Reproductive Endocrinology and Genitourinary Disorders Clinical Evaluation and Management Examination: Endometriosis Ectopic Endometrial Implantation Pathophysiology and Chronic Pelvic Pain with Infertility Risk, Uterine Fibroids Leiomyoma Hormone-Depende

Reproductive Endocrinology and Genitourinary Disorders Clinical Evaluation and Management Examination: Endometriosis Ectopic Endometrial Implantation Pathophysiology and Chronic Pelvic Pain with Infertility Risk, Uterine Fibroids Leiomyoma Hormone-Dependent Tumor Growth and Abnormal Uterine Bleeding Evaluation, Polycystic Ovary Syndrome Insulin Resistance Hyperandrogenism and Ovulatory Dysfunction Management, Menopause Climacteric Hormonal Transition with Vasomotor Symptoms and Estrogen Deficiency Complications, Ovarian and Endometrial Cancer Risk Factors Early Detection and Diagnostic Imaging Strategies, Benign Prostatic Hyperplasia Lower Urinary Tract Symptoms and Pharmacologic Alpha-Blocker Therapy, Prostate Cancer Screening Controversies PSA Interpretation and Treatment Options Exam Questions Verified and Provided with Complete A+ Graded Rationales Latest Updated 2026 Endometriosis Defined as the presence of endometrial glandular and/or stromal cells outside of the uterine cavity: abdomen, ovaries, fallopian tubes, ligaments that support the uterus, areas btw the vagina and rectum, outer surface of the uterus, lining of the pelvic cavity May also be located in teh bladder, bowel, vagina, cervix, and abdominal surgical scars endometriosis defined •The tissue reacts as normally placed endometrial tissue would during the menstrual cycle •Bloody discharge produced by such tissue has no outlet •Presence of discharge may cause severe pain with each menstrual cycle, either during ovulation menstruation or both •Accumulation of discharge may form dense fibrous tissue, leading to adhesions, sterility, and destruction of the ovarian tissue Endometriosis presentation Affects an estimated 5.5 million women in the U.S. & Canada Highest occurrence in women 25-29 years old Endometriosis is diagnosed in 70 to 90 percent of women with chronic pelvic pain Presentation is highly variable - from debilitating pelvic pain and infertility to no symptoms at all: Mild to incapacitating pain associated with menstruation (generalized abdominal or pelvic) Dyspareunia Pain with urination or defecation Fatigue, diarrhea, constipation, nausea endometriosis risk factors Early menarche First-degree relative with endometriosis Late menopause Low body mass index Müllerian anomalies Nulliparity Prolonged menstruation ( five days) Shorter lactation intervals Shorter menstrual cycles ( 28 days) White race (compared with black race) endometriosis pathophysiology Theories: Retrograde menstruation and implantation theory: menstrual tissue backs up through the fallopian tubes, implants in the abdomen, and proliferates in response to ovarian steroids Endometrial tissue is distributed from the uterus to other parts of the body through either lymphatic or hematological circulatory systems May be a link to immune system dysfunction Any pelvic organ can be involved. Cyclic production of ovarian sex hormones allows for the proliferation and maintenance of these implants. Occurs primarily during the woman's reproductive phase. Stages: minimal to severe depending on location and size endometriosis: evaluation Diagnosis in primary care is initially clinical and based on history and physical examination findings Diagnostic testing: Laproscopy is preferred diagnostic method CBC for anemia, infection CA-125 may be elevated in advanced disease. Not sensitive and not a good screening tool Endometriosis management Guidelines from American Family Physician If pregnancy is desired, immediate referral is warranted Initiation of therapy is appropriate in primary care if desired by patient - Low threshold for referral Uterine fibroids: patho Common benign neoplasms called leiomyomas: Originate in the uterine smooth muscle tissue Growth dependent on progesterone and estrogen Increase in size and prevalence during reproductive years Decrease in size after menopause Higher prevalence in older women and those of African and Asian descent, those with early menarch,