Endometriosis

Question 1

What is endometriosis?

Answer 1

Condition where there’s ectopic endometrial tissue outside the uterus

Question 2

1) A lump of endometrial tissue outside the uterus is called what?
2) What is endometrial tissue within the myometrium of the uterus called?

Answer 2

1) Endometrioma
2) Adenomyosis

Question 3

1) What is the main symptom of endometriosis?
2) How is this symptom often described?
3) What is the pathophysiology of this symptom?

Answer 3

1) Pelvic pain
2) Cyclical, dull, heavy or burning pain that occurs during menstruation
3) During menstruation, as the endometrial tissue in the uterus sheds its lining and bleeds, the same thing happens in the endometrial tissue elsewhere in the body causing irritation and inflammation of the tissues around the sites of endometriosis

Question 4

1) Name 2 ways endometriosis can present
2) Name a feature on examination of endometriosis

Answer 4

1) Cyclical abdominal or pelvic pain, deep dyspareunia, dysmenorrhoea, infertility, cyclical bleeding from other sites i.e. haematuria
2) Endometrial tissue visible in the vagina on speculum examination, particularly in the posterior fornix, a fixed cervix on bimanual examination, tenderness in the vagina, cervix and adnexa

Question 5

What is the gold standard way to diagnose abdominal and pelvic endometriosis?

Answer 5

Laparoscopic surgery

Question 6

How can the cyclical pain of endometriosis be treated, and what treatment modalities can be used?

Answer 6

Hormonal medications that stop ovulation and reduce endometrial thickening - COCP, oral progesterone-only pill, progestin depot injection, the progestin implant (Nexplanon) and the Mirena coil.

Question 7

How can laparoscopic surgery be used in the treatment of endometriosis?

Answer 7

• Excise or ablate the ectopic endometrial tissue
• Dissect adhesions and attempt to return anatomy to normal