Endometriosis

Question 1

What is this describing?

Presence and growth of tissue similar to the endometrium outside the uterus.

Answer 1

Endometriosis

Question 2

In what group of people is endometriosis more common?

Answer 2

Between 30-45 years, nulliparous women.

Question 3

What is the underlying pathology involved in endometriosis?

Answer 3

1. Oestrogen dependent, regresses after menopause and during pregnancy.
2. Occurs throughout pelvis.
3. Inflammation with progressive fibrosis and adhesions
4. Probably due to retrograde menstruation

Question 4

What is this a presentation of?
Cyclical pelvic pain, dysmenorrhoea prior to onset of menses, deep dyspareunia, subfertility, pain on passing stools, dysuria. Fixed retroverted uterus (advanced disease).

Answer 4

Endometriosis

Question 5

How is endometriosis investigated?

Answer 5

1. Gold standard is laparoscopy and biopsy for histological confirmation
2. TV USS
3. Ovarian endometriotic cysts (sign of severity)

Question 6

What are the differentials to consider in endometriosis?

Answer 6

1. Adenomyosis
2. Chronic pelvic inflammatory disease
3. Chronic pelvic pain
4. IBS

Question 7

What is the medical management for endometriosis?

Answer 7

1. 1. NSAIDs +/- paracetamol +/- opioids
2. COCP back to back
3. IUS
4. POP, GnRH analogues

Question 8

What is the surgical management for endometriosis?

Answer 8

1. Only once medical failed or if fertility desired
2. Laparoscopic ablation/excision to destroy endometriosis
3. Adhesiolysis
4. Hysterectomy and bilateral salpingo-oophorectomy as last resort