Dysmenorrhoea and Endometriosis Flashcards
Where can dysmenorrhoea pain be felt?
Suprapubic
Back
Radiating down the thighs
What is dysmenorrhoea?
Cramping pain with menstrual periods
What causes dysmenorrhoea?
Primary - cause unknown
Secondary
- Endometriosis
- Adenomyosis
- Intracavity mass - IUD, polyp, fibroid
- Cervical stenosis
- Isolated endometrial pocket
What percentage of women experience severe dysmenorrhoea?
18-21%
What causes dyspareunia?
Superficial
- Thrush
- Skin conditions - atrophic vaginitis, contact dermatitis
- Vestibulodynia
Midway
- Pelvic floor - spasm, trigger points
Deep
- Endometriosis
- Adenomyosis
- Adhesions
- Ovarian cysts
What is vestibulodynia?
Chronic pain at the hymen insertion
How do you examine for dyspareunia?
Cottonbud prodding at the introitis to see if it elicits vestibulodynia
What is characteristic for Mittelschmerz?
Midcycle pain - usually unilateral at about D10-14
What is endometriosis?
Presence of endometrial glands and stroma outside the uterus
What is the prevalence of endometriosis?
10-15% of reproductive age
60-70% of women with cyclical pelvic pain
What is the pathophysiology of endometriosis?
Implantation spread - retrograde menstruation but 90% of women have this so Implantation spread + risk factors Coelomic metaplasia Congenital - rest cells Iatrogenic implantation Metastatic spread Direct spread
What is coelomic metaplasia?
Stimulation of metaplasia of peritoneum to endometrial tissue by menstrual blood
How does endometriosis present?
Cyclical pain - dysmenorrhoea, midcycle, nonmenstrual (worse with periods)
Provoked pain - dyspareunia, dyschezia
Infertility
Incidental finding
What are some signs of endometriosis?
Lower abdo tenderness Tenderness on PV Palpable adnexal mass Palpable vaginal nodule or thickening Fixed uterus
What do you Ix endometriosis?
US - traditional and with bowel prep
?MRI
Laparoscopy - gold standard
What is endometriosis commonly found?
Areas where gravity takes it
- End of tube
- Pouch of Douglas
How do you decide how to treat?
Previous treatment outcomes
Desire for fertility
Symptom severity
How do you treat endometriosis?
Analgesics Stop periods - symptom control - COCP continuously - Progestin - GnRH-analogues Surgery - Ablate/excise the lesions - Remove uterus, ovaries
How do you treat endometriosis infertility?
No hormonal control Surgery - Remove large endometriomas or all endometriosis - Remove hydrosalpinges Move towards pregnancy/IVF early
What is the adenomyosis?
Endometrial glands and stroma in myometrial layer of uterus
How does adenomyosis present?
Menorrhagia and dysmenorrhoea
Bulky uterus
How do you Ix?
US
Tissue sample
How do you treat adenomyosis?
Analgesics Stop periods - symptom control - COCP continuously - Progestin - GnRH-analogues Mirena IUD Surgery - Hysterectomy, myometromy
How do you treat primary dysmenorrhoea?
Analgesics Stop periods - symptom control - COCP continuously - Progestin - GnRH-analogues Mirena IUD Surgery - Hysterectomy Acupuncture Nifedipine/GTN/buscopan - SE are not acceptable
