Endometriosis

Question 1

What is endometriosis?

Answer 1

A disease affecting reproductive age women

Presence of endometrial tissue outside the uterine cavity

Usually pelvi-peritoneum, pouch of Douglas, uterosacral ligaments, bladder, ovaries, adenomyosis

Rarely brain, eyes, chest and lung

Causes fibrosis and adhesions leading to dysmenorrhea, dyspareunia and infertility

Question 2

What are the theories explaining genesis of endometriosis?

Answer 2

Sampson’s implantation theory (retrograde menstrual regurgitation of endometrium)

Meyer’s coelomic metaplasia theory
(Dedifferentiation of peritoneal cells to endometrium)

Halban’s systemic and lymphatic spread theory

Question 3

What are the clinical features of endometriosis?

Answer 3

Severe non colicky cyclical perimenstrual pelvic pain (secondary dysmenorrhea)

may be HMB

Chronic non cyclical pelvic pain
Fatigue
Deep dyspareunia 
Infertility 
Dyschezia and cyclical rectal bleeding
Cyclical epistaxis/hemoptysis/hematuria 
Dysuria and loin/flank pain

Question 4

What are the examination findings in endometriosis?

Answer 4

Thickened nodular uterosacral ligaments

Tender pouch of Douglas

Adnexal mass (endometrioma)

Fixed retroverted uterus

Question 5

How is endometriosis managed?

Answer 5

Medical (if normal examination and TVUSS)
Surgical (abnormal findings or failed medical therapy for 6 months)

Analgesia (NSAIDS.....not opioids-IBS)
COCP tricyclical 
High fiber diet and hydration for IBS
DMPA / LNG IUS if cocp risks
Goserelin 

Laparoscopic resection and drainage
Hysterectomy and oophorectomy

Question 6

What are the epidemiological figures on endometriosis?

Answer 6

10-12 % of General female population

Infertility 20-50%

Chronic pelvic pain 20-50 %

Dysmenorrhea 40-60%