dysmenorrhea

Question 1

what is dysmenorrhea

Answer 1

a subjectively very painful period

Question 2

3 causes of dysmenorrhea

Answer 2

1. endometriosis
2. adenomyosis
3. pelvic inflammatory disease

top 2 are more common

Question 3

what is endometriosis

Answer 3

ectopic endometrial tissue dispatched anywhere in the body

Question 4

epidimeology of endometriosis

Answer 4

typically affects 20-40y
mean age 28y
affects 10% of females in uk

Question 5

5 locations endometriosis can occur

Answer 5

1. ovary
2. bladder
3. bowel (including douglas pouch)
4. abdomen
5. thorax

Question 6

what is thoracic endometrial syndrome

Answer 6

important differential for endometriosis

causes cyclical haemoptysis + endometrial tissue deposition in pulmonary nodules

Question 7

3 theories of spread for endometriosis

Answer 7

1. haemotogenous + lympth node spread
2. retrograde menstruation
3. metaplasia

Question 8

what is haematgaenous and lymph node spread known as

Answer 8

halbans theory

Question 9

what is retrogade menstrution spread known as

Answer 9

sampsons theory

Question 10

what is metaplasia spread known as

Answer 10

meyers theory

Question 11

risk factors for endometrisis

Answer 11

• nulliparity
• autoimmune disease
• early menarche + late menopause
• fhx
• vaginal outflow obstruction (eg trans vaginal septae)

Question 12

main symptoms of endometriosis

Answer 12

• dysmennorhea
• menorrhagia
• subfertility
• deep dysparaneunia (painful sex)

Question 13

how long does dysmenorhea last in endometriosis

Answer 13

a few days

Question 14

minor symptoms of endometriosis

Answer 14

• dysuria
• discharge
• haemoptysis
• fatigue
• SOB

Question 15

how do u stage endometriosis

Answer 15

ASRM system
according to the number of lesions and depth of infiltration

1. minimal
2. mild
3. moderate
4. severe

Question 16

1st line diagnosis for endometriosis

Answer 16

transverse vaginal ultrasound

might see ovarian chocolate cyst

Question 17

gold standard diagnosis for endometriosis

Answer 17

laparoscopy

Question 18

other diagnostic exams for endometriosis

Answer 18

bimanual exam

Question 19

what does bimanual exam for endometriosis show

Answer 19

adnexal motion tenderness + fixed retroverted uterus + uterosaceral nodules

Question 20

1st line treatment for endometriosis

Answer 20

NSAIDS

iburprofen then refer to secondary care

Question 21

2nd line treatment for endometriosis

Answer 21

COCP

then specialist led GnRH analogue

Question 22

3rd line treatment for endometriosis to preserve fertility

Answer 22

ablation

Question 23

3rd line treatment for endometriosis to not preserve fertility

Answer 23

hysterectomy

Question 24

what is adenomyosis

Answer 24

endometrial invasion into myometrium

Question 25

epidiemolgy of adenomyosis

Answer 25

typically affects 35-45 year with history of uterine surgery

Question 26

risk factors for adenomyosis

Answer 26

- uterine surgery !!! - oestrogen dependent (same RF as endometriosis)

Question 27

3 types of adenomyosis

Answer 27

1. focal 2. diffuse 3. adenomyoma

Question 28

what is focal adenomyosis

Answer 28

only affects one site

Question 29

what is diffuse adenomyosis

Answer 29

invasion dotted throughout myometrium

Question 30

what is adenomyoma

Answer 30

benign focal mass but big like uterine fibroma

Question 31

symptoms of adenomyosis

Answer 31

- dysmenorrhea + cyclical pain - deep dysparaneiunia - menorhagia - subfertility

Question 32

how long does dysmenorrhea last in adenomyosis

Answer 32

2 weeks ( longer than endometriosis)

Question 33

1st line diagnosis for adenomyosis

Answer 33

trans vaginal ultra sound

Question 34

gold standard diagnosis for adenomyosis

Answer 34

post exicision biopsy

Question 35

what does bimanual exam for adenomysos show

Answer 35

boggy uterus

Question 36

medical treatment for adenomyosis

Answer 36

1. COCP 2. mefanamic acid 3. GnRh with 20 specialist input

Question 37

fertility preserving surgical treatment for adenomyosis

Answer 37

myometcomy

Question 38

non fertility preserving surgical treatment for adenomyosis

Answer 38

hysterectomy