endometriosis Flashcards

1
Q

what is it

A

growth of endometrial like tissue outside uterus

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2
Q

who does it affect

A

mainly women of reproductive age

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3
Q

although the exact cause is unknown, it is …..-dependent condition and is associated with…

A

oestrogen dependent
associated with menstruation

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4
Q

symptoms

A
  • pelvic pain
  • painful periods
  • subfertility
  • pain (freq, chronic, severe)
  • tiredness
  • more sick days
  • significant physical, sexual, psychological and social impact
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5
Q

is it related to fertility

A

yes, it is an important cause of subfertility (failing to conceive after one year of regularly trying)

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6
Q

management options include (2)

A

drug treatment
surgery

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7
Q

how do most drug treatments for endometriosis work

A

by suppressing ovarian function and are contraceptive

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8
Q

what does surgical treatment aim to do

A

to remove or destroy endometriotic lesions

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9
Q

1st line management of endometriosis related pain

A

short trial (e.g. 3 months) paracetamol or NSAID alone or in combination

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10
Q

if 1st line management (short trial of paracetamol +/- NSAID) is inadequate, consider ..

A

other forms of pain management and referral for further assessment

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11
Q

what to offer to women with suspected, confirmed or recurrent endometriosis

A

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)

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12
Q

For deep endometriosis involving the bowel, bladder or ureter, consider

A

gonadotropin-releasing hormones given for 3 months before surgery

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13
Q

excision or ablation when treating endometriomas?

A

excision rather than ablation should be considered

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14
Q

after laparoscopic excision or ablation of endometriosis, consider the following treatment to prolong benefits of surgery and manage symptoms

A

hormonal treatment e.g. with COC

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15
Q

when may hysterectomy be indicated

A

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.

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16
Q

with surgery, always ask pt about the following to guide surgical decision making

A

preferences and priorities with respect to pain and fertility and ovarian reserve

17
Q

Surgical management if fertility is a priority

A

management of endometriosis-related subfertility should have multidisciplinary involvement with input from a fertility specialist

18
Q

should women with endometriosis who are trying to conceive be offered hormonal treatment

A

no because it does not improve spontaneous pregnancy rates.