A Case 1 26-year-old female complained of severe, dull, aching pain, and crampin

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A Case 1 26-year-old female complained of severe, dull, aching pain, and cramping in the lower abdomen. There were no other physical findings. A laparoscopy revealed the presence of ectopic endometrial tissue on the uterine wall and ovaries. Danazol (a synthetic androgen and inhibitor of gonadotropins), 600 mg/day, was prescribed for up to nine months to inhibit ovulation, suppress the growth of the abnormal endometrial tissue, and achieve appreciable symptomatic relief, with a 30% possibility of conception after withdrawal of the therapy. 1a. What is this condition called? This condition is called Endometriosis. Endometriosis is the abnormal growth of endometrial cells similar to those that form the inside of the uterus, but in a location outside of the uterus. Ectopic means that the endometriosis was found inside and outside the Fallopian Tubes. Symptoms of endometriosis include lower abdominal pain, diarrhea, constipation, lower back pain, chronic fatigue and irregular or heavy menstruation. 1b. What causes it? The possible reasons for the cause of endometriosis are that the endometrial tissue is deposited in unusual locations by the retrograde flow of menstrual debris through the Fallopian Tubes into the pelvic and abdominal cavities. The retrograde menstruation is not the only cause of endometriosis, as many women who have retrograde menstruation do not develop the condition. Another possibility is that areas lining the pelvic organs possess primitive cells that are able to develop into other forms of tissue, such as endometrium. The direct transfer of endometrial tissues at time of surgery may be responsible for the endometriosis implants occasionally found in surgical scars. Some women with endometriosis have an altered immune response in women with endometriosis, which may affect the body’s natural ability to recognize ectopic endometrial tissue. 2. What is ectopic endometrial tissue? Ectopic endometrial tissue is endometrial tissue that occur in a place other than the uterine tubes. 3. What is the rationale for using danazol, a gonadotropin inhibitor? Danazol is a gonadotropin inhibitor which blocks GnRH output. This in turn results in decrease in FSH and LH output, thus decreasing circulating estrogen and progesterone. Deficiency of estrogen and progesterone will prevent endometrial growth vascularization and menses and allow the aberrant endometrial implants to regress. 4. Why do you think oral contraceptives could also be used as a treatment?

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4. Oral contraceptive contain estrogen and progesterone (in low dose). They act by inhibition of FSH and LH from anterior pitutary (by negative feedback). This prevent excessive release of Estrogen and Progesterone which prevent stimulation of ovulation, growth of endometrial tussue, and bleeding. This decreases the symptoms of endometriosis.

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