Endometriosis

Question 1

what is endometriosis?

Answer 1

Endometrial glands and stroma outside the uterine body

Question 2

what is adenomyosis?

Answer 2

Endometrial tissue in myometrium

Question 3

describe cysts found in ovarian endometriosis

Answer 3

chocolate cysts

Question 4

what is an endometrioma?

Answer 4

lump of endometrial tissue out with the endometrium

Question 5

what causes endometriosis?

Answer 5

Not clear

THEORIES:
-Retrograde Menstruation
*During menstruation endometrial lining flows backwards through fallopian tubes and out into pelvis and peritoneum, seeding around pelvis and peritoneal cavity

-Embryonic Cells

-Lymphatic Spread (similar to cancer)

-Metaplasia

Question 6

where is endometriosis commonly found?

Answer 6

-Ovary
-Pouch of Douglas
-Peritoneal surfaces, including uterus
-Cervix, vulva, vagina
-Bladder, bowel ect

Question 7

why do patients with endometriosis experience cyclical dull pain?

Answer 7

-Endometrial tissue reacts the same outwith the uterus as it does in
-Inflammation and bleeding during menstruation causes dull, cyclical pain

Question 8

why do patients with endometriosis experience non cyclical sharp pain?

Answer 8

Due to adhesions/ scarring
-Inflammation causes damage and development of scar tissue, binding organs together causing non cyclical sharp, stabbing pain

Question 9

Symptoms of Endometriosis?

Answer 9

-Cyclical Abdominal/ Pelvic pain
-Dyspareunia
-Dysmenorrhoea
-Infertility
-Cyclical bleeding from other sites (blood in stool or urine due to endometriosis in bladder or bowel)
-Occasionally asymptomatic

Question 10

Signs of endometriosis?

Answer 10

-A fixed, retroverted uterus
-Uterosacral nodules/ thickening
-General tenderness

Question 11

gold standard investigation for endometriosis?

Answer 11

laparascopic surgery with biopsy

Question 12

what is seen macroscopically in endometriosis?

Answer 12

Ovary- chocolate cysts
-Peritoneal spots or nodules (brown spots due to haemorrhages from the endometriotic lesions)
-Fibrous adhesions

Question 13

what is seen microscopically in endometriosis?

Answer 13

-Endometrial glands and stroma
-Haemorrhage, inflammation and fibrosis

Question 14

what investigation should be done if patient with endometriosis has blood in stool?

Answer 14

PR to rule out malignancy

Question 15

what is seen on examination of endometriosis?

Answer 15

-Can see endometrial tissue on speculum examination (especially in POSTERIOR FORNIX)
-Fixed cervix on bimanual exam
-Tenderness in vagina, cervix and adnexa

UTEROSACRAL NODULES

Question 16

what imaging can be used for endometriosis and what disadvantages are there with it?

Answer 16

Transvaginal USS

Will show large endometriomas or chocolate cysts (ovarian endometriosis)

Disadvantage= Can be unremarkable even if patient has endometriosis

Question 17

Stage 1 endometriosis?

Answer 17

Small superficial lesions

Question 18

Stage 2 endometriosis?

Answer 18

Mild, but deeper lesions than stage 1

Question 19

Stage 3 endometriosis?

Answer 19

Deeper lesions than Stage 1 or 2, with lesions on the ovaries and mild adhesions

Question 20

Stage 4 endometriosis?

Answer 20

Deep and large lesions affecting the ovaries with extensive adhesions

Question 21

Management of endometriosis?

Answer 21

1st= COCP/ Mirena + NSAID
2nd= GnRH (goserelin)
3rd= laparascopic ablation

Suppression of ovulation:
For 6-12 months can reduce thickening of endometriosis lesions and so reduce symptoms
· Hormonal Medication (COC, POP, Depot, Nexplanon, Mirena coil)
· GnRH agonists- shut down ovaries and so induces menopause SE: hot flushes, osteoporosis
· Surgery: Laparoscopic surgery to excise or ablate tissue
- Hysterectomy

Question 22

complications of endometriosis?

Answer 22

-Pain
-Cyst formation (especially in ovary and can destroy other ovarian tissue)
-Adhesions
-Infertility
-Ectopic pregnancy
-Malignancy (endometrioid carcinoma or Clear cell carcinoma)

Question 23

what cancer can come from endometriosis?

Answer 23

endometriod carcinoma

Clear cell carcinoma

Question 24

example of GnRH analogue?

Answer 24

Goserelin and leuprorelin

Question 25

how do GnRH analogues work?

Answer 25

GnRH analogues are agonists and given as IM/ subcutaenous injection

-they act on the anterior pituitary gland, binding to the GnRH receptors
-at first they cause an increased release of LH, FSH and so oestrogen and can worsen symptoms for a couple days
-Over time they cause the GnRH receptors on the anterior pituitary to become desensitized and so stop the release of LH, FSH and oestrogen