Endometriosis Flashcards
What is endometriosis?
Presence of endometrial tissue outside the uterus.
What is the aetiology/ epidemiology of endometriosis?
Suggested theories include:
· Retrograde menstruation – passage of endometrial tissue through tubes into pelvis during menstruation (Samson’s)
· Metaplasia of coelomic epithelium into endometrial glands (Meyer’s)
· Vascular and lymphatic spread
· Immune
· Genetic
RF include nulliparity, family history, short cycle, long periods.
15% women in reproductive age.
What would you find in the history of endometriosis?
Cyclical dysmenorrhea (starting before M and reaching peak at onset). Chronic pelvic pain, dyspareunia, infertility. Rarely involvement of other organs: haematuria, PR bleed, epistaxis, haemoptysis.
What would you find in the examination of endometriosis?
Vaginal: unremarkable, immobile uterus, tender uterosacral ligament, palpate uterosacral nodules.
What is the pathology of endometriosis?
Ectopic endometrial tissue produces chronic inflammatory reaction. Can cause fibrosis and adhesions. Classic powder burn or gun shot lesions on pelvic surfaces. On the ovary, endometriotic cyst can dorm which enlarges with blood during each menstrual cycle (endometrioma/chocolate cyst)
What are the investigations of endometriosis?
USS: endometrioma, DDx
Laparoscopy: Gold standard for diagnosis
Staging: ASRM for staging (fertility focussed)
What is the management of endometriosis?
Medical: analgesia (NSAID), suppress ovulation (COCP, progestogens, Mirena, GnRH analogues.
Surgical: Laparoscopic ablation, excision of lesions, adhesionolysis, ovarian cystectomy, TAH/BSO rarely (last resort)
What are the complications/ prognosis of endometriosis?
Cyst accident, infertility, chronic pain, adhesions, sexual dysfunction. Medical management improves symptoms in 80%. Symptoms subside in pregnancy/menopause.
