••• Chapter 25^ Adenomyosis and Endometriosis^251
❍ Is there any role for postoperative medical treatment?
Yes. Medical treatment after surgical treatment can delay return of symptoms with at least 6 months postoperative
medical treatment.
❍ What is the typical classification scheme of endometriosis?
- Minimal endometriosis—Isolated superficial disease on the peritoneal surface with no significant associated
adhesions. - Mild endometriosis—Scattered superficial disease on the peritoneal surface and ovaries, totaling less than 5 cm
in aggregate, with no significant associated adhesions. - Moderate endometriosis—Multifocal disease, both superficial and invasive, that may be associated with
adhesions involving the fallopian tubes and/or the ovaries. - Severe endometriosis—Multifocal disease, both superficial and invasive, including large ovarian
endometriomas, usually associated with adhesions, both filmy and dense, involving the fallopian tubes,
ovaries, and cul-de-sac.
❍ What are the options for postoperative medical treatment?
Gonadotropin-releasing hormone (GnRH) agonist.
Danazol.
Oral contraceptives.
Letrozole.
❍ How do oral contraceptive pills treat endometriosis?
They suppress follicle-stimulating hormone (FSH) and luteinizing hormone (LH) secretion causing decreased
estrogen production and reduced menstrual volume.
❍ Can tubal ligation be performed as a treatment of endometriosis?
No. Some women even experience symptoms of endometriosis after hysterectomy.
❍ Can an intrauterine device (IUD) be used to treat endometriosis?
Yes. The levonorgestrel IUD causes decidualization of the endometrium and decreased menstrual flow.
❍ True or False: A CA-125 level can predict active endometriosis.
True, but controversial; CA-125 levels often correlate with the degree of disease; however, a normal level does not
exclude the absence of disease.
❍ Name the three main theories for the pathogenesis of endometriosis.
Coelomic metaplasia (Robert Meyer): Tissue from prenatal development transforms into endometrial cells.
Transplantation theory: Lymphatic, vascular, iatrogenic, retrograde menstruation (Sampson).
Induction theory: Possible substance in body that results in cellular transformation/differentiation.