Endometriosis Flashcards
What is endometriosis
Ectopic endometrial tissue outside the uterus
What is a lump of endometrial tissue outside the uterus
endometrioma
What are choclate cysts
Endometriomas in ovaries
What is adenomyosis
endometrial tissue within myometrium of uterus (muscle)
Theories for what causes endometriosis
There is a genetic component but none found to directly cause
Retrograde menstruation through fallopian tubes
Embryonic cells -> endometrial tissue outside uterus
Endometrial cells through lymphatic system
Cells outside uterus metaplasia -> endometrial tissue
Why is pelvic pain the main symptoms of endometriosis?
Cells of endometrial tissue respond to hormones the same way as in uterus - sheds lining and bleeds -> irritation and inflammation of tissues around endometriosis
Type of pain in menstruation with endometriosis
Cyclical, dull, heavy or burining pain
Can blood in the urine or stools be caused by endometriosis
In bladder or bowel
What causes chronic cyclical pain in endometriosis
Local bleeding and inflammation -> adhesions, scar tissue
Pain ass with sharp, stabbing or pulling + nausea
Why might endometriosis cause infertility
Sometimes unclear
Adhesions blocking tubes or ovaries - release of eggs
Damage eggs if adhesions in ovaries
Endometriosis presentation
Asymptomatic
Cyclical abdominal or pelvic pain
Deep dyspareunia - pain on deep sexual intercourse
Dysmenorrhoea
Infertility
Cyclical bleeding from other sites eg haematuria
What other systems can have symptoms from endometriosis
Urinary, bowel
What is seen on sepculum exam in endometriosis
Endometrial tissue visible, particuarly in posterior fornix, tenderness vagina, cervix and adnexa
What see on bimanual exam in endometriosis
Fixed cervix on bimanual examination
What can see on pelvic US endometriossi
Often unremarkable
Large endometriomas and chcolate cysts
What is gold standard to diagnose abdominal and pelvic endometriosis
Laprascopic surgery
Biopsy of lesions during laproscopy
Can also remove depositis if there
What is a staging systen to be aware of
American society of reproducitve medicine
* Stage 1: Small superficial lesions
* Stage 2: Mild, but deeper lesions than stage 1
* Stage 3: Deeper lesions, with lesions on the ovaries and mild adhesions
* Stage 4: Deep and large lesions affecting the ovaries with extensive adhesions
Guidleines for the management of endometriosis
RCOG - green top guideline 41 on chronic pelivc pain 2012
ESHRE guidelines on endometriosis
NICE
Initial management of endometriosis
Establish diagnsois
Clear explanantion
Listening to patient, ICE
analgesia - NSAIDs and paracetemol
Hormonal management of endometriosis
COCP - can be used back to back without pill free period if needed
Progesterone only pill
Medroxyprogesterone acetate injection - depo-provera
Nexplanon implant
Mirena coil
GnRH agonsits
Surgical management for endometriosis
Laprascopic surgery to excise or ablate endometrial tissue and remove adhesions (adhesiolysis)
Hysterectomy
What is the problem with hormonal treatments for endometriosis
Dont improve fertility
What is the purpose of hormonal treatment for endometrisosi
Stop ovulation
Reduce endometrial thickening
What do GnRH agonsits do
Induce menopause like state to reduce cyclical pain - shut down ovaries
Examples of GnRH agonists
Goserelin - zoladex
Leuprorelin - prostap
Side effects of GnRH agonists
Hot flushes, night sweats, risk of osteoporosis
