Endometriosis Flashcards
What is endometriosis?
A condition in which there is ectopic endometrial tissue outside of the uterus
What is an endometrioma?
A ‘lump’ of endometrial tissue
What are some theories for the cause of endometriosis?
- Possible genetic component
- Possible flow of endometrial lining up through the fallopian tubs during menstruation (Retrograde menstruation), causing seeding
- Possible embryonic cell involvement, lymphatic spread of metaplasia
What are some main symptoms of endometriosis?
- Cyclical abdominal or pelvic pain
- Deep dyspareunia (pain on deep sexual intercourse)
- Dysmenorrhoea (painful periods)
- Infertility
- Cyclical bleeding from other sites, such as haematuria
- Bowel and urine symptoms
Describe the pathophysiology of symptoms in endometriosis
The ectopic endometrial tissue sheds its lining with the menstrual cycle causing deep inflammation and irritation
This can lead to adhesions as inflammation leads to scarring, causing chronic, non-cyclical pain and nausea
How can endometriosis cause reduced fertility
Possibly due to adhesions blocking the eggs or kinking the fallopian tubes
Possible egg damage with ovarian endometrioma
What may be seen on examination in endometriosis?
Endometrial tissue in the vagina (Esp. posterior fornix)
Fixed cervix on bimanual exam
tenderness in the vagina, cervix and adnexae
How is endometriosis diagnosed?
Pelvic USS
Laparoscopic surgery with biopsy
What are the 4 stages of the ASRM staging for endometriosis?
- Stage 1: Small superficial lesions
- Stage 2: Mild, but deeper lesions than stage 1
- Stage 3: Deeper lesions, with lesions on the ovaries and mild adhesions
- Stage 4: Deep and large lesions affecting the ovaries with extensive adhesions
What are the initial management options for endometriosis?
- Establishing a diagnosis
- Providing a clear explanation
- Listening to the patient, establishing their ideas, concerns and expectations and building a partnership
- Analgesia as required for pain (NSAIDs and paracetamol first line)
What are some hormonal management options for endometriosis?
- Combined oral contractive pill, which can be used back to back without a pill-free period if helpful
- Progesterone only pill
- Medroxyprogesterone acetate injection (e.g. Depo-Provera)
- Nexplanon implant
- Mirena coil
- GnRH agonists
What are some surgical management options for endometriosis?
Laparoscopic excision or ablation
Adhesion removal (Adhesiolysis)
Hysterectomy
How will surgical and hormonal management affect fertility in endometriosis?
Surgery may improve fertility
Hormonal management will not
How do hormonal management options work in endometriosis?
POP, DMPA, implant and Mirena coil all stop ovulation and reduce endometrial thickening therefore preventing bleeding and therefore pain
GnRH agonists temporarily shut down the ovaries and induce “menopause” to prevent oestrogen production
What are some examples of GnRH agonists?
Goserelin
Leuprorelin
