Endometriosis Flashcards
What is endometriosis?
presence of endometrium outside the uterus
What hormone is it driven by/>
oestrogen
What group of women does it tend to affect
reproductive age
Where is infiltration commonly found
pouch of douglas and uterosacral ligaments
when does it regress
after the menopause and during pregnancy
What other areas of the body can it affect?
umbilicus abode wound scars vagina bladder rectum lungs
what is the main theory of how it occurs?
Retrograde menstruation - menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity which leads to adherence, invasion and growth of tissue, those who are genetically predisposed are the ones who get it
What are the other two theories?
- Metaplasia of mesothelial cells
2. Impaired immunity means that retrograde menstruation endometrial cells fail to be destroyed by the immune response
What is the presentation
- can be asymptomatic
- pain - cyclical due to endometrial tissue responding to cycle formation of adhesions from chronic inflammation
- severe dysmenorrhoea before onset of menstrual cycle, deep - dyspareunia, dysuria, dyschezia
subfertility
What is found on examination?
May be normal if minimal disease
• Speculum - may show visible lesions in the vagina or cervix - rare and sign of deep infiltrating endometriosis
On bimanual vaginal examination - a fixed retroverted uterus is a classic sign due to adhesions
There may be adnexal masses or tenderness and tender nodules palpable over the uterosacral ligaments
What is gold standard ix?
laparoscopy w biopsy
Active lesions look like red vesicles or punctate marks on peritoneum w
Less active look like white scars or brown spots
what are other ix?
TVS - ovarian endometriosis cysts
CA125 may be raised
MRI - if bowel involvement
what are DDs?
→ PID
→ Ectopic pregnancy
→ Fibroids
→ IBS
In how many does the disease regress or not progress?
50%
what is the principle of medical treatment?
take away oestrogen
give progesterone to antagonise oestrogen
