Endometriosis

Question 1

What is endometriosis

Answer 1

Ectopic endometrial tissue outside the uterus

Question 2

What is a lump of endometrial tissue outside the uterus

Answer 2

endometrioma

Question 3

What are choclate cysts

Answer 3

Endometriomas in ovaries

Question 4

What is adenomyosis

Answer 4

endometrial tissue within myometrium of uterus (muscle)

Question 5

Theories for what causes endometriosis

Answer 5

There is a genetic component but none found to directly cause
Retrograde menstruation through fallopian tubes
Embryonic cells -> endometrial tissue outside uterus
Endometrial cells through lymphatic system
Cells outside uterus metaplasia -> endometrial tissue

Question 6

Why is pelvic pain the main symptoms of endometriosis?

Answer 6

Cells of endometrial tissue respond to hormones the same way as in uterus - sheds lining and bleeds -> irritation and inflammation of tissues around endometriosis

Question 7

Type of pain in menstruation with endometriosis

Answer 7

Cyclical, dull, heavy or burining pain

Question 8

Can blood in the urine or stools be caused by endometriosis

Answer 8

In bladder or bowel

Question 9

What causes chronic cyclical pain in endometriosis

Answer 9

Local bleeding and inflammation -> adhesions, scar tissue
Pain ass with sharp, stabbing or pulling + nausea

Question 10

Why might endometriosis cause infertility

Answer 10

Sometimes unclear
Adhesions blocking tubes or ovaries - release of eggs
Damage eggs if adhesions in ovaries

Question 11

Endometriosis presentation

Answer 11

Asymptomatic
Cyclical abdominal or pelvic pain
Deep dyspareunia - pain on deep sexual intercourse
Dysmenorrhoea
Infertility
Cyclical bleeding from other sites eg haematuria

Question 12

What other systems can have symptoms from endometriosis

Answer 12

Urinary, bowel

Question 13

What is seen on sepculum exam in endometriosis

Answer 13

Endometrial tissue visible, particuarly in posterior fornix, tenderness vagina, cervix and adnexa

Question 14

What see on bimanual exam in endometriosis

Answer 14

Fixed cervix on bimanual examination

Question 15

What can see on pelvic US endometriossi

Answer 15

Often unremarkable
Large endometriomas and chcolate cysts

Question 16

What is gold standard to diagnose abdominal and pelvic endometriosis

Answer 16

Laprascopic surgery
Biopsy of lesions during laproscopy
Can also remove depositis if there

Question 17

What is a staging systen to be aware of

Answer 17

American society of reproducitve medicine
* Stage 1: Small superficial lesions
* Stage 2: Mild, but deeper lesions than stage 1
* Stage 3: Deeper lesions, with lesions on the ovaries and mild adhesions
* Stage 4: Deep and large lesions affecting the ovaries with extensive adhesions

Question 18

Guidleines for the management of endometriosis

Answer 18

RCOG - green top guideline 41 on chronic pelivc pain 2012
ESHRE guidelines on endometriosis
NICE

Question 19

Initial management of endometriosis

Answer 19

Establish diagnsois
Clear explanantion
Listening to patient, ICE
analgesia - NSAIDs and paracetemol

Question 20

Hormonal management of endometriosis

Answer 20

COCP - can be used back to back without pill free period if needed
Progesterone only pill
Medroxyprogesterone acetate injection - depo-provera
Nexplanon implant
Mirena coil
GnRH agonsits

Question 21

Surgical management for endometriosis

Answer 21

Laprascopic surgery to excise or ablate endometrial tissue and remove adhesions (adhesiolysis)
Hysterectomy

Question 22

What is the problem with hormonal treatments for endometriosis

Answer 22

Dont improve fertility

Question 23

What is the purpose of hormonal treatment for endometrisosi

Answer 23

Stop ovulation
Reduce endometrial thickening

Question 24

What do GnRH agonsits do

Answer 24

Induce menopause like state to reduce cyclical pain - shut down ovaries

Question 25

Examples of GnRH agonists

Answer 25

Goserelin - zoladex Leuprorelin - prostap

Question 26

Side effects of GnRH agonists

Answer 26

Hot flushes, night sweats, risk of osteoporosis

Question 27

Which acid is better at reducing bleeding vs pain?

Answer 27

Mefanemic acid also addresses pain Tranexamic acid doesn’t but may be better at reducing bleeding