Endometriosis

Question 1

definition

Answer 1

ectopic endometrial tissue outside the uterus

Question 2

endometrioma

Answer 2

lump of endometrial tissue outside the uterus

Question 3

endometrioma in the ovaries

Answer 3

chocolate cyst

Question 4

adenomyosis

Answer 4

endometrial tissue within the myometrium

Question 5

aetiology

Answer 5

retrograde menstruation
lymphatic spread
metaplasia
embryonic cells do not migrate

Question 6

main symptom

Answer 6

pelvic pain

Question 7

describe the pain experienced and explain why

Answer 7

Tissue responds to hormones and sheds with menstruation
irritation and inflammation
cyclical, dull, heavy or burning pain

Question 8

what can deposits of endometriosis in bladder or bowel lead to?

Answer 8

blood in urine or stools

Question 9

what can localised bleeding and inflammation cause?

Answer 9

adhesions

Question 10

what can adhesions lead to?

Answer 10

chronic, non-cyclical pain
sharp, stabbing or pulling
nausea

Question 11

endometriosis and fertility

Answer 11

can be reduced
adhesions around ovaries and fallopian tubes block release of eggs
endometriomas

Question 12

symptoms

Answer 12

cyclical abdominal or pelvic pain 
deep dyspareunia 
dysmenorrhoea 
infertility 
cyclical bleeding from other sites eg haematuria

Question 13

examination findings

Answer 13

fixed cervix

tenderness in vagina, cervix and adnexa

Question 14

gold standard diagnosis

Answer 14

laparascopic surgery and biopsy

Question 15

ultrasound

Answer 15

pelvic - endometriomas and chocolate cysts

often unremarkable

Question 16

staging

Answer 16

1–> 4
1= small, superficial lesions
4 = deep and large lesions affecting ovaries and adhesions

Question 17

first line analgesia

Answer 17

NSAIDs and parcetamol

Question 18

hormonal management options

Answer 18

COCP 
progesterone only pull
depo provera
nexplanon
mirena coil 
GnRH agonists

Question 19

surgical options

Answer 19

laparascopic surgery to excise or ablate the tissue and adhesions
hysterectomy

Question 20

what treatment can help fertility - hormonal or surgical?

Answer 20

surgical

Question 21

hormonal medications eg COCP, depo injection

Answer 21

stop ovulation

reduce endometrial thickening

Question 22

what does GnRH agonist do?

Answer 22

induce a menopause like state as cyclical pain improves after menopause
shut down ovaries temporarily

Question 23

examples of GnRH agonist

Answer 23

goserelin - zoladex

leuprorelin - prostap

Question 24

side effects of GnRH agonist

Answer 24

hot flushes
night sweats
osteoporosis

Question 25

final surgical option

Answer 25

hysterectomy with bilateral salpingo-ophrectomy