What is Endometriosis; the Pathophysiology of the disease and its prognosis. Can it be prevented? and what are the risk factors of Endometriosis?

1. Endometriosis
Ivory Diane C. Amancio, RPh
University of the Immaculate Conception
Clinical Pharmacy Department

2. What is Endometriosis?

3. Pathophysiology Endometrial Tissue
is deposited in the
peritoneal cavity by
Retrograde
Menstruation
through the
Fallopian Tubes
- Sampson’s Theory

4. 10% to 15%
develop
endometriosis Uterus
Fallopian
Tube
Ovary
Space
Retrograde
Menstruation
occurs up to 90%
of Women

5. Etiology
• Most common during reproductive years:
• Range 12 to 80 years old; average 28 years old
Early Menarche (< 11 y/o)
Shorter Menstrual cycles (< 27 days)
Heavy Prolonged menstruation
Taller, thinner women

6. What are the symptoms
of Endometriosis?
Dysmenorrhea Infertility
Prostaglandin F2a = Induce
vasoconstriction ; cause uterine
contractions
Prostaglandin E2 = induce
direct pain through the nerves
Signs ( PE during
Menstruation):
 Pelvic Tenderness
 Enlarge Ovaries
 Pelvic Masses or nodules
 Retroverted Uterus

7. Staging of Endometriosis

8. Treatment
Desired Outcomes:
Minimization of associated pain
Improved quality of life
Correction of associated infertility

9. Nonpharmacologic Therapy
1. Surgery:
 Reserved for patients experiencing medication failure
or who suffer from infertility.
Women with continuing pain symptoms who do not
desire pregnancy may be offered the option of
Hysterectomy with or without oophorectomy.

10. Nonpharmacologic Therapy
2. Acupuncture
• Relieves menstrual pain
• Reduce the size of pelvic masses
• Reduce recurrence rate
of endometriosis

11. Hysterectomy Oophorectomy

12. TAH-BSO
Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy
This surgery will
remove all the uterus,
cervix, ovaries and
fallopian tubes.
Heavy Periods
Endometriosis
Uterine Fibroids
Cancer

13. MYOMAS
Noncancerous growths in the Uterus
Appears during child bearing years
Not associated with an increased risk
of Uterine Cancer
Almost never developed into cancer

15. Nonpharmacologic Therapy
3. Dietary Therapy
 Increase intake of Omega-3
Fats
( Nuts, Salmon, Mackerel, Tuna,
Soy Bean, Canola Oil,
Plant Oils)

16. Nonpharmacologic Therapy
3. Dietary Therapy
Avoid Trans fat
(Animal Fat)

17. Nonpharmacologic Therapy
3. Dietary Therapy
 Cut Down Red Meat

18. Nonpharmacologic Therapy
3. Dietary Therapy
 Eat Plenty of Vegetables
Fruits and Whole Grains

19. Nonpharmacologic Therapy
3. Dietary Therapy
 Limit Caffeine and
Alcohol

20. Pharmacological Treatment
•Danazol
Same with Male Hormone
(Testosterone); it works by
decreasing the amount of
hormones made by the Ovaries

21. Pharmacological Treatment
Adverse Effects:
Weight gain
Acne
Abnormal growth of body hairs
Vaginal dryness and irritation
Decrease breast size
Voice changes (Hoarseness)

22. Pharmacological Treatment
GnRH Agonist
(Gonadotropin Releasing
Hormone)
 Deprives the endometrial implants
of estrogen, causing them to
become inactive and degenerate

23. Pharmacological Treatment
Adverse Effects:
Prevents the onset of
masculinizing changes of
adolescence
Slows Puberty and its
physical effects

24. Thank you for your
Time…