Endometriosis

Question 1

What is endometriosis?

Answer 1

When endometrial tissue is found outwit the uterus.

Question 2

What is a lump of endometrial tissue deposited in the ovary called?

Answer 2

An endometrioma - they are called a chocolate cyst.

Question 3

What is a lump of endometrial tissue within the walls of the uterus (Myometrium) called?

Answer 3

Adenomyosis.

Question 4

Where are common sites of endometrial deposits?

Answer 4

Ovary
Pouch of Douglas (rectouterine pouch)
Vesicouterine pouch 
Uterine ligaments 
Myometrium 
Fallopian tubes
Abdomen (uncommon)

Question 5

What are signs and symptoms of endometriosis?

Answer 5

cyclical bleeding/heavy periods 
Dull pain around/before menstruation 
Dysmennorhoea 
Dysparenuria (painful intercourse)
Infertility
Cyclical rectal bleeding (RARE, only if there is endometrial tissue in the rectum)

Question 6

What is the main investigation for endometriosis?

Answer 6

1st line - transvaginal ultrasound

GOLD STANDARD - laparoscopy

Question 7

What is the medical management of endometriosis?

Answer 7

NSAIDs
Artificial menopause - GnRH analogues
Lowering oestrogen and progesterone to stop endometrial thickening (Progesterone, Mirena coil, combined oral contraceptive pill)

Question 8

What are the surgical managements of endometriosis?

Answer 8

Diathermy of lesions
Hysterectomy + bilateral salpingectomy (Fallopian tube removal)
Ovarian cystectomy (for Endometriomas - to remove cyst)
Bilateral oophorectomy (removes ovaries)
Bilateral saplingo-oophorectomy (removal of uterus, Fallopian tubes and ovaries).