Endometriosis Flashcards
1
Q
Define Endometriosis & its Epidemiology
A
Presence of endometrium outside the uterus
1-2% of women
30-45yrs
Nulliparous women
2
Q
Outline the Pathology of Endometriosis
A
- Oestrogen dependent [regresses after menopause & during pregnancy]
- Throughout pelvis [uterosacral ligaments/ ovaries]
- Accumulated blood may form in ovaries [aka chocolate cyst/ endometrioma]
- Most severe; entire pelvic ‘frozen’
3
Q
Outline the Aetiology of Endometriosis
A
- Retrograde menstruation?
- Mechanical/ lymphatic/ blood -spread
- Degree of inherited genetic links?
- Metaplasia of coelomic cells?
4
Q
Outline the clinical features of Endometriosis
A
- Asymptomatic
- 3 D’s
- Dysmenorrhoea cyclical
- Dyspareunia
- Dyschezia cyclical
- Pelvic pain & Fertility problems
- Chocolate cyst rupture: Acute pain
- O/E
- PV: tenderness/ thickening
5
Q
How do you investigate Endometriosis?
A
- Laparoscopy
- Diagnosis = visualisation + biopsy
- Lesions
- Active: Red/ punctate marks on peritonem
- Less active: White scars/ brown spots (‘powder burn’)
- Transvaginal ultrasound
- Exclude ovarian endometrioma/ adenomyosis [MRI better]
- MRI: peritoneal endometriosis
6
Q
How do you grade Endometriosis
A
revised American Fertility Society (rev-AFS) grading system
Graded at lapaoscopy depending on presence/ position of endometriosis/ adhesions
- Minimal
- Mild
- Moderate
- Severe
Not representative of pain/ symptoms so not often used.
7
Q
Outline the management of Endometriosis
A
- Medical
- Analgesia
- Regresses during;
- Pregnancy: COCP or Progestogens
- Menopause: GnRH analogues
- Androgens: Danazol [bad SEs]
- IUS
- Surgery
- Scissors, laser & bipolar diathermy laparoscopically
- Dissection..
- TAH + BSO..
8
Q
Outline the effect Endometriosis can have on fertility
A
- Endometriosis found in 25% of lap’s for investigating subfertility
- More extensive = More chance of affecting fertility
- Medical treatment may help if fallopian tubes affects
- Surgery may help
- IVF may help
