Endometriosis

Question 1

What is it?

Also where?

Answer 1

1) Presence and growth of endometrial tissue similar to endometrium outside the uterus
Is oestrogen dependent - regresses after menopause and during pregnancy
2) Throughout the pelvis, particularly uterosacral ligaments and on or behind the ovaries. Occaisionally affects umbilicus, abdominal wound scars, vagina, bladder, rectum or lungs

Question 2

Complications

Answer 2

Inflammation with progressive fibrosis and adhesions
Can cause a ‘frozen’ pelvis
Subfertility

Question 3

Clinical features

Answer 3

Symptoms correlate poorly with extent of disease
May be asymptomatic
Chronic pelvic pain, usually cyclical
Pain before menstruation
Deep dyspareunia
Subfertility
Pain on passing stool during period
Tenderness/thickening behind the uterus or in the adnexa
Advanced cases - uterus retroverted and immobile
Nodule felt on PR

Question 4

Managment

Answer 4

Diagnosed at laparoscopy
50% disease regresses or does not progress
Analgesia (NSAIDs, paracetamol, opiates)
Hormonal treatment - COC, progesterones or GnRH analogues or androgens (danazol)
Diathermy/laser
Dissection of adhesions
Hysterectomy