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Obs and Gynae > Endometriosis > Flashcards

Endometriosis Flashcards

1
Q

What is endometriosis?

A

The presence and growth of tissue similar to endometrium (endometrial tissue) outside of the uterus

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2
Q

What percentage of women are diagnosed with endometriosis?

A

1-2%

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3
Q

Most common age of endometriosis?

A

30 to 45

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4
Q

Who is endometriosis more common in (parity wise)

A

Nulliparous women

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5
Q

What hormone does endometrium depend on?

A

Oestrogen

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6
Q

What happens to endometriosis after the menopause and why?

A

It regresses as the endometrium regresses without oestrogen

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7
Q

Where can endometriosis occur?

A
  1. Uterosacral ligaments
  2. Ovaries
  3. Umbilicus
  4. Abdominal wound scars
  5. Vagina
  6. Bladder
  7. Rectum
  8. Lungs
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8
Q

What are ‘chocolate cysts’?

A

Accumulated altered blood (from the endometrium) that is dark brown

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9
Q

What are endometrioma?

A

Pools of accumulated blood from the endometrium that pools in the ovaries

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10
Q

What is the progression of endometriosis?

A

Endometriosis causes inflammation, with progressive fibrosis and adhesions

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11
Q

What is a ‘frozen’ pelvis?

A

When the entire pelvis is ‘frozen’, the pelvic organs rendered immobile by adhesions

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12
Q

What causes endometriosis?

A

Retrograde menstruation (more distant foci may result from mechanical, lymphatic or blood-bourne spread)

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13
Q

Sx of endometriosis?

A
  1. Chronic pelvic pain
  2. Cyclical pain
  3. Dysmenorrhoea before the onset of menstruation
  4. Deep dyspareunia
  5. Subfertility
  6. Dyschezia (pain on passing stools) during menses
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14
Q

Examination signs of endometriosis?

A
  1. Vaginal tenderness
  2. Thickening behind the uterus or adnexa
  3. Retroverted, immobile uterus
  4. May feel normally if mild endometriosis
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15
Q

Ix that should be done in endometriosis?

A
  1. Laparoscopy

2. Transvaginal US

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16
Q

What is the only way to diagnose endometriosis?

A

Laparoscopy on visualisation and/or biopsy

17
Q

Why is transvaginal USS done?

A

To make and exclude the diagnosis of ovarian endometrioma. Also can check for adenomyosis as differential

18
Q

Differential diagnosis of endometriosis?

A
  1. Adenomyosis
  2. Chronic PID
  3. Chronic pelvic pain
  4. Other causes of pelvic masses
  5. IBS
19
Q

In what percentage of women does endometriosis regress and not progress?

A

> 50%

20
Q

Medical Tx of endometriosis?

A
  1. NSAIDs for pain
  2. The combined oral contraceptive pill
  3. Progestogen preparations
  4. Intrauterine system (IUS)
  5. GnRH analogues
21
Q

Who is the COC not suitable for?

A

Older women and/or smokers

22
Q

How is COC taken for endometriosis Tx?

A

Back-to-back or ‘tricycling’ regime where two or three pill packets are taken without a break to reduce the frequency of painful withdrawal bleeds

23
Q

How do GnRH analogues work?

A

By inducing a temporary menopausal state; overregulation of the pituitary leads to downregulation of its GnRH receptors. As such, pituitary gonadoptrophin and therefore ovarian hormone production are inhibited

24
Q

Side effects of GnRH analogues?

A

Mimic the menopause;

1. Reversible bone demineralisation

25
Q

How long is GnRH analogue therapy limited to?

A

6 months, but can be used for up to 2 years or more using ‘add-back’ hormone replacement therapy (HRT) which prevents bone loss and reduces menopausal side effects

26
Q

Surgical Tx for endometriosis?

A
  1. Laparoscopic laser ablation / diathermy / scissors and/or adhesiolysis
  2. Hysteroscopy and bilateral salpingo-oophorectomy
27
Q

How many laproscopies for Ix of subfertility find endometriosis?

A

25%

28
Q

What is the relationship between endometriosis and subfertility?

A

More severe endometriosis = greater chance of subfertility

Obs and Gynae (19 decks)

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