Endometriosis

Question 1

Describe the epidemiology of endometriosis

Answer 1

7-10% of women in the US
Affects fertile women as it’s oestrogen dependent
The presence of an affected first degree relative confers a 10-fold increased risk of developing it

Question 2

Describe the pathophysiology of endometriosis

Answer 2

Ectopic deposition of endometrial tissue in abnormal locations (commonly posterior and anterior cul-de-sac, uterosacral ligaments, tubes, ovaries) responds to normal hormonal fluctuations. This anomaly causes an inflammatory response with neovascularisation and fibrosis and can manifest as pain and bleeding

Question 3

Describe the clinical features of endometriosis

Answer 3

• Dysmenorrhea
• Heavy or irregular bleeding
• Dyspareunia
• Pelvic, lower abdo/back pain
• Dyschezia, dysuria
• Pain during exercise
• Bloating, nausea, vomiting

Question 4

Describe the diagnosis of endometriosis

Answer 4

Laproscopy has 97% sensitivity, 77% specificity

Question 5

Describe the management of endometriosis

Answer 5

Medical

• Combined oral contraceptive pill
• Danazol (gonadotropin suppressor)
• Progestation agents
• GnRH analogue

Surgical

• Conservative
• Semi-conservative
• Radical - hysterectomy and oophorectomy