Endometriosis Flashcards
What is endometriosis?
A gynecological condition where endometrial tissue, which typically lines the uterus, proliferates outside the uterine cavity.
What can it be caused by?
Retrograde menstruation, coelomic metaplasia, and lymphatic or vascular dissemination of endometrial cells.
How do patients with endometriosis present?
Dysmenorrhoea
Dyspareunia
Subfertility
Cyclical rectal bleeding, if endometrial tissue grows outside the female reproductive system
On pelvic examination, tender, nodular masses may be palpable on the ovaries or the ligaments surrounding the uterus
What are primary differentials?
Primary dysmenorrhoea: characterized by crampy pelvic pain at the onset of menses with no identifiable pelvic pathology.
Uterine conditions (e.g. fibroids, adenomyosis): these can cause heavy menstrual bleeding and pelvic discomfort.
Adhesions: pelvic pain and possible bowel obstruction.
Pelvic inflammatory disease (PID): presents with lower abdominal pain, fever, abnormal vaginal discharge, and possible dyspareunia.
What investigations are carried out?
Transvaginal ultrasound: Often normal, but may identify an ovarian endometrioma, a cyst made of endometrial tissue in the ovary.
Diagnostic laparoscopy: Considered the gold standard diagnostic tool, but it carries a small risk of complications (e.g., bowel perforation) and is not the first-line investigation.
What are medical management options?
Analgesia: paracetamol or non-steroidal anti-inflammatory drugs
Hormonal therapies: combined oral contraceptive pill, medroxyprogesterone acetate, gonadotrophin-releasing hormone agonists
What are surgical management options?
Diathermy of lesions
Ovarian cystectomy (for endometriomas)
Adhesiolysis
Bilateral oophorectomy (sometimes with a hysterectomy)
What should be done where endometriosis is causing infertility?
In cases where endometriosis is causing infertility, menstrual suppression would be unsuitable, and so ablation or surgery is more appropriate.
