Endometriosis

Question 2

Gold standard Ix for endometriosis

Answer 2

Laparoscopy w/bx

Question 3

Endometriosis Ix

Answer 3

TVUS even if pelvic or abdominal examination is normal

Question 4

Endometriosis 1st line Tx

Answer 4

1st: Short trial 3/12 of paracetamol or NSAIDs e.g.Mefenamic acid
2nd: Hormonal treatment (combined contraceptive pill or progesterone).
3rd: Referral to gynaecology if initial management is ineffective, not tolerated, or if symptoms are severe, persistent, or recurrent.

refer if ineefective

Question 5

6 Sx

Endometriosis clinical presentations

Answer 5

• chronic pelvic pain
• dysmenorrhoea affecting daily activities and quality of life
• Dyspareunia
• period-related or cyclical gastrointestinal symptoms, in particular, painful bowel movements
• period-related or cyclical urinary symptoms, in particular, blood in the urine or pain passing urine
• infertility in association with 1 or more of the above.

Question 6

Define Endometriosis

Answer 6

A chronic inflammatory disease defined by the growth of endometrium-like tissue outside the uterus

Question 7

3 subtypes

Endometriosis subtypes

Answer 7

1. Superficial peritoneal endometriosis
2. Ovarian endometriosis (often called chocolate cysts or endometriomas)
3. Deep endometriosis (5mm below the peritoneum)

Question 8

Common distrubution of endometriotic deposits

Answer 8

The pelvis
the ovaries
uterosacral ligaments
pouch of Douglas
rectum and sigmoid colon
bladder
distal ureter.

Question 9

Endometriosis Risk Factors

Answer 9

Low birth weight.
Early menarche.
Late menopause
Short menstrual cycles.
Increased menstrual flow.
Nulliparity.
Family history.
Vaginal outflow obstruction.
White ethnicity.
Low body mass index (BMI).
Autoimmune disease
Smoking

Question 10

Endometriosis complications

Answer 10

• Adhesion formation
• Fertility problems
• Bowel obstruction
• Chronic pain
• Endometriomas (ovarian cysts containing blood and endometriosis-like tissue)
• Possible increased risk of ovarian cancer

Question 11

Endometriosis surgical Mx (If fertility is not a priority)

Answer 11

1. Laparoscopic treatment of peritoneal endometriosis. +/- Hormonal treatment for deep endometriosis (involving bowel, bladder or ureter).
2. Hysterectomy (indications incl. adenomyosis or menorrhagia resistant to other treatments)

Question 12

Endometriosis surgical Mx (If fertility is a priority)

Answer 12

Laparoscopy +/- Excision or ablation of endometriosis, adhesiolysis and removal of endometriomas can be offered because this may improve chances of spontaneous pregnancy.

Question 13

Percentage of women affected by endometriosis in the UK

Answer 13

10% of women at reproductive age