Endometriosis

Question 1

Define endometriosis.

Answer 1

Presence of endometrial tissue outside the uterus.

Question 2

Explain the aetiology of endometriosis.

Answer 2

Suggested theories include:

Retrograde menstruation – passage of endometrial tissue through tubes into pelvis during menstruation (Samson’s)

Metaplasia of coelomic epithelium into endometrial glands (Meyer’s)

Question 3

What are the risk factors for endometriosis?

Answer 3

Nulliparity

Family history

Short cycle

Long periods.

Question 4

Summarise the epidemiology of endometriosis.

Answer 4

15% women in reproductive age.

Question 5

Recognise the presenting symptoms of endometriosis.

Answer 5

Cyclical dysmenhorrea, chronic pelvic pain, dyspareunia, infertility.

Rarely involvement of other organs: haematuria, PR bleed, epistaxis, haemoptysis

Question 6

Recognise the signs of endometriosis on physical examination.

Answer 6

Vaignal: unremarkable, immobile uterus, tender uterosacral ligament, palpate uterosacral nodules.

Question 7

Identify appropriate investigations for endometriosis and interpret the results.

Answer 7

USS: endometrioma

Laparoscopy: Gold standard for diagnosis

Question 8

Generate a management plan for endometriosis.

Answer 8

Medical: analgesia (NSAID), suppress ovulation (COCP, progestogens, Mirena, GnRH analogues.

Surgical: Laparoscopic ablation.excision of lesions, adhesionolysis, overian cystectomy, Total hysterostomy with bilateral salpingo-oophrectomy

Question 9

Identify the possible complications of endometriosis and its management. Summarise the prognosis for patients with endometriosis.

Answer 9

Cyst accident, infertility, chronic pain, adhesions, sexual dysfunciton. Medicla management improves symtpoms in 80%. Symptoms subside in pregnancy/menopause.