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A - MSRA Gynaecology > Endometriosis > Flashcards

Endometriosis Flashcards

1
Q

What is endometriosis?

A

A chronic oestrogen dependant condition characterised by the growth of endometrial tissue in sites other than the uterine cavity

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2
Q

What sites are most commonly involved in endometriosis?

A
  • Pelvic cavity
  • Uterosacral ligaments
  • Pouch of Douglas
  • Rectosigmoid colon
  • Bladder or distal ureter
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3
Q

What other sites are more rarely involved in endometriosis?

A
  • Umbilicus
  • Scar sites
  • Pleura
  • Pericardium
  • CNS
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4
Q

What is the prevalence of endometriosis?

A

Estimated to effect 10-15% of women of reproductive age

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5
Q

Why is it difficult to determine the prevalence of endometriosis?

A
  • Because of diversity of symptoms and their severity

- Endometriosis may be asymptomatic

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6
Q

Who does endometriosis have a higher prevalence in?

A

Infertile women

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7
Q

What is the prevalence of endometriosis in infertile women?

A

25-40%

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8
Q

In what age group is endometriosis found in?

A

Almost exclusively in women of childbearing age

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9
Q

At what age does the diagnosis of endometriosis most commonly occur?

A

30’s

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10
Q

What are the risk factors for endometriosis?

A
  • Early menarche
  • Late menopause
  • Delayed childbearing
  • Short menstrual cycles
  • Long duration of menstrual flow
  • Obstruction to vaginal outflow
  • Genetic factors
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11
Q

What can cause obstruction to vaginal outflow?

A
  • Hydrocolpos
  • Female genital mutilation
  • Defects in uterus or Fallopian tubes
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12
Q

What indicates that there are genetic factors involved in endometriosis?

A

The risk of endometriosis in first-degree relatives with severe endometriosis is 6x that of relatives of unaffected women

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13
Q

What factors are protective against endometriosis?

A
  • Multiparity

- Use of oral contraceptives

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14
Q

What are the main symptoms of endometriosis?

A
  • Dysmenorrhoea
  • Dyspareunia
  • Cyclic or chronic pelvic pain
  • Subfertility
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15
Q

What other symptoms may be present in endometriosis?

A
  • Bloating
  • Lethargy
  • Constipation
  • Low back pain
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16
Q

What are the less common symptoms of endometriosis?

A
  • Cyclical rectal bleeding
  • Menorrhagia
  • Diarrhoea
  • Haematuria
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17
Q

How does the clinical presentation of endometriosis vary?

A

Some women experience severe symptoms, whereas some women have no symptoms at all

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18
Q

What happens to the severity of symptoms of endometriosis with age?

A

Tends to increase

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19
Q

Can endometriosis be asymptomatic?

A

Yes

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20
Q

How might endometriosis be detected if the patient is asymptomatic?

A

Diagnosed incidentally or during investigations for infertility

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21
Q

What proportion of women with infertility have endometriosis?

A

1/3

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22
Q

What % of women with endometriosis are infertile?

A

40%

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23
Q

How does endometriosis cause infertility?

A

Exact mechanism is unknown, but possible mechanisms include;

  • Anatomical distortions and adhesions
  • Release of factors from endometriotic cysts which are detrimental to gametes or embryos
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24
Q

What is often found on examination in endometriosis?

A

Examination is normal

25
Q

What findings, if any, might there be on examination in endometriosis?

A
  • Posterior fornix or adnexal tenderness
  • Palpable nodules in the posterior fornix or adnexal masses
  • Bluish haemorrhagic nodules visible in posterior fornix
26
Q

What are the differential diagnoses of endometriosis?

A
  • Pelvic inflammatory disease
  • Ectopic pregnancy
  • Torsion of ovarian cyst
  • Appendicitis
  • Primary dysmenorrhoea
  • Irritable bowel syndrome
  • Uterine fibroids
  • Urinary tract infection
27
Q

What is the gold standard for investigation for most forms of endometriosis?

A

Laparoscopy

28
Q

What is the problem with laparoscopy in the diagnosis of endometriosis?

A

Invasive with small risk of major complications

29
Q

Give a complication of laparoscopy

A

Bowel perforation

30
Q

What other investigations may be performed in endometriosis?

A
  • MRI scan

- Transvaginal ultrasound

31
Q

When might MRI scan be useful in endometriosis?

A

In non-invasive diagnosis, especially for sub-peritoneal deposits

32
Q

Why do investigations need to be done in an acute setting of endometriosis?

A

To exclude important differentials

33
Q

What investigations are performed to rule out differentials in acute endometriosis?

A
  • Blood tests
  • Urinalysis
  • Cervical swabs
  • ß-hCG
34
Q

Is there a cure for endometriosis?

A

No

35
Q

What are the types of intervention for endometriosis?

A
  • Treatment of pain

- Treatment of endometriosis-associated infertility

36
Q

What will abate the process of endometriosis in many women?

A

Menopause - natural or surgical

37
Q

What is the goal of management of endometriosis in women in reproductive years?

A
  • Provide pain relief
  • Restrict progression of the process
  • Restore or preserve fertility where needed
38
Q

In what % of patients does medical treatment reduce the symptoms of endometriosis?

A

80-90%

39
Q

Which of the treatment options for endometriosis have been shown to reduce the recurrence of symptoms once treatment has stopped?

A

None of them

40
Q

What might the management of endometriosis involve?

A
  • Suppression of ovarian function for at least 6 months
  • Surgical options
  • Pain management
  • Fertility management
41
Q

What is the basis for most medical treatment of endometriosis?

A

Suppression of ovarian function

42
Q

What are the options for the suppression of ovarian function?

A
  • COCP
  • Medroxyprogesterone acetate
  • GnRH agonist
43
Q

Does hormonal treatment improve fertility in endometriosis?

A

No

44
Q

What are the surgical options for the management of endometriosis?

A
  • Laparoscopy
  • Stripping of endometriomatas
  • Hysterectomy with salpingo-oophrectomy
45
Q

What management can be performed for endometriosis at the time of diagnostic laparoscopy?

A

Laparoscopic excision or ablation

46
Q

What are the main conservative surgical techniques for endometriosis performed by laparoscopy?

A
  • Thermal or laser ablation
  • Excision
  • Ovarian cystectomy
  • Denervation procedures
47
Q

What are endometriomatas?

A

Large cysts or endometriosis

48
Q

What is hysterectomy with salpingo-oophrectomy reserved for in endometriosis/

A

Last resort

49
Q

What is the general principle for the management of pain in endometriosis?

A

Create a pseudo-pregnancy or pseudo-menopause

50
Q

How is a pseudo-pregnancy/menopause achieved in endometriosis?

A

Suppression of ovarian function

51
Q

What analgesics are commonly used for reducing pain in endometriosis?

A

NSAIDs, e.g. naproxen, or paracetamol with or without codeine

52
Q

Is medical or surgical management more effective for addressing infertility associated with endometriosis?

A

Surgery

53
Q

What form of surgical management is effective for addressing infertility associated with endometriosis?

A

Attempts to remove endometrial tissue and preserve the ovaries without damaging normal tissue

54
Q

What is an appropriate treatment for infertility related to endometriosis?

A

IVF

55
Q

When in particular is IVF an appropriate treatment for infertility associated with endometriosis?

A

If there are co-existing causes of infertility and/or other treatments have failed

56
Q

What are the complications of endometriosis?

A
  • Fertility problems
  • Adhesions
  • Ovarian cysts
  • Increased risk of ovarian cancer
57
Q

How can moderate-to-severe endometriosis lead to infertility?

A

Can cause tubal damage leading to infertility

58
Q

What are lesser degrees of endometriosis associated with, with regard to fertility?

A

Sub-fertility and increased risk of ectopic pregnancy, even in absence of obvious tubal damage

59
Q

What can adhesions lead to in endometriosis?

A

Bowel and ureter obstruction

A - MSRA Gynaecology (52 decks)

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