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Adenomyosis
Description of
Endometriosis
ovary
broad ligament
cul-de-sac
rectovaginal septum
Hematogenous spread
Epidemiology
early menarche
in those with menstrual flow exceeding seven days
cycles of less than 27 days
years of menstruation uninterrupted by pregnancy
family history of endometriosis
Incidence
History
dysmenorrhea
dyspareunia (especially on deep penetration)
perimenstrual back pain
infertility
Diagnostic Tests
CA-125 elevated
CBC normal
ESR normal
Diagnostic laparoscopy
http://medstat.med.utah.edu/kw/human_repro
d/mml/hr08.html
Differential Diagnoses
chronic PID
recurrent acute salpingitis
hemorrhagic corpus luteum
benign or malignant ovarian neoplasm
ectopic pregnancy
adenomyosis
Treatment Plan
psychosocial intervention
medications
danazol
progestogens
combined Ocs
gonadotropin-releasing hormone agonists
(GnRH-a)
Lupron injection qmo x 6 mos
Synarel nasal spray bid x 6 mos
GnRH analogs
Cost
Parenteral administration
Potential for accelerated bone mineral loss
Hot flashes & hypo-estrogen states
Adenomyosis
Adenomyosis - S &S
Dysmenorrhea
Menorrhagia
Bulky, boggy, tender, uterus on exam : if
menstruating, uterus may be board-like!
Treatment of Adenomyosis