endometriosis

Question 1

endometriosis is

Answer 1

presence of endometrial cells outside of the uterine cavity that are responsive to oestrogen, resulting in cyclical symptoms.

Question 2

endometrioma is

Answer 2

Endometriosis found in the ovaries. develop to the stage of cysts, commonly referred to as chocolate cysts, due to their dark brown appearance.

Question 3

investigations for endometriosis

Answer 3

• Negative STI screen
• Abdominal and pelvic USS shows cysts (ovarian endometrioma)
• Laparoscopy shows powder-burn lesions and chocolate cysts- gold standard

Question 4

management of endometriosis

Answer 4

• Combined Oral Contraceptive (COC)
• Levonorgestrel IUS (i.e. Mirena) to reduce endometriosis pain and control dysfunctional bleeding
• Progestogens (medroxyprogesterone)

if unresponsive to these methods:
- Surgical ablation or excision of endometriosis
- Radical hysterectomy
- Surgical excision of Endometrioma if the cyst is≥3cm in diameter

Question 5

what is adenomyosis

Answer 5

presence of endometrial tissue within the muscular wall of the uterus, which responds to female sex hormone stimulation cyclically and undergoes proliferation, haemorrhage, adhesions and ultimately scar tissue changes.

Question 6

investigation of adenomyosis

Answer 6

Often a clinical diagnosis once other causes have been excluded.

• Negative STI screen for sexually active women (rule out PID)
• Transvaginal ultrasound may identify cystic spaces within the myometrium

Question 7

managment of adenomyosis

Answer 7

NSAIDs
Mefanemic acid
COCP
levonorgestrel IUS
progestogens
uterine artery embolisation
hysterectomy

Question 8

adenomyosis presentation

Answer 8

• Menorrhagia
• Chronic cyclical pelvic pain (>6 months)
• Dysmenorrhoea (pain often peaks near the end of menstruation)
• Dyspareunia
• Feeling of heaviness in the pelvis
• Symmetrically enlarged and tender uterus
• Multiparous women

Question 9

management of bartholins cyst and what is

Answer 9

• Focal vaginal swelling that gets worse after intercourse
• Erythematous and hard lesion with a centre
• Located on the sides of the vagina
• Conservative: warmth and compression to aid drainage
• If abscess: antibiotics and incision and drainage may be required (often E coli)