••• Chapter 25^ Adenomyosis and Endometriosis^253
❍ List three causes of pelvic pain associated with endometriosis.
(1) Inflammatory factors.
(2) Scarring and retraction.
(3) Compression and stretching.
❍ Abnormal bleeding occurs in what percentage of women? (Specify a range).
10% to 35%.
❍ State the macrophage hypothesis in endometriosis.
The inflammatory response caused by endometriosis results in increased concentration of pelvic macrophages. This
causes a decrease in fertility by phagocytosis of sperm and secretion of IL-1 that is shown to be toxic to mouse embryos.
❍ True or False: Spontaneous abortions are increased in women with endometriosis.
False. There is no evidence that spontaneous abortion rate is altered in patients with this disease.
❍ True or False: Endometriosis is a risk factor for ectopic pregnancy.
True. Management of endometriosis in adolescents.
❍ List two characteristics that increase the risk of endometriosis.
Cycle lengths <27 days and menstrual flow >1 week.
❍ How do you choose medical treatment?
By cost and side effect profile; no one medication has been shown to be more effective than any other.
❍ Name some side effects of danazol.
Weight gain, fluid retention, fatigue, smaller breast size, acne, facial hair, atrophic vaginitis, hot flushes,
muscle cramps, emotional lability, irreversible deepening of the voice, hepatocellular damage (check LFTS
first), increase low-density lipoprotein (LDL), lower high-density lipoprotein (HDL), and in utero female
pseudohermaphroditism.
❍ True or False: In premenopausal women, danazol lowers basal gonadotropin secretion.
False. Danazol eliminates the midcycle LH and FSH surge, and inhibits steroidogenesis in the corpus luteum
creating a high androgen, low estrogen state and amenorrhea.
❍ Name four currently utilized regiments in the treatment of endometriosis.
Progestins, combination estrogen/progesterone pills (oral contraceptives), danazol, and GnRH agonists.
❍ What are the side effects of progestational agents?
Weight gain, fluid retention, breakthrough bleeding, and depression.
❍ Name some side effects of GnRH agonists.
Flare response, menopausal symptoms (hypoestrogenism), and bone loss (need add back therapy after 6 months
of treatment).