Treatment: – Principles: patients’ age; severity of symptoms; fertility requirements –Medication: symptom relieved, none radical cure NASIDs; Ocs; Mirena( a low-dose hormonal IUD) −Surgery: no fertility desire; no respond to medical treatment Hysterectomy (ovary preservation as appropriate)
Case 1 History: 33-year-old female, pelvic pain during menstruation for 4 years, progressively worse over the years, with pre and postmenstrual spotting; dyspareunia and pain during defecation for 6 months, progressively worse ; no change in the color or caliber of her stool; no sexually active besides her husband; no birth control, and been trying to get pregnant for the last 3.5 years. Menstrual history: regular G0P0 Normal Pap smear 6 months ago. Case discussion
Case 1 Pelvic examination –Uterus: fixed, retroverted. –Tender nodularity of the uterosacral ligaments bilaterally. –Both ovaries are somewhat tender and mildly enlarged. Case discussion
Initial diagnosis: Pelvic inflammation PCOS Endometriosis Ovarian cancer hydrosalpinx Next step?
Ultrasonography ： 1)bilateral adnexal masses; 2)a thick, viscous dark brown fluid CA125 ： 87 U/ML
PCOS Endometriosis What is your answer?
Management Principle Principle The certainty of the diagnosis The severity of symptoms The extent of the disease The desire for future fertility The age of the patients
Case 2 History 41-year-old female, increasing colicky pain during menstruation which needs ibuprofen to relieve symptom; her volume of menstrual flow has increased steadily over the last several months, though her cycles continue to be regular; no vaginal discharge or fever. Menstrual history: regular G1P1 Normal Pap smear 2 months ago Dilation and curettage 2 months ago Case discussion
Case 2 Pelvic examination –Uterus: symmetrically enlarged, smooth with a boggy consistency that is somewhat tender. –No adnexal masses are appreciated. Laboratory Findings –Hemoglobin: 11g/dL Case discussion
Questions Current diagnosis Differential diagnosis Further examination Treatment Case discussionCase 2
Questions Current diagnosis Adenomyosis? Differential diagnosis Uterine myoma Dysfunctional uterine bleeding (DUB) Endometriosis Further examination Radiologic imaging Ultrasound Treatment Medication OR surgery Case discussionCase 2
Take home message 1. Familiarize with the causes and pathogenesis of endometriosis 2. Master the clinical features, diagnosis and differential diagnosis of endometriosis 3. Grasp the major principles behind the treatment strategy of endometriosis