endometriosis Flashcards
What is endometriosis?
Presence of endometriosis tissue outside of the uterine cavity.
Who does endometriosis affect?
Hormonally driven, principally by oestrogen so affects women of reproductive age
What is adenomyosis
Presence of endometrial tissue within the myometrium
What is the cause of endometriosis?
Unknown
3 theoties:
1. retrograde menstruation leading to adherence. invasion and growth of tissue
2. Metaplasia of mesothelial cells (which may explain how it can develop in unusual places such as lung)
3. impaired immmunity
What are clinical features of endometriosis?
Chronic pelvic pain
Dysmenorrhoea - pain often starts days before bleeding
Deep dyspareunia
Subfertility
Non gynaecological: urinary symptoms (dysuria, urgency, haematuria). Dyschezia (painful bowel movements)
Describe pain in endometriosis
Cyclical due to endometrial tissue responding to menstrual cycle
Constant due to formation of adhesions from chronic inflammation
Severe dysmenorrhoea
Deep dyspareunia from invovlemtn of uterosacral ligaments
Dysuria
Dyschezia (pain on defaecation)
Describe examination in endometriosis?
Fixed retroverted uterus
Reduced organ mobility
Tender modularity in the posterior vaginal fornix or visible vaginal endometriosis lesions
What investigation in endometriosis?
Laparoscopy with biopsy is gold standard
Histological confirmation
What does management depend on?
Severity of symptoms and whether main symptom is pain or subferitlity
Describe management for pain in endometriosis
NSAIDs/paracetamol
COCP or pregestogens (medroxyprogesteronea acetate)
Cyclically or continuous
If analgesia/hormonal treatment does not work - refer to secondary care.
What can be used as secondary treatment?
GnRH analogues (goserelin) Used short term <6m with add-back HRT to induce a pseudo menopause due to low oestrogen levels (Goserelin can be used in sub fertility patients prior to IVF to increase success rates
GnRH is normally released in pulsatile fashion however when produced continuously it inhibits the pituitary-gonadal axis, lowering levels of oestrogen
What is surgical management for endometriosis?
Indicated once medical treatment has failed
Laparoscopy using ablation, excision or coagulation ot destroy endometriosis
Nodules should should be excised and endometriosis removed rather than drained.
Laser treatment of endometriosis ovarian cysts may improve fertility
Hysterectomy is last resort
What are features of adenomyosis? What is management?
Features:
Dysmenorhoea
Menorrhagia
Enlarged, boggy uterus
Mx:
GnRH agonists ( goserelin)
Hysterectomy
