Endometriosis Flashcards
What is the definition of dysmenorrhoea?
Pelvic pain during menstruation
What is the definition of dyspareuria?
Pain with sexual intercourse (superficial and deep)
What is the definition of dyschezia?
Pain with defecation
What is Mittelschmerz?
Mid-cycle pain due to ovulation, usually felt in an iliac fossa
What is the definition of endometriosis?
Occurrence of endometrial tissue outside the uterus, most commonly on the pelvic peritoneal surfaces
What is the definition of adenomyosis?
Occurrence of endometrial tissue within the myometrium/ endometriosis in the wall of the uterus
What are the common sites of endometriosis?
Uterosacral ligament (most common)
Pouch of Douglas (2nd most)
Ovaries (3rd most)
Other: fallopian tubes, bladder, vagina, lungs (rare)
What are the causes of endometriosis?
Retrograde menses with some kind of predisposition e.g. genetics
Spread across the peritoneal cavity (transcoelomic spread)
Metastatic spread (lymphatic and haematogenous)
Wound spread e.g. C-section
How may endometriosis present?
Cyclical pain - dysmenorrhoea, midcycle pain, premenstrual pain, pain on void or defecation with period
Provoked pain - dyspareunia, pain inserting tampons, pain on VE
Infertility
Incidental finding
What might you find on examination for endometriosis?
Lower abdominal tenderness Tenderness on PV, especially POD Palpable adnexal mass Palpable nodularity, especially POD/ uterosacral ligaments Fixed immobile uterus
What Ix would you do for endometriosis?
Transvaginal U/S - kissing ovaries, cyst with ground glass appearance
Laparoscopy (gold standard) - visualisation, histology
What are the treatment options for endometriosis?
Depends on symptom severity and desire for fertility
Do nothing
Analgesia e.g. NSAIDs, avoid opiates (exacerbate Sx)
Hormonal: OCP, oral and depot progesterone, GnRH analogue or danazol if severe disease
Surgery: endometriosis resection (chocolate cyst), endometrial ablation (dot and spot), total abdominal hysterectomy + bilateral salpingo-oophorectomy
Ddx for endometriosis
PID Primary dysmenorrhoea Appendicitis Other GIT - IBS, diverticulitis, UC Malignancy, especially if pelvic mass
What are the clinical features of adenomyosis?
Dysmenorrhoea
Menorrhagia
Tender, bulky uterus on examinaton
