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Dr.Niraj Mahajan
Dr.Niraj Mahajan
Dr.Niraj Mahajan


Endometriosis Treatment

By AdminPosted On 05-Oct-2016

1. Drug of choice for endometriosis treatment

a) COC pills

b) Progesterone pills

c) Danazol

d) Leuprolide (GnRH)

e) Estrogen

Correct Answer: d) Leuprolide (GnRH). The aim of endometriosis treatment with hormone is to limit or stop the production of estrogen. The significant adverse side effects of danazol are related to its androgenic and hypo-oestrogenic properties. The most common side effects include weight gain, fluid retention, acne, oily skin, hirsutism, hot flushes, atrophic vaginitis, reduced breast size, reduced libido, fatigue, nausea, muscle cramps, and emotional instability. Deepening of the voice is another potential side effect that is non reversible. A Cochrane review (2010) on endometriosis treatment, comparing GnRH analogues with danazol treatment showed no difference in improvement of dysmenorrhea, dyspareunia, pelvic pain, or pelvic tenderness. Likewise, no difference in retrospective American Fertility Society (rRAFS) score was found at approximately 24 weeks' follow-up. In contrast, studies that evaluated total pain resolution showed greater benefit from GnRH analogues compared with danazol. Side-effect profiles differed, with greater frequency of hot flushes and vaginal dryness with GnRH analogues, whereas danazol treatment resulted in a greater frequency of weight gain, acne, and headaches.

2. “Powder burn” lesions are classically seen in

a) PID

b) Genital tuberculosis

c) Ovarian fibroma

d) Endometriosis

Correct Answer: d) Endometriosis. Characteristic findings in endometriosis include typical “powder burn”, “gunshot” lesions on the serosal surface of the peritoneum. These are black, dark brown, or brownish nodules or small cysts containing old hemorrhage surrounded by variable degree of fibrosis. Larger endometriotic cysts (endometrioma) are usually located on the anterior surface of the ovary. These ovarian endometriotic cysts often contain a thick, viscous dark brown fluid (“chocolate fluid”) composed of hemosiderin derived from previous intraovarian hemorrhage.

3. Dysmenorrhoea, Dysparunia and Menorrhagia

28-year-old woman presents to the gynaecology clinic with a history of dysmenorrhoea, dysparunia and menorrhagia. A vaginal examination reveals a thickened nodule in the posterior fornix. Which anatomical structure is most likely to be affected?

a) Constipated bowel

b) Ovaries

c) Pectineal ligaments

d) Ureter

e) Uterosacral ligaments

Correct Answer: e) Uterosacral ligament. The above triad of symptoms is characteristic of endometriosis. It is possible to palpate the affected uterosacral ligament by vaginal examination.

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Dr. Niraj Mahajan

MD- Gynecologist, Laparoscopic Surgeon, Uro-gynecologist , Infertility specialist & Cosmetic Gynecologist.

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