Endometriosis

Question 1

Define endometriosis

Answer 1

Presence and growth of tissue similar to the endometrium outside the uterus

Question 2

Prime age for endometriosis

Answer 2

30-45

Question 3

Pathology of endometriosis

Answer 3

Oestrogen dependent growth according to the cycle occurring in tissue present in uterosacral ligaments, on or behind ovaries,, umbilicus, surgical scars etc. endometriosis causes inflammation with progressive fibrosis.

Question 4

Aetiology of endometriosis

Answer 4

Retrograde menstruration or distantly- mechanical, lymphatic or blood borne spread. Some genetic predisposition.

Question 5

Symptoms of endometriosis

Answer 5

Cyclical chronic pelvic pain, dysmenorrhea BEFORE mesuration, deep dyspareunia, subfertility and painful defecation during menses. Cyclical umbilical, rectal bleed or haematuria.

Question 6

Examination findings of endometriosis

Answer 6

Tenderness/thickening behind uterus/adnexa
Retroverted/immobile uterus due to adhesions
Rectovaginal nodule of endometriosis on PR

Question 7

Investigation for suspected endometriosis

Answer 7

Exploratory laparoscopy +/- biopsy

Question 8

Investigation for suspected ovarian endometrioma

Answer 8

TVS

Question 9

Investigation for suspeccted deeply infiltrated endometriosis

Answer 9

MRI +/- IVP and barium studies

Question 10

Management of endometriosis

Answer 10

Medical: Analgesia, COCP, Progestages, GnRH analogues +/- HRT, IUS
Surgical- Lap laser ablation/diathermy/ Scissors +/- adhesiolysis, Hysterectomy and BSO

Question 11

chronic pelvic pain is defined as

Answer 11

Intermittent or constant pain in lower abdoment for 6 months not occuring exclusively with meses/intercourse

Question 12

Differentials for chronic pelvic pain

Answer 12

Endometriosis/adenomyosis- cyclical
Gynae/pelvic adhesions- pain?
Ovarian tissue trapped in adhesions- cyclial pain
IBS
Interstitial cystitis
Psychological factors- sleep disorders, depression abuse
Pelvic congestion syndrome- venous congestion in pelvis
Myofascial syndrome- muscle trigger points/trapped nerves.

Question 13

Management of chronic pelvic pain

Answer 13

Analgesia
Treat IBS- antispasmodics
COCP/GnRH analogue trial with add back HRT for 3-6 months, diagnostic lap if unresolved
Possible progestogen IUS
Couselling, psychotherapy/sex therapy diet and excercise
Amitryptiline/gabapentin