From
Grand Rounds
GYN #1 Importance of Documenting Reproductive Anatomy with Dr. Lesley Breech
With Dr. Lesley Breech · hosted by Dr. M. Godi
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
In patients with a renal anomaly, there is about a 30% chance of having an associated Mullerian anomaly.
A fair amount of Mullerian anomalies associated with renal anomalies are obstructive in nature.
OHVIRA (obstructed hemivagina with ipsilateral renal agenesis) occurs on the same side where there is an absent kidney.
Anywhere between 25 to 40% of adolescents with chronic pain may have associated endometriosis.
About 5% of reproductive age individuals with uterus will have endometriosis.
95% of girls do not have endometriosis.
When patients present with dysmenorrhea, initial treatment is a trial of oral contraceptive pills.
Not every patient with dysmenorrhea who seems inadequately treated with NSAIDs should go to the OR right away.
Patients who have endometriosis can have an associated component of acyclic pain.
Infertility is a long-term association with endometriosis, but it's not well documented if it's really about the disease burden or other cytokines.
The main goal in caring for patients with endometriosis is to improve the patient's quality of life.
White vesicles on the peritoneal surface are a finding that warrants tissue biopsy for endometriosis.
Red lesions are more consistently seen in younger patients with endometriosis.
Darker powder-burn lesions are more advanced and mature endometriosis lesions seen in adults.
Red endometriosis lesions are much more sensitive to medications like NSAIDs.
Patients with red endometriosis lesions who use NSAIDs with timing and take them regularly during menses will have significant benefit.
Endometriosis lesions usually look in the posterior cul-de-sac, dependent portions of the pelvis, behind the uterus.
If no obvious endometriosis disease is seen, uterosacral ligaments are usually biopsied because microscopic disease can come with pain and discomfort.
Standard treatment methods for endometriosis include resection of lesions, laser ablation, and cautery.
Endometriosis is a condition that would need to be managed all throughout a patient's life.
Historically, hysterectomies were a primary part of surgical care for patients with endometriosis.
When thinking about young patient population and potential for fertility for the future, different therapies than hysterectomy are now considered.
Progesterone-containing IUDs have a more and more prominent role in caring for patients with endometriosis.
Progestin therapy is excellent in treating endometriosis, and the IUD is right there in the pelvis.