Endometriosis Flashcards
Endometriosis
Ectopic endometrial tissue outside the uterus
Adenomyosis
Endometrial tissue within the myometrium of the uterus
Presentation of endometriosis
Cyclical abdominal or pelvic pain
Deep dyspareunia
Dysmenorrhoea
Infertility
Cyclical bleeding from other sites, such as haematuria
Complications of endometriosis
Adhesions - chronic, non-cyclical pain
Reduced fertility
Endometriosis on examination
Endometrial tissue visible in the vagina on speculum examination
Fixed cervix on bimanual examination
Tenderness in the vagina, cervix and adnexa
How to diagnose endometriosis
Pelvic USS may reveal large endometriomas and chocolate cysts.
(Often unremarkable)
Referral to a gynaecologist for laparoscopy
Laparoscopic biopsy - gold standard
Management of endometriosis
Analgesia - NSAIDs and paracetamol first line
Hormonal management:
- COCP - back to back without a pill-free period if helpful
- POP
- Medroxyprogesterone acetate injection (Depo-Provera)
- Nexplanon implant
- Mirena coil
- GnRH agonists
Surgical management options:
- Laparoscopic surgery
- Hysterectomy
Risk factors for adenomyosis
Multiparous women
Late reproductive age
Presentation of adenomyosis
Dysmenorrhoea
Menorrhagia
Dyspareunia
Complications of adenomyosis
Infertility
Adenomyosis on examination
Enlarged and tender uterus.
More soft than a uterus containing fibroids
Investigations for adenomyosis
Transvaginal USS of the pelvis - first-line
MRI and transabdominal USS if transvaginal USS is not suitable
The gold standard - hysterectomy and biopsy (but not done)
Management of adenomyosis
Symptomatic relief:
- Tranexamic acid (no pain)
- Mefenamic acid (with pain)
Contraceptive management:
- Mirena coil (first line)
- COCP
- Cyclical oral progestogens
- POP, injection or implant
Specialist options:
- GnRH analogues
- Endometrial ablation
- Uterine artery embolisation
- Hysterectomy
Pregnancy and Adenomyosis
Adenomyosis is associated with:
Infertility Miscarriage Preterm birth Small for gestational age PROM Malpresentation Need for caesarean section Postpartum haemorrhage
