Endometriosis

Question 1

SBA

1st line medical ttt of endometriosis in women w/ chronic pelvic pain

Answer 1

COCs

same effect of GnRH, less side effects

Question 2

What is endometriosis

Answer 2

presence of endometrial-like tissue outside the uterus, which induces a chronic inflammatory reaction.

Question 3

Commonly affected sites of endometriosis

Answer 3

• The pelvic organs and peritoneum (uterosacral ligaments, pouch of Douglas, rectovaginal septum, and ovaries).
• Extra-pelvic deposits such as the lungs, caesarean section scar, and the bowel areoccasionally seen

Answer 4

1. Secondary dysmenorrhoea (usually before or during menstruation).
2. Deep dyspareunia.
3. Chronic pelvic pain.
4. Infertility.
5. Cyclical or perimenstrual symptoms, such as bowel or bladder, with or without abnormal bleeding or pain.
6. Dyschezia (pain on defecation).
7. Painful caesarean section scar.

Question 5

Prevelence of Endometriosis

Answer 5

5–10% among the general female population

Question 6

Percentage of women undrgoing investigations for subfertility who has endometriosis

Answer 6

20-30%

Question 7

percentage of women who undergoing sterilization who has endometriosis

Answer 7

1-5%

Question 8

Percentage of women who has dysmenorrhea or chronic pelvic pain who has endometriosis

Answer 8

40-60%

Question 9

Pathogenesis theories of endometriosis

Answer 9

1. Retrograde menstruation.
2. Peritoneal metaplasia.
3. Lymphatic or blood-borne dissemination.

Question 10

Complications of emdometriosis

Answer 10

• Dysmenorrhoea.
• Chronic pelvic pain.
• Subfertility.
• Can impact on general physical, mental, and social wellbeing.

Question 11

Gold standard investigating endometriosis

Answer 11

Laparoscopy

Question 13

advantages of laparoscopy investigating endometriosis

Answer 13

• allows visual inspection of the pelvis
• palpate lesions to determine their nodularity
• document the type, location, and extent of all lesions and adhesions.

Question 14

Is there a specific time (during the menses) to perform laparoscopy investigating endometriosis

Answer 14

No evidence to perfom it in a specific time.
Do not perform it during or within 3 months of hormonal treatment, to avoid under-diagnosis.

Question 15

advantage of empirical ttt of endometriosis

Answer 15

• TTT of pain sym without a definitive diagnosis – a therapeutic trial
  of a hormonal drug to reduce menstrual flow is appropriate.

Question 16

what is the empirical ttt of endometriosis

Answer 16

• Counselling, analgesia, progestogens, or the COCs
• GnRHa may be taken short term

Question 17

Investigations of endometriosis

Answer 17

1. Laparoscopy (Gold standard)
2. Serum CA 125 (elevated)
3. Histology: if +ve ok, if -ve don’t exclude.
4. TVS (limited value in peritoneal, useful in ovarian)
5. MRI