Endometriosis

Question 1

What is adenomyosis

Answer 1

Presence of endometrial tissue within the myometrium

Question 2

Symptoms of endometriosis

Answer 2

Dysmenorrhoea
Menorrhagia
Dyspareunia
Lower abdo pain
Post coital bleeding
Epistaxis during periods 
Infertility

Question 3

Diagnosis of endometriosis

Answer 3

Laparoscopy shows:
Powder burn spots if active
Scars if inactive
Peritoneal defects

Question 4

What influences management

Answer 4

Whether patient wants kids

Medical management suppresses ovulation

Question 5

Medical management of endometriosis

Answer 5

COCP
MPA (continuous progesterone)
GnRH analogue

Mefanamic or tranexamic acid for pain relief

Question 6

Surgical management of endometriosis

Answer 6

Laparoscopic diathermy

Total hysterectomy and bilateral oophrectomy

Question 7

Endometriosis and infertility

Answer 7

No evidence that treating endometriosis treats infertility

Endometriosis may be incidental finding on infertility investigations that has no effect on fertility

Question 8

Examination findings in adenomyosis

Answer 8

Smooth enlarged boggy uterus

Question 9

Diagnosis of adenomyosis

Answer 9

Histological

Question 10

Benefit of GNRH agonist in endometriosis treatment

Answer 10

Puts women into medical menopause so can be permanent solution if used short term close to menopausal age
Predicts success of hysterectomy - if no response suggests pain more likely psychological