostly in 20-30’s Affects women who are still menstruating Affects more than 5 million women 10-20% premenopausal women are affected by endometriosis in the United States


ENDOMETROISIS Symptoms include: Dysmenorrhea Chronic pelvic pain Dyspareunia (painful sex) Dyschezia (painful bowel movement) Dysuria Bimanual exam: tenderness and nodularity of the uterosacral ligament


ENDOMETROSIS CAUSES The exact cause is unknown Estrogen dependent Retrograde Menstruation Immune System Environmental Factors STD (Chlamydia, Gonorrhea) Aerobic and Anaerobic Bacteria


ENDOMETRIOSIS COMPLICATIONS Scarring Adhesions Ruptured cysts Chocolate cysts Bowel obstruction

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Relevance to Women’s Health : 

Relevance to Women’s Health Interfers with activities of daily living There is a possibility of addiction and treatment can put a financial burden on the family Endometriosis may cause Infertility Infertility can cause psychosocial problems (depression, anxiety)

Analyze Research Findings : 

Analyze Research Findings Researchers continue to investigate the cause Under investigation is the hormonal manipulation, endometrial ablation and possible artery embolization Research shows that the risk of endometriosis is lower in women who have taken OC (decreases menstrual flow and blocks ovulation) Research suggest that 30% of women risk of developing ovarian cancer


ANALYZE RESEARCH FINGINGS Findings suggest the endometriosis is associated with other cancers such as, ovarian cancer, non-Hogkins lymphoma, and brain cancer In 1988 survey they found that hypothyroidism, fibromyalgia, chronic fatigue syndrome, autoimmune diseases, allergens, and asthma were affiliated with endometriosis


TREATMENT The Golden Standard of diagnosis is a Laparoscopy with biopsy Ultra sound MRI Gynecological exam Aspirin, narcotics and NSAID


TREATMENT Depends on individual needs, symptoms, age and fertility wishes and the quality of life Monophasic oral contraceptives (35mcq ethinyl estradiol) protective effect against endometriosis OC can decrease symptoms up to 50% in women Laser or cautery laparoscopy maybe the only needed treatment in severe cases Risks and benefits: bleeding, infection and injury to other organs, relieve of pain,


TREATMENT Diclofenac: decreases inflammation and acts as a analgesic reducing pain Progesterone: counteracts estrogen and inhibits the growth of the endometrium Danazol: Suppresses LH,FSH, mild 100-200mg po BID, severe 400mg po BID, contraindicated in pregnancy, breast feeding, hepatic impairment, HTN GnRH Gonadotropin Releasing Hormone Agonist (works by increasing levels of GnRH Lupron Depot shot is a GnRH agonist used to lower the hormone levels in the womens body to prevent or reduce growth of endometroiosis

Treatment : 

Treatment Contraindicated: pregnancy, depression Once every 3 months (11.25mg IM) or once every month (3.75mg IM) for six months Add Back Therapy Lupron (11.25mg) and norethindrone actate (5mg) daily for six months Reduce bone loss, hot flashes and pain

Laparoscopy : 

Laparoscopy General anesthesia Abd inflated with carbon dioxide/nitrous oxide: the gas pushes the abd wall away from the organs Procedure time: 30-45 minutes Technique: cutting or destroying with a laser beam or electric current Pain after surgery decreased 70-100% 45% symptoms return within one year

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Controversy : 

Controversy CA-125 not a definite marker of endometroisis, because it is not specific to gynecological problems After a hysterectomy 40% may recur unless the seeds or nodules have been removed The amount of research in endometriosis using quality of life measures found that their was a slight increase in the quality of life in the last five years, there is little data on the reliability and validity or measures used in this area.


PATIENT EDUCATION Gynecological Problems Endometriosis (www.acog/publication/patient_education/bp013.cfm) Support groups in your area www.endometriosis.org Pamphlet (endometriosis: understanding your treatment) www.endofacts.com


RESEARCH QUESTIONS What is the percentage of women getting pregnant after having endometroisis ? What is the percentage of pelvic pain being endometrosis?


RELEVANCE FOR CLINICAL PRACTICE The NP should know that endometriosis occurs equally among Caucasian and African Americans The clinician should know that endometriosis can occur at any time during while one is menstruating It is important to perform a thorough history and physical to make a tentative diagnosis Definitive diagnosis is made by performing a laparoscopy with biopsy Treatment is to control pelvic pain, there is no cure NP must be current with the most recent diagnosis and treatment

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