Endometriosis

Question 1

Define endometriosis.

Answer 1

Presence of endometrial tissue outside the uterus.

Question 2

Explain the aetiology of endometriosis.

Answer 2

Theories:

Retrograde menstruation: passage of endometrial tissue through tubes into pelvis during menstruation (Samson’s)

Metaplasia of coelomic epithelium into endometrial glands (Meyer’s)

Question 3

What 5 risk factors for endometriosis?

Answer 3

Early menarche
Nulliparity
FH
Short cycle
Long periods

Question 4

Summarise the epidemiology of endometriosis.

Answer 4

10% women in reproductive age.

Question 5

List 4 symptoms of endometriosis.

Answer 5

Cyclical dysmenhorrea

Cyclical/ chronic pelvic pain

Deep dyspareunia

Sub-fertility.

Question 6

Give 5 non-gynaecological symptoms of endometriosis

Answer 6

Haematuria
Urgency
Dsyuria
Dyschezia
PR bleed

Question 7

List 4 signs of endometriosis on physical examination.

Answer 7

Fixed retroverted uterus
Tender nodularity in posterior vaginal fornix
Vaginal endometriosis lesions
Uterosacral ligament nodules.

Question 8

What is the gold standard investigation for endometriosis. What may be seen?

Answer 8

Laparoscopy
Chocolate cysts
Adhesions
Peritoneal deposits

Question 9

Describe the medical management for endometriosis

Answer 9

Analgesia: NSAID
Suppress ovulation: COCP, Norethisterone, Mirena
GnRH analogues

Question 10

Describe the surgical management plan for endometriosis.

Answer 10

Maintain fertility: Laparoscopic ablation/ excision of endometriomas
Adhesionolysis
Ovarian cystectomy

Definitive: Total hysterostomy with bilateral salpingo-oophrectomy

Question 11

List 6 possible complications of endometriosis and its management.

Answer 11

Cyst rupture
Adhesions
Bowel obstruction
Infertility
Chronic pain
Sexual dysfunciton.

Question 12

Summarise prognosis of endometriosis

Answer 12

Medical Mx improves Sx in many.
Sx subside in pregnancy/ menopause.