Endometriosis

Question 1

What is endometriosis?

Answer 1

Endometrial glands occurring anywhere outside of the uterine cavity?

Question 2

What sites can be affected by endometriosis?

Answer 2

Peritoneum
Ovaries
Pouch of Douglas
Sacro-tuberous ligament
Myometrium

Question 3

What is the pathophysiology of endometriosis?

Answer 3

Endometrial tissue is sensitive to oestrogen
Free blood from bleeding from the ectopic tissues during menstruation irritates and causes fibrosis, adhesions and infertility

Question 4

What is the presentation of endometriosis?

Answer 4

Dysmenorrhoea (painful cyclical menstrual pain)
Menorrhagia
Dyspareunia
Painful defecation
Bloating/distension

Question 5

What is seen on examination of endometriosis?

Answer 5

Fixed retroverted uterus
Reduced organ mobility
Tender nodularity in posterior vaginal fornix

Question 6

What is seen on USS in endometriosis?

Answer 6

Chocolate cysts on ovaries

Question 7

What is the diagnostic investigation for endometriosis?

Answer 7

Laparoscopy

Question 8

What is the management of endometriosis?

Answer 8

Symptomatic relief - analgesia (NSAIDs)
1st - COCP/Mirena IUD
2nd - GnRH agonist
3rd - laparoscopic ablation

Question 9

How does hormonal treatment help in endometriosis?

Answer 9

Hormonal therapy suppresses ovulation and allows foci to atrophy

Question 10

What complications can endometriosis cause?

Answer 10

Subfertility
Pelvic adhesions
Ectopic pregnancy