endometriosis

Question 1

Clinical features

Answer 1

chronic pelvic pain
secondary dysmenorrhoea
pain often starts days before bleeding
deep dyspareunia
subfertility

on pelvic examination reduced organ mobility, tender nodularity in the posterior vaginal fornix and visible vaginal endometriotic lesions may be seen

Question 2

Investigation

Answer 2

laparoscopy is the gold-standard investigation

Question 3

tx for endometriosis

Answer 3

NSAIDs and/or paracetamol are the recommended first-line treatments for symptomatic relief

if analgesia doesn’t help then hormonal :combined oral contraceptive pill
or progestogens e.g. medroxyprogesterone acetate should be tried

Question 4

If analgesia/hormonal treatment does not improve symptoms, or if fertility is a priority, the patient should be referred

Answer 4

Secondary treatments include:
GnRH analogues - said to induce a ‘pseudomenopause’ due to the low oestrogen levels

aparoscopic excision is further down the line, as surgery carries significant risks. The next step, after simple analgesia, is the use of hormonal options.