Question

42 year old female with irregular, heavy menses plus pelvic pain

Exam: enlarged uterus; endometrial tissue outside uterus in pelvic cavity

Diagnosis?

Possible treatment?

Answer 1

1. The diagnosis is Endometriosis

It is a disorder in which tissue similar to the tissue that forms the lining of your uterus grows outside of your uterine cavity.

2. Treatment includes :-

- Pain medication

Such as the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) to help ease painful menstrual cramps.

- Hormone therapy

Supplemental hormones are sometimes effective in reducing or eliminating the pain of endometriosis. The rise and fall of hormones during the menstrual cycle causes endometrial implants to thicken, break down and bleed. Hormone medication may slow endometrial tissue growth and prevent new implants of endometrial tissue. It includes :-

1. Hormonal contraceptives. Birth control pills, patches and vaginal rings help control the hormones responsible for the buildup of endometrial tissue each month. Many have lighter and shorter menstrual flow when they're using a hormonal contraceptive. Using hormonal contraceptives — especially continuous-cycle regimens — may reduce or eliminate pain in some cases.

2. Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists. These drugs block the production of ovarian-stimulating hormones, lowering estrogen levels and preventing menstruation. This causes endometrial tissue to shrink. Because these drugs create an artificial menopause, taking a low dose of estrogen or progestin along with Gn-RH agonists and antagonists may decrease menopausal side effects, such as hot flashes, vaginal dryness and bone loss. Menstrual periods and the ability to get pregnant return when you stop taking the medication.

3. Progestin therapy. A variety of progestin therapies, including an intrauterine device with levonorgestrel (Mirena, Skyla), contraceptive implant (Nexplanon), contraceptive injection (Depo-Provera) or progestin pill (Camila), can halt menstrual periods and the growth of endometrial implants, which may relieve endometriosis signs and symptoms.

4. Aromatase inhibitors. Aromatase inhibitors are a class of medicines that reduce the amount of estrogen in your body.

- Conservative surgery

Surgery to remove the endometriosis implants while preserving your uterus and ovaries (conservative surgery)

- Fertility treatment

Endometriosis can lead to trouble conceiving. If you're having difficulty getting pregnant, you may be recommend for fertility treatment supervised by a fertility specialist. Fertility treatment ranges from stimulating your ovaries to make more eggs to in vitro fertilization.

- Hysterectomy with removal of the ovaries