endometriosios

Question 1

definition

Answer 1

ectopic endometrial glands and stroma outside of the uterine cavity

Question 2

locations

Answer 2

It is primarily a pelvic disease with implants in the ovaries, fallopian tubes,
uterosacral ligaments, recto-sigmoid, bladder and appendix.
 Less commonly found in the lung, pleura, and pericardium

Question 3

diagnosis

Answer 3

laproscopy and biopsy - standard

retroverted uterus

you wont see much abnormality on examination because uteurs will look normal, the only thing you will see is the chocolate cysts

allen masters- deep retarction pockets of peritoneum

Question 4

treatment

Answer 4

Combined oral contraceptive pill: 1
st line treatment

or just progesterones
gnrh agonists
DANAZOL- steroid
aromatase inhibitors

surgical

Conservative surgery: excision, fulguration or laser vaporisation of endometriotic
lesions leaving at least one ovary and fallopian tube intact
 Usually done laproscopically but in severe cases laparotomy may be requires
 Increased risk of recurrence with severity of disease

or if shes donew ith kids or pain too bad
total hysterectomy + bilateral salpingo-oophorectomy. Then give
estrogen replacement therapy to prevent osteoporosis and treat hypoestrogenic
symptoms – hot flushes, night sweats, sleeplessness, vaginal dryness

Question 5

symptoms

Answer 5

Dysmenorrhoea

Dyspareunia

Subfertility

Rarely, the endometrial tissue can grow outside the female reproductive system, such as in the bowel leading to cyclical rectal bleeding.

Pelvic examination may reveal tender, nodular masses on the ovaries or the ligaments surrounding the uterus.

Question 6

ques med surgical

Answer 6

Surgical Management
Diathermy of lesions

Ovarian cystectomy (for endometriomas)

Adhesiolysis

Bilateral oophorectomy (sometimes with a hysterectomy)

Question 7

why is CA-125 not specific

Answer 7

ovarian cancer, PID, Inflammatory bowel disease etc

Question 8

what does the combined contraceptive pill do

Answer 8

(they create a state of ‘pseudo-pregnancy’ associated with amenorrhoea. This causes decidualisation and resorption of the ectopic endometrium)

Question 9

the most common symptoms

Answer 9

chronic pelvic pain ! which may be lcoalised or spread to the back or leg

Question 10

stages of endometriosis (oral)

Answer 10

check essay