Endometriosis Flashcards
What is endometriosis
A common condition characterised by the growth of ectopic endometrial tissue outside of the uterine cavity. Around 10% of women of reproductive age have a degree of endometriosis.
What are the clinical features
chronic pelvic pain
secondary dysmenorrhoea
pain often starts days before bleeding
deep dyspareunia
subfertility
What are the non gynae features
non-gynaecological: urinary symptoms e.g. dysuria, urgency, haematuria. Dyschezia (painful bowel movements)
What is seen on pelvic exam
on pelvic examination reduced organ mobility, tender nodularity in the posterior vaginal fornix and visible vaginal endometriotic lesions may be seen
What is the gold standard investigation
laparoscopy is the gold-standard investigation
What is the role of primary care in diagnosis
there is little role for investigation in primary care (e.g. ultrasound)- if the symptoms are significant the patient should be referred for a definitive diagnosis
What is the correlation between findings in laparoscopy and severity of symptoms
there is poor correlation between laparoscopic findings and severity of symptoms. NICE published guidelines in 2017
What is the correlation between findings in laparoscopy and severity of symptoms
there is poor correlation between laparoscopic findings and severity of symptoms. NICE published guidelines in 2017
What is the first line management in symptomatic relief
NSAIDs and/or paracetamol are the recommended first-line treatments for symptomatic relief
What is the treatment if analgesia is ineffective
if analgesia doesn’t help then hormonal treatments such as the combined oral contraceptive pill or progestogens e.g. medroxyprogesterone acetate should be tried
What is the treatment if analgesia/hormonal treatment does not improve symptoms, or if fertility is a priority
Referred to secondary care
What is GnRH
GnRH is a secondary treatment said to induce a ‘pseudomenopause’ due to the low oestrogen levels
Who is recommended for surgery
this may be an option for women who have not responded to conventional medical treatment
What surgery is recommended for those who are trying to conceive
for women who are trying to conceive, NICE recommend laparoscopic excision or ablation of endometriosis plus adhesiolysis as this has been shown to improve the chances of conception. Ovarian cystectomy (for endometriomas) is also recommended
