Endometriosis

Question 1

Define Endometriosis.

Answer 1

Presence and growth of endometrial tissue outside the uterus.

Question 2

What are the risk factors for endometriosis?

Answer 2

• Early menarche
• FHx
• Nulliparity
• Prolonged menstruation (>5 days)
• Short menstrual cycles

Question 3

What are the signs and symptoms of endometriosis?

Answer 3

• Cyclical or chronic pelvic pain occurring before or during menstruation
• Dyspareunia
• Dyschezia (pain on defecation)
• Dysmenorrhoea
• Symptoms of extra-uterine endometriosis → eg rectal pain, bleeding
• Subfertility

Question 4

What are the appropriate investigations for suspected endometriosis?

Answer 4

• Bimanual & speculum
  
  • Reduced mobility
  • Tender nodularity in posterior vaginal fornix
  • Visible vaginal endometriotic lesions
  • Fixed retroverted uterus (ectopic tissue on utero-sacral ligament)
• TVUSS
• Diagnostic laparoscopy (Gold-Standard)
  
  • Red vesicles or punctate marks on peritoneum = active lesions
  • White scars / brown spots = less active endometriosis

Question 5

What is disease are associated with endometriosis?

Answer 5

• Clear cell ovarian carcinoma
• Endometroid ovarian carcinoma

Question 6

What is the management of endometriosis?

Answer 6

• 1st line (3m trial) = paracetamol ± NSAIDs
  
  • Avoid opiates due to often co-existing constipation
  • Adjunct: Tranexamic acid
• 1st line (3m trial) = COCP or progesterone
  
  • COCP can provide cycle control (21 days with 7 days off) and contraception whilst alleviating symptoms of endometriosis
• 2nd line = surgical = laparoscopic ablation or hysterectomy with BSO - GnRH analogues used pre-surgery to shrink endometriosis
• Subfertility = laparoscopic ablation ± endometrioma cystectomy - no hormonal treatment if trying to conceive

Question 7

What are the complications of endometriosis?

Answer 7

• Subfertility
• Recurrence