Endometriosis

Question 1

Define Endometriosis

Answer 1

Presence of endometrial tissue (glands and storm) outside of the uterine cavity.

Question 2

Cause of endometriosis

Answer 2

4 theories

• Retrograde menstruation (sampson’s theory)
• Immunologic theory - decrease NK cells and decrease clearance of transplanted cells
• Metaplasia of coelomic epithelium
• Extrapelvic disease due to aberrant vascular or lymphatic spread

Question 3

Who gets it

Answer 3

15-30% premenopausal women
~ age 25-30 yr
decrease after menopause

Question 4

Risk factors for endometrosis

Answer 4

FmHx increase risk by 7-10 times if 1st degree relative.
Obstructive anomalies of genital tract
Nulliparity
age >25 age

Question 5

DDX for endometriosis

Answer 5

Chronic PID
Recurrent acute salpingitis
Hemorrhagic corpus lute
Engine/maliganat ovarian neoplasm
Ectopic pregnancy

Question 6

Site of occurrence for endometriosis

Answer 6

60% ovaries
broad ligament
vesicoperitoneal fold
Pouch of douglas
Uterosacral ligaments
Colon
Appendix

Question 7

Clinical features of endometriosis

Answer 7

Triad - dysmenorrhea/menorrhagia, Dyspareunia, dyschezia
Hx
Menstrual cycles symptoms - usually 24-48hr prior to census and continue throughout and afterwards. Secondary dysmenorrhoea
Infertility
non specific pelvic pain
Menorrhagia
Acute pain if endometrioma rupture
Signs
Fixed uterine retroversion, tenderness, and nodules in the pouch of douglas/retrovaginal septum, uterine enlargement and tenderness.

Question 8

How do you diagnosis endometriosis

Answer 8

Laparoscopy for dx

USS can be helpful

Question 9

Treatment for endometriosis

Answer 9

Careful explanation
Basic analgesic - NSAIDs
Medical - COCP for 6m skip sugar pills, progestogen e.g. deep, GnRH analogues, Danazol,
Surgical - Laparoscopic