Endometriosis

Group F
Lauren Austin, Brooklyn Barney, McKenna Foxworthy,
Kaitlyn Jensen, Becka Johnson, Emily Kingsley, Krista
Laurie, Jen Riedel, & Jillian Weber
Layers of the uterus

● Endometrium: thickens and

sheds during menstruation
● Myometrium: smooth muscle
layer
● Perimetrium: derivative of the
visceral peritoneum
What is endometriosis?

● Endometrium grows outside of the uterus

○ Common sites: ovaries and fallopian tubes
● Endometrium functions normally: thickens and bleeds with each
menstrual cycle
○ No place for tissue to exit the body
● Potential causes
○ Retrograde menstrual flow
○ Stem cell metaplasia
○ Lymphatic transfer of endometrial tissue
How the woman is affected

- Severe pain
- Chronic
- Worsens during menses
- During sex
- Infertility
- Psychosocial implications
- Symptoms aren’t taken seriously
- Delayed diagnosis
- Unable to work or travel due to pain
- Concerns for conception
- Problems with intimacy
Signs & Symptoms
● ⅓ of women are
asymptomatic
● the degree of symptoms
do not directly correlate
with the size of lesions.
● Pelvic pain and
dysmenorrhea
● Low back pain
● Pelvic Pressure
● Infertility
● Premenstrual spotting and
menorrhagia
● Diarrhea, pain with defecation, and
constipation
● Bloody urine when the bladder is
involved
● Fixed retroverted uterus
● Enlarged and tender ovaries.
● Dyspareunia
Natural Course
● After abnormal tissue growth starts occurring outside
of the uterus, the tissue responds to changes in
estrogen and progesterone.
● The tissue grows and thickens during the secretory
and proliferative stages of the menstrual cycle.
● The tissue then breaks down and bleeds into the
surrounding tissues during the menstrual phase.
● This bleeding causes inflammation.
● Scarring, fibrosis, and adhesions can result from the
constant inflammation.
Risk Factors

● Family history ● Low BMI

● Early onset of menstruation
● Nullipara
● Late menopause
● Short menstrual cycles
● Medical conditions
preventing normal
menstrual flow
● Increased alcohol
consumption
● High levels of estrogen in
body
● Uterine abnormalities
 Treatment

Treatment options are often dependent on various

factors

1. Supportive care & comfort measures: OTC pain

relief (such as NSAIDs), heating pads, opioids if
severe
2. Hormone therapy: overall function is to inhibit
growth of endometriosis
3. Surgical treatment: indicated for severe pain - short
term relief
4. Possible use of assistive reproductive
technologies: In vitro fertilization (IVF)
Natural/non-pharmacologic treatment methods

● Acupuncture
● Heating pads
● Rest
● Distraction
● Stress reduction
● Cannabis
Chocolate Cysts

Endometriomas:
● Endometriosis cyst of the ovary
● Tiny patch of endometrial tissue bleeds,
sloughs off, transplanted in the ovaries
where it grows and forms “chocolate
cyst”
● May occur in one ovary or both
● Occurs in 20-40% of patients with
endometriosis
● Symptoms: some may be asymptomatic
while others experience pelvic pain
outside of periods, infertility, painful
intercourse
Chocolate Cysts

Treatment:

● Laparoscopic cystectomy
● Aspiration
● Laparoscopic endometrial ablation
● Three stage technique
● Combined ablation and cystectomy
Correlation to cancer

● Women with endometriosis have a higher risk of

developing certain cancers
○ Ovarian Cancer
○ Breast Cancer
○ Non-Hodgkin’s lymphoma
○ Endometrial Cancer
● Get cancer screenings and mammograms
Resources for cancer prevention

● CDC- What you can do, Facts about cancer and women

● Cancer.net- Ovarian, Fallopian Tube, and Peritoneal Cancer: Risk

Factors and Prevention

● World Health Organization (WHO)- Breast Cancer: Prevention and

control
Staging

● Stage I (minimal): small surface lesions or inflammation on or near

organs in the pelvic cavity
● Stage II (mild): more extensive than stage I but limited scarring,
adhesions, and infiltration of pelvic organs
● Stage III (moderate): can be more widespread with scarring and
adhesions and starts to infiltrate pelvic organs, peritoneum, and other
structures
● Stage IV (severe): infiltration, affects many pelvic organs and
ovaries, and can cause distortion of anatomy and adhesions
Questions

A 23 year old nullipara woman has recently been diagnosed with stage III
endometriosis following laparoscopic biopsy. Which of the following is the
most appropriate response for the nurse to make?

A) “Here is some information on adoption since you will not be able to

conceive”
B) “Do not use tampons because they contribute to pelvic inflammation”
C) “Surgery is the only way to permanently remove the adhesions and
implants will stop more from occurring”
D) “What is your biggest concern regarding this diagnosis?”
Questions

A 35 year old is suspected to have stage I endometriosis. After discussing

this with the nurse, the patient demonstrates understanding by saying:

A) “My diet can heal the damage caused by the adhesions”

B) “I will need IVF to get pregnant”
C) “I will take birth control pills and skip the placebo week to control my
symptoms”
D) “Pain relievers like ibuprofen slow the progression of endometriosis”
 References

- Berna, C. (2017). Endometrioma: What you need to know. Retrieved from

https://www.endofound.org/endometriomas-what-you-need-to-know

- Bush, D. (n.d.). About endometriosis. Retrieved from http://www.nzendo.org.nz/about-

endometriosis

- Durham, R. & Chapman, L. (2014). Maternal-newborn nursing: The critical components of

nursing care (2nd Ed). Philadelphia: F. A. Davis Company.

- Impact Network. (2015). Cannabis & endometriosis. Retrieved from

http://www.impactcannabis.org/endometriosis/

- Mayo Clinic (2016). Endometriosis symptoms and causes. Retrieved from

http://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/dxc-20236425