endometriosis Flashcards
what is it
growth of endometrial like tissue outside uterus
who does it affect
mainly women of reproductive age
although the exact cause is unknown, it is …..-dependent condition and is associated with…
oestrogen dependent
associated with menstruation
symptoms
- pelvic pain
- painful periods
- subfertility
- pain (freq, chronic, severe)
- tiredness
- more sick days
- significant physical, sexual, psychological and social impact
is it related to fertility
yes, it is an important cause of subfertility (failing to conceive after one year of regularly trying)
management options include (2)
drug treatment
surgery
how do most drug treatments for endometriosis work
by suppressing ovarian function and are contraceptive
what does surgical treatment aim to do
to remove or destroy endometriotic lesions
1st line management of endometriosis related pain
short trial (e.g. 3 months) paracetamol or NSAID alone or in combination
if 1st line management (short trial of paracetamol +/- NSAID) is inadequate, consider ..
other forms of pain management and referral for further assessment
what to offer to women with suspected, confirmed or recurrent endometriosis
hormonal treatment with a COC or progestogen
this can reduce pain and has no negative effect on subsequent fertility
if initial hormonal treatment not effective, not tolerated, or CI, the woman should be referred to gynaecologist or specialist for possible further treatment (e.g. other hormonal treatment or surgery)
For deep endometriosis involving the bowel, bladder or ureter, consider
gonadotropin-releasing hormones given for 3 months before surgery
excision or ablation when treating endometriomas?
excision rather than ablation should be considered
after laparoscopic excision or ablation of endometriosis, consider the following treatment to prolong benefits of surgery and manage symptoms
hormonal treatment e.g. with COC
when may hysterectomy be indicated
adenomyosis (enlarged uterus due to endometrial tissue that grows into muscular wall of uterus) or heavy menstrual bleeding that has not responded to other treatments.
with surgery, always ask pt about the following to guide surgical decision making
preferences and priorities with respect to pain and fertility and ovarian reserve
Surgical management if fertility is a priority
management of endometriosis-related subfertility should have multidisciplinary involvement with input from a fertility specialist
should women with endometriosis who are trying to conceive be offered hormonal treatment
no because it does not improve spontaneous pregnancy rates.
