Endometriosis

Question 1

Define endometriosis

Answer 1

This is a condition in which tissues similar to normal endometrium, in structure and function, are found
in sites outside the uterine cavity

Question 2

Risk factors

Answer 2

Race
Menstrual Factors like early menarche and short menstrual cycle
Family Hx
Outflow obstructions like cervical stenosis

Question 3

Implantation theory of endometriosis

Answer 3

There is retrograde passage of menstrual blood containing fragments of endometrium along
the fallopian tubes to reach the peritoneum.
 The endometrial tissues become implanted on the peritoneal surface of organs
 These implants then undergo proliferation, bleeding and subsequently seeds further implants
at other sites

Question 4

Coelomic metaplasia

Answer 4

Coelomic epithelium gives rise to the epithelial lining of the Mullerian duct. It also
differentiates into peritoneal, pleural and epithelium covering the surface of ovaries
 In the presence of an appropriate induction agent, coelomic cells differentiate into
endometrial cells through metaplasia
 The induction agent could be repeated hormonal stimulus
 Why metaplastic changes occur is not known

Question 5

Lymphatic and vascular dissemination

Answer 5

Viable endometrial cells enter lymph and blood vessels and

are embolised to ectopic sites

Question 6

Presentation of endometriosis

Answer 6

• Pain
  ^Pelvic pain, deep dyspareunia, dysmenorrhea
• Abnormalities of menstruation: menorrhagia and polymenorrhea (usually due to adenomyosis)
   Ovarian enlargement (endometrioma)
   Reactive peritonitis, acute abdomen requiring laparotomy (when there is rupture of an ovarian
  endometrioma)

Question 7

sites of endometrosis

Answer 7

Ovary
bowel
Lower genital tract
Perineum(episiotomy scars)
Urinary tract
Umbilicus
Surgical scar

Question 8

Medical treatment for endometriosis

Answer 8

Oral contraceptive pill
Danazol
LH-RH analogues
LH-RH analogues with add back

Question 9

MOA for danazol

Answer 9

. This is a derivative of testosterone and an anti-progesterone. It works by
 Reduction of gonadotropin to early follicular phase levels
 Reduces sex hormone binding globulins, thus increasing levels of free testosterone
 Direct inhibition of endometrial growth

Question 10

MOA for Oral contraceptive pill.

Answer 10

This causes anovulation and thinning out/ absorption of the ectopic
endometrial tissues. Side effects include weight gain, breast tenderness, nausea, vomiting,
break through bleeding.

Question 11

Side effects of medical treatment

Answer 11

The breast tenderness, hot flushes, sweating, atrophic vaginitis, acne, hirsutism,
occasional voice changes.

Question 12

MOA for LH-RH analogues

Answer 12

Create pseudo-menopause
 Suppression of gonadotrophin secretions
 Anovulation, reduced estradiol levels

Question 13

surgical treatment of endometriosis

Answer 13

Removing the lesions with laser

Question 14

define adenomyosis

Answer 14

Endometiosis of the myometrium

Question 15

in which group of people is adenomyosis usually found

Answer 15

Multiparous women

Question 16

Presentation of adenomyosis

Answer 16

menorrhagia
 secondary dysmenorrhea
 dyspareunia
 pelvic discomfort
 bulky uterus, which may be tender

Question 17

Treatment of Adenomyosis

Answer 17

In symptomatic patients, hysterectomy is the treatment of choice as adenomyosis responds poorly to
hormonal treatment