Endometriosis

Question 1

What is Endometriosis?

Answer 1

Condition where there is Ectopic endometrial tissue OUTSIDE uterus

Question 2

What is Adenomyosis?

Answer 2

Endometrial tissue in myometrium (muscle layer of uterus)

Question 3

What is the main age group for Endometriosis?

Answer 3

25-40 yrs

Question 4

Is the pathophysiology of Endometriosis clear?

Answer 4

No

Question 5

What is the Retrograde Menstruation theory for Endometriosis? (2 steps)

Answer 5

1. Endometrial cells travel backwards from uterine cavity –> Fallopian tubes –> Pelvis / Peritoneum
2. Endometrial cells seed + grow here

Question 6

What is another theory for Endometriosis pathophysiology?

Answer 6

Endometrial cells travel through lymphatic system (same way as cancer spreads)

Question 7

What is endometrial tissue sensitive to?

Answer 7

Oestrogen

Question 8

During menstruation, what happens to the ectopic endometrial tissue?

Answer 8

Bleeds, just like normal endometrial tissue

Question 9

What does the bleeding of ectopic endometrial tissue cause? (2 things)

Answer 9

1. Pain
2. Bloating / distension @ ectopic sites

Question 10

What can repeated bleeding and inflammation at ectopic sites lead to?

Answer 10

Scarring –> Adhesions

Question 11

When are the symptoms of endometriosis reduced? (2 things)

Answer 11

1. Pregnancy
2. Menopause

Question 12

What are the RF for Endometriosis? (6 things)

Answer 12

1. Early menarche
2. FHx Endometriosis
3. Short menstrual cycles
4. Long duration of menstrual bleeding
5. Heavy menstrual bleeding
6. Defects in uterus / fallopian tubes

Question 13

What are the CF of Endometriosis?

Answer 13

1. Pelvic / abdominal pain (cyclic)
2. Dyspareunia (pain @ intercourse)
3. Dysmenorrhoea
4. Infertility
5. Dysuria / Dyschezia
6. Cyclic bleeding @ other sites (e.g haematuria)

Question 14

What examinations can you do for sus Endometriosis? (2 things)

Answer 14

1. Bimanual examination
2. Speculum examination

Question 15

What might you find @ examination of sus Endometriosis? (3 things)

Answer 15

1. Endometrial tissue visible in vagina (esp post fornix)
2. Fixed retroverted cervix
3. Tenderness in vagina / cervix / adnexa

Question 16

What does an enlarged, tender, boggy uterus indicate?

Answer 16

Adenomysosis

Question 17

What are some DDx that present similarly to Endometriosis? (4 things)

Answer 17

1. PID
2. Ectopic pregnancy
3. Fibroids
4. IBS

Question 18

How does PID present similarly to Endometriosis? (3 things)

Answer 18

1. Pelvic pain
2. Dyspareunia
3. Abn / heavy bleeding

Question 19

How does Ectopic pregnancy present similarly to Endometriosis? (4 things)

Answer 19

1. Pelvic pain
2. Dyspareunia
3. Abn / heavy bleeding
4. Collapse

Question 20

How does Fibroids present similarly to Endometriosis? (4 things)

Answer 20

1. Pelvic pain
2. Long duration of menstrual bleeding
3. Heavy menstrual bleeding
4. Bloating / feeling of a mass

Question 21

How does IBS present similarly to Endometriosis? (3 things)

Answer 21

1. Abd pain
2. Dyspareunia
3. Bloating

Question 22

What is the GOLD standard investigation for sus Endometriosis?

Answer 22

Laparoscopy

Question 23

What are the typical findings of Endometriosis on Laparoscopy? (4 things)

Answer 23

1. Endometriotic lesions (see pic)
2. Chocolate cysts (endometriosis of ovaries)
3. Peritoneal deposits
4. Adhesions

Question 24

What are the benefits of doing a Laparoscopy for sus Endometriosis? (2 things)

Answer 24

1. Take biopsy (for definitive dx)
2. Surgically remove deposits (can improve symptoms)

Question 25

What other investigation can be done for sus Endometriosis?

Answer 25

Pelvic US (Usually unremarkable tho and will be referred to gynae for Laparoscopy)

Question 26

What does NICE recommend instead of using a staging system for Endometriosis?

Answer 26

Detailed documentation of endometriosis

Question 27

What are the 3 components of Mx of Endometriosis?

Answer 27

1. Pain 2. Hormonal 3. Surgical

Question 28

How do you manage the pain of Endometriosis?

Answer 28

Analgesia / NSAIDS (follow analgesia ladder)

Question 29

What is a benefit of Hormonal Mx of Endometriosis?

Answer 29

Can be tried even before definitive Dx with laparoscopy

Question 30

What are the options for Hormonal Mx of Endometriosis? (5 things)

Answer 30

1. COCP 2. POP (Norethisterone) 3. Depo-Provera injection 4. IUD (Mirena coil) 5. GnRH agonists

Question 31

How do COCP / POP / Depo / IUD work to manage Endometriosis? (3 steps)

Answer 31

1. Suppresses ovulation 2. Causes atrophy of endometriosis lesions 3. Reduces symptoms

Question 32

How do GnRH agonists work to manage Endometriosis? (3 steps)

Answer 32

1. Induce menopause-like state 2. Female sex hormones reduced 3. Reduces symptoms

Question 33

What are the side fx of using menopause-like inducing meds like GnRH agonists? (3 things)

Answer 33

1. Hot flushes 2. Night sweats 3. Osteoporosis

Question 34

What are the Surgical Mx options of Endometriosis? (2 things)

Answer 34

1. Laparoscopy 2. Hysterectomy

Question 35

What can be done in Laparoscopic Tx of Endometriosis? (3 things)

Answer 35

1. Excision 2. Ablation 3. Adhesiolysis

Question 36

What is the benefit of Laparoscopic Tx over Hormonal Tx of Endometriosis?

Answer 36

Laparoscopic Tx can improve fertility

Question 37

When is Hysterectomy a better option than Laparoscopic Tx of Endometriosis?

Answer 37

Beh relapses (which almost always occur after laparoscopic tx)