Endometriosis

Question 1

Clinical features

Answer 1

10% incidence

Puberty to menopause, peak 25–35 yrs

Secondary dysmenorrhoea

Premenstrual spotting

Infertility

Dyspareunia

Non-specific pelvic pain

Menorrhagia

Acute pain with rupture of endometrioma

Question 2

DXT:

Answer 2

dysmenorrhoea + menorrhagia + dyspareunia + pelvic pain

Question 3

Diagnosis

Answer 3

Can be made best by direct visual inspection at laparoscopy or laparotomy

Ultrasound scan helpful

New blood DNA test Mitomic Endometriosis Test (MDNA, Oxford)

Question 4

Treatment

Answer 4

Careful explanation—point out risk of infertility

Basic analgesics

Treatment can be surgical or medical

Question 5

Medical Rx:

Answer 5

To induce amenorrhoea—options:

levonorgestrel-releasing IUCD—5 yrly

danazol (Danocrine)—for 3–6 mths

combined oestrogen–progestogen oral contraceptive: once daily continuously for about 6 mths or longer

progestogens (e.g. medroxy-progesterone acetate (Depo Provera))

GnRH analogues (e.g. goserelin)

Question 6

Surgical Rx:

Answer 6

Surgical measures depend on the:

• patient’s age
• symptoms and
• family planning.

Laser surgery and microsurgery can be performed either via laparoscopy or laparotomy to ablate endometrial deposits and uterine nerve.

Note: Pregnancy beneficial but endometriosis can recur.