Endometriosis Flashcards
1
Q
Definition
A
Where endometrium-like tissue grows outside of the uterine cavity.
2
Q
Where can this ectopic tissue grow in
A
- Fallopian tubes
- Ovaries
- Rectovaginal pouch
- Uterosacral ligaments
- Pelvic peritoneum
- Lateral pelvic walls
- Extra-pelvic deposits: found in bowel or pleural cavity, (rare)
3
Q
Epidemiology
A
- Age: 20-40
- Nulliparity: women who have not given birth
- Early menarche
- Late menopause
- Vaginal outflow obstruction
- Family history
- Low BMI
- Smoking
- White ethnicity
4
Q
Signs
A
Bimanal examination:
- Generalised tenderness
- Palpable and tender uterosacral ligament nodules, tender nodularity in the posterior vaginal fornix
5
Q
Symptoms
A
- Chronic pelvic pain (>6 months): cyclical or continuous
- Period-related pain (dysmenorrhoea)
- Heavy periods (menorrhagia)
- Deep pain
6
Q
Diagnosis
A
GOLD STANDARD: Diagnostic laparoscopy
Transvaginal ultrasound (TVUS)
Vaginal swabs: screen for chlamydia and gonorrhoea if PID suspected
7
Q
Treatment
A
- FIRST LINE = Analgesia: consider short trial of para or NSAID
- Second line:
= Oral contraception: the COCP or progestogen-only pill reduces menstruation and thus Sx
= Intrauterine system (IUS): levonorgestrel-releasing coils (e.g. Mirena) can reduce endometriosis-related pain
= Do not offer hormonal treatment to women trying to conceive
8
Q
When should Px be referred to secondary care
A
- Women with persistent or severe symptoms
- Women with pelvic signs of endometriosis
- If initial management is ineffective or contraindicated
9
Q
Secondary care options
A
- Surgical management: laparoscopically or hysterectomy in severe, refractory cases
- GnRH analogues: these agonists (e.g. leuprorelin acetate) can prevent FSH/LH release, inducing a ‘pseudomenopause’, and should be considered as an adjunct pre-surgery
10
Q
Complications
A
- Endometriomas: also known as “chocolate cysts”. This can lead to rupture of ovarian cysts, as well as subfertility
- Subfertility
- Adhesions: fibrotic bands may form in the abdominal or pelvic cavity secondary to endometriosis or laparoscopy, increasing the risk of bowel obstruction
- Chronic pain
- Depression and anxiety