Endometriosis

Question 1

What is endometriosis?

Answer 1

The growth of ectopic endometrial tissue outside the uterine cavity.

Question 2

What percentage of women have endometriosis?

Answer 2

10-15%

Question 3

What are some clinical features of endometriosis?

Answer 3

Common features

• chronic pelvic pain
• dysmenorrhoea - pain often starts days before bleeding
• deep dyspareunia
• subfertility

Less common features

• Urinary symptoms e.g. dysuria and urgency.
• Dyschezia (painful bowel movements)

Question 4

What is the gold standard investigation for endometriosis?

Answer 4

Laparoscopy

(there is no role for USS)

Question 5

What is the management of endometriosis?

Answer 5

Referral all suspected to gynecologist.

Medication (won’t improve fertility)

1. Analgesia - NSAIDs
2. Hormal contraceptive (1st choice) - to 6 month trial.
   
   • 1st choice - Oral - COCP (35 micrograms of ethinylestradiol and norethisterone) or Desogestrel 75mcg.
   • Depot provera
   • Mirena

• Progestogens - norethisterone or medroxyprogesterone.
• GnRH analogues (secondary care) (induces pseudomenopause)

Surgery

• Laparoscopic excision and laser treatment of endometriotic ovarian cysts may improve fertility.