Endometriosis

Question 1

What is endometriosis

Answer 1

Presence and growth of endometraial tissue outside of uterus - (cervix or anywhere else-like GI tract
affects 1/10 women - 30/45 y/o

RF- early mearche, fhx, long menstruation, short cycles

assocaited with clear cell ovarian cancer, endometrioid cancer

complications of subfertility and reccurence
and classically assocaited with IBS/ constipation

Question 2

Sx of endometriosis

Answer 2

Cyclical/chronic pelvic pain before/during menstruation

dyspareunia, pain on shit
Dysmennorhea (pain) -NO menorhagia (more blood) (unlike fibroids)

if GI tract -rectal bleeds/pain
subfertility

Question 3

Ix of endometriosis

Answer 3

Ix -
Bimanual and speculum -
can see the tissue around cervix), reduced mobility, tender in posterior fornix, fixed retroverted uterus)

TVUSS– can sshow endometrioma or NOTHING-but good for the associated cancer risks

diagnostic gold standard - laproscopies - see active lesions

Question 4

Mx of endometriosis

Answer 4

Medical treatemt can start after exam/TVUSS- but lapro might be needed if not improving

1st line - 3m trial - paracetamol+ NSAID (adjunct - tranexamic acid)

1st line other 3m trial - COCP or progesterone (POP. implant, etc
allievate sx with COCP

2nd line - laproscopic ablation or hysterectomy with BSO
(use GnRH analogues can induce pseudo menopause- shrink endometriosis before surgery)

subfertile - laproscopic abltion, cystectomy