Endometriosis/ adenomyosis 2B

Question 1

what is endometriosis

Answer 1

presence of endometrial tissue outside the endometrial cavity i.e. lining of the uterus grows outside the uterus causing abdominal pain and pelvic pain

Question 2

• Common sites of growth

Answer 2

Mnemonic = OPP Round FT and SC) = ovary, pelvic, peritoneum, round ligament, fallopian tube and sigmoid colon

Question 3

endometriosis is typically found on what type of woman

Answer 3

women of reproductive age

Question 4

• Symptoms include

Answer 4

mnemonic= DD Is ABove PP) 
	Dysmenorrhea 
	Dyspareunia 
	Infertility
	Abnormal bleeding 
	Chronic pelvic pain

Question 5

what is found on examination

Answer 5

 In early stages findings are subtle
 When disease has spread; note uterosacral nodularity, a fixed or retroverted uterus
 If ovary is involved: a tender, fixed adnexal mass may be noted

Question 6

• Diagnosis

Answer 6

laparoscopy (direct visualisation)

Question 7

What is treatment aimed at

Answer 7

• Treatment is aimed at suppression and atrophy of endometrial tissue

Question 8

what are the pharmacological treatments involved

Answer 8

 Oral contraceptives or medroxyprogesterone = it suppresses ovulation and menstruation hence preventing dysmenorrhoea (remember it prevents conception so advice patient)
 Danazol = an androgen derivative which inhibits FSH and LH resulting in no oestrogen production and a ↓ in endometriosis (SE: acne, weight gain, oedema, hirsutism)

Question 9

what does surgical management of endometriosis involves

Answer 9

ablation, electrocauterization or excision

Question 10

what is the definitive therapy

Answer 10

abdominal hysterectomy or bilateral salpingo-oophorectomy (HSO)

Question 11

what is adenomyosis

Answer 11

• Endometrial tissue within the myometrium (uterine musculature)

Question 12

what type of women does adenomyosis usually develop in

Answer 12

• Typically develops in parous women in their late 30-s and early 40s

Question 13

most common symptoms

Answer 13

secondary dysmenorrhea, menorrhagia

Question 14

what is seen on examination

Answer 14

may note an enlarged globular uterus with a soft consistency

Question 15

what is the definitive diagnosis of adenomyosis

Answer 15

hysterectomy

Question 16

what may identify the adenomyosis

Answer 16

• TVUS or MRI

Question 17

what does the treatment involves

Answer 17

 In mild disease= analgesia
 Progesterone contraceptive for symptom relief of dysmenorrhea (levonorgestrel aka mirena coil), norethistherone
 Definitive treatment = Hysterectomy