ENDOMETRIOSIS Flashcards
What is endometriosis?
A disease in which tissue that normally grows inside the uterus grows outside it
What is endometriosis occurring in the myometrium known as?
Adenomyosis
What proportion of women will be affected by endometriosis in their reproductive years?
10%
What are the theories surrounding how and why endometriosis occurs?
Retrograde menstruation/implantation theory
Lymphatic and venous embolization
Coelemic metaplasia
Immunological factors
What are the two most common sites for endometriosis?
Ovaries
Uterosacral ligaments
Pouch of Douglas
What are the other parts of the body can be affected by endometriosis?
Endometriosis has been diagnosed in every organ in the body except for the spleen. However, extrapelvic endometriosis is rare.
What is the main symptoms of endometriosis?
Cyclical pain prior to menstruation
What is the classic quartet of symptoms of endometriosis?
Secondary dysmenorrhea
Deep dyspareunia
Pelvic pain
Infertility
Other than the classic quartet of secondary dysmenorrhea, deep dyspareunia, pelvic pain and infertility, what other symptoms are commonly associated with endometriosis?
Dyschezia - pain on opening bowels
Ovulation pain
Chronic fatigue
Chronic pelvic pain
What are the complications of endometriosis?
Rupture - ovarian endometrioma rupture will cause acute, severe lower abdominal pain. The release of the very irritant ‘chocolate’ material from the cyst causes peritonism.
Fibrosis and scarring - cause problems with reproductive organs as well as colonic or ureteric obstruction.
Ovarian cancer - a rare complication of endometriosis
What proportion of infertile women are found to be affected by endometriosis?
1/3rd
Why does endometriosis cause infertility?
Dense adhesions
Tubal and ovarian damage and distortion
Release of substances such as prostaglandins, which affect ovulation and tubal mobility
What clinical signs may be found on examination of someone with endometriosis?
Slightly distended abdomen
Tender abdomen especially during menses
Tender uterus
Retroverted or retroflexed fixed uterus
Thickening of cardinal and uterosacral ligament
Endometrial nodules may be palpable on bimanual examination
Pain on moving cervix (stretching the uterosacral ligaments)
What single investigation effectively diagnoses and assesses the severity of endometriosis?
Laparoscopy
What will be seen on laparoscopy of someone with endometriosis?
Blue-black ‘powder burn’ lesions - areas of haemosiderin pigmentation
Opaque white areas of peritoneum
Red lesions
Glandular lesions
What is the differential diagnosis for pelvic pain?
Endometriosis Pelvic inflammatory disease Pelvic pain syndrome Submucous fibroids Ovarian accident Adhesions
What percentage of women with endometriosis will have recurring symptoms within a year of stopping treatment?
40%
What medical treatment is available to treat endometriosis?
Medical treatment is aimed at mimicking either pregnancy or post-menopause state, as endometriotic lesions regress during these times.
Combined oral contraceptive pill (more often used as maintenance therapy)
Progestogens
Mirena hormone coil
Gonadotrophin (LH) releasing hormone analogues (LHRH/GnRH)
Gestrinone
Danazol - rarely used
What are the side effects of progestogens?
Break through bleeding Weight gain Oedema Acne Abdominal bloating Increased appetite Decreased libido
What are the side effects of gonadotrophin releasing hormone analogues?
Hot flushes Break through bleeding Vaginal dryness Headaches Decreased libido Bone density loss
How can the side effects of gonadotrophin releasing hormone analogues be reduced?
Using ‘add-back’ continuous combined hormone replacement therapy
What is gestrinone?
Synthetic steroid with mild androgenic, marked antioestrogenic and antiprogestogenic activity.
What are the side effects of danazol and gestrinone?
Increased weight Break through bleeding Muscle cramps Decreased breast size Hot flushes Emotional lability Oily skin Acne Hirsutism Headache Increased libido Hoarseness or Deepening of voice
