9 - Gynae - Endometriosis + Chronic Pelvic Pain - Endometriosis MGMT + fertility

Question 1

in >50% of women it ?/doesn’t ?

• aSx requires ? trt + consider removing ? due to v low risk of missing ? ?
• must review diagnosis if ???
• what can be done w/o a definitive diagnosis?

Answer 1

regresses, progress
no trt
endometriomas 
ovarian Ca
trt doesnt help 
pain trt w trial of hormonal drugs to suppress ovarian activity

Question 2

Medical mgmt

- 5 things?

Answer 2

analgesia
COC
progestogens
GnRH analogues +/- HRT
Intrauterine system

Question 3

Surgical mgmt - 2 things?

Answer 3

laparoscopic laser ablation/diathermy/scissors +/- adhesiolysis
hysterectomy and BSO

Question 4

When is hormonal trt definitely used?

• it mimics ? (using ?/?) or ? (using GnRH analogues)
• or is androgenic - which drug?
• what helps reduce pain?
• one thing to bare in mind with trts?

Answer 4

if Sx regress during preg/post menopause and under influence of androgens

preg (pill/progestogens)
menopause
Danazol

analgesics and suppression of ovarian fx

all contraceptive - not suitable for trying to conceive

Question 5

Medical mgmt - when is COCP no suitable?

• what SE can prog preps cause? (4)
• GnRH analogues - SE? how can this be worked around?
• danazol + gestrinone - seldom used due to ? they have ? effects
• what is alt to systemic hormone trt? reduces pain, and esp ?, symptom control maintained >5y

Answer 5

older women/smokers
fluid retention, wt gain, erratic bleeding, PMS
bone demineralisation - with add back HRT can use up to 2y (normally 6m)
SE
androgenic
intrauterine system (prog only - mirena)
dysmenorrhea

Question 6

Surgery - when is this preferred to med trt?

• more radical surgery involves ? of adhesions, removal of ? ? or hysterectomy w/ ? as a ?? only if ? is complete
• what can make surgery really difficult? what are the risks?
• what needed if ovaries removed?

Answer 6

may improve conception so if infertility/subfertility an issue
dissection
ovarian endometriomas
BSO
last resort
family
severe adhesions and anatomic distortion
-bowel, bladder, vessels and ureter injury
-HRT

Question 7

Fertility - endomet is found in ?% of laparoscopies for Ix of ?

• more severe = ? chance of subfertility
• compared to drainage and cyst wall ablation of ov endometriomas, what improves fertility more?
• when might IVF be best option?

Answer 7

25%
subfertility
greater
drainage/stripping of ov endometriomas
with severe disease that affects fallopian tubes