Endometriosis Flashcards
what is endometriosis?
Endometrial glands and stroma outside the uterine body
what is adenomyosis?
Endometrial tissue in myometrium
describe cysts found in ovarian endometriosis
chocolate cysts
what is an endometrioma?
lump of endometrial tissue out with the endometrium
what causes endometriosis?
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
where is endometriosis commonly found?
-Ovary
-Pouch of Douglas
-Peritoneal surfaces, including uterus
-Cervix, vulva, vagina
-Bladder, bowel ect
why do patients with endometriosis experience cyclical dull pain?
-Endometrial tissue reacts the same outwith the uterus as it does in
-Inflammation and bleeding during menstruation causes dull, cyclical pain
why do patients with endometriosis experience non cyclical sharp pain?
Due to adhesions/ scarring
-Inflammation causes damage and development of scar tissue, binding organs together causing non cyclical sharp, stabbing pain
Symptoms of Endometriosis?
-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
Signs of endometriosis?
-A fixed, retroverted uterus
-Uterosacral nodules/ thickening
-General tenderness
gold standard investigation for endometriosis?
laparascopic surgery with biopsy
what is seen macroscopically in endometriosis?
Ovary- chocolate cysts
-Peritoneal spots or nodules (brown spots due to haemorrhages from the endometriotic lesions)
-Fibrous adhesions
what is seen microscopically in endometriosis?
-Endometrial glands and stroma
-Haemorrhage, inflammation and fibrosis
what investigation should be done if patient with endometriosis has blood in stool?
PR to rule out malignancy
what is seen on examination of endometriosis?
-Can see endometrial tissue on speculum examination (especially in POSTERIOR FORNIX)
-Fixed cervix on bimanual exam
-Tenderness in vagina, cervix and adnexa
UTEROSACRAL NODULES
what imaging can be used for endometriosis and what disadvantages are there with it?
Transvaginal USS
Will show large endometriomas or chocolate cysts (ovarian endometriosis)
Disadvantage= Can be unremarkable even if patient has endometriosis
Stage 1 endometriosis?
Small superficial lesions
Stage 2 endometriosis?
Mild, but deeper lesions than stage 1
Stage 3 endometriosis?
Deeper lesions than Stage 1 or 2, with lesions on the ovaries and mild adhesions
Stage 4 endometriosis?
Deep and large lesions affecting the ovaries with extensive adhesions
Management of endometriosis?
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
complications of endometriosis?
-Pain
-Cyst formation (especially in ovary and can destroy other ovarian tissue)
-Adhesions
-Infertility
-Ectopic pregnancy
-Malignancy (endometrioid carcinoma or Clear cell carcinoma)
what cancer can come from endometriosis?
endometriod carcinoma
Clear cell carcinoma
example of GnRH analogue?
Goserelin and leuprorelin
how do GnRH analogues work?
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
