Endometriosis

Question 1

What is endometriosis?

Answer 1

a gynaecological condition where endometrial tissue, which typically lines the uterus, proliferates outside the uterine cavity.

Results in pelvic pain and irregular menstrual cycles.

Question 2

What are the potential consequences of endometriosis?

Answer 2

Pelvic inflammation
Infertility
Pain

Question 3

What sites can endometriosis affect?

Answer 3

Ovary (“chocolate” cyst)

Pouch of Douglas (represents the caudal extension of the peritoneal cavity. It is the rectovaginal pouch in the female)

Peritoneal surfaces, including uterus

Cervix, vulva, vagina

Bladder, bowel etc

Question 4

What are some complications of endometriosis?

Answer 4

Pain
Cyst formation
Infertility
Ectopic pregnancy
Malignancy (endometrial carcinoma)

Question 5

What are “chocolate” cysts?

Answer 5

Occur in endometriosis when endometrial-like tissues form sacs on the ovaries.

Question 6

Symptoms and features of endometriosis?

Answer 6

Dysmenorrhoea (pain during menstruation)

Dyspareunia (pain during sexual intercourse)

Subfertility (inability to reproduce)

On pelvic examination, tender, nodular masses may be palpable on the ovaries or the ligaments surrounding the uterus

Question 7

Common investigations for endometriosis?

Answer 7

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.

Question 8

Medical management of endometriosis?

Answer 8

Analgesia: paracetamol or non-steroidal anti-inflammatory drugs

Hormonal therapies: combined oral contraceptive pill, medroxyprogesterone acetate, gonadotrophin-releasing hormone agonists

Question 9

Surgical management of endometriosis?

Answer 9

Ovarian cystectomy (for endometriomas)
Adhesiolysis
Bilateral oophorectomy (sometimes with a hysterectomy)

Question 10

Can endometriosis cause infertility?

Answer 10

Yes

Question 11

Features of deep infiltrating endometriosis?

Answer 11

Pain and bleeding during defecation

Along with standard endometriosis symptoms:
- Pain during sex
- heavy bleeding
- painful periods

Question 12

Most common ages for endometriosis?

Answer 12

affects women during their reproductive years between the ages of 25 and 35

Question 13

Gold standard investigation for endometriosis?

Answer 13

Laparoscopy

Diagnosis can also be made by Transvaginal ultrasound or clinically, however Transvaginal ultrasound often doesn’t show abnormal findings

Question 14

The gold standard investigation for endometriosis is transvaginal ultrasound. True/false?

Answer 14

False

Diagnostic laparoscopy is the gold standard investigation.

Transvaginal ultrasound can also be useful however some features can be missed on this imaging.

Question 15

Does primary or secondary dysmenorrhoea (painful periods) occur with endometriosis?

Answer 15

Secondary dysmenorrhoea

Question 16

What is the difference between primary and secondary dysmenorrhoea?

Answer 16

Primary dysmenorrhoea = painful menstruation in the absence of any underlying pelvic pathology.

Secondary dysmenorrhoea = painful menstruation secondary to underlying pelvic pathology such as endometriosis, fibroids or polyps.

Question 17

Primary and secondary dysmenorrhoea typical onset in menstruation?

Answer 17

Primary dysmenorrhoea typically occurs with the onset of menstruation.

Secondary dysmenorrhoea usually occurs before the start of menstruation.

Question 18

What are all the features of endometriosis?

Answer 18

Worsening abdominal and pelvic pain associated with heavy bleeding (menorrhagia)

Blood in the urine (possible contamination with menstrual blood)

Deep dyspareunia (pain on sexual intercourse) and a fixed cervix could indicate adhesions due to endometriosis

Question 19

What is a common side effect of diagnostic laparoscopy due to endometriosis?

Answer 19

Shoulder pain