Endometriosis Flashcards
What is endometriosis?
The presence and growth of tissue similar to endometrium (endometrial tissue) outside of the uterus
What percentage of women are diagnosed with endometriosis?
1-2%
Most common age of endometriosis?
30 to 45
Who is endometriosis more common in (parity wise)
Nulliparous women
What hormone does endometrium depend on?
Oestrogen
What happens to endometriosis after the menopause and why?
It regresses as the endometrium regresses without oestrogen
Where can endometriosis occur?
- Uterosacral ligaments
- Ovaries
- Umbilicus
- Abdominal wound scars
- Vagina
- Bladder
- Rectum
- Lungs
What are ‘chocolate cysts’?
Accumulated altered blood (from the endometrium) that is dark brown
What are endometrioma?
Pools of accumulated blood from the endometrium that pools in the ovaries
What is the progression of endometriosis?
Endometriosis causes inflammation, with progressive fibrosis and adhesions
What is a ‘frozen’ pelvis?
When the entire pelvis is ‘frozen’, the pelvic organs rendered immobile by adhesions
What causes endometriosis?
Retrograde menstruation (more distant foci may result from mechanical, lymphatic or blood-bourne spread)
Sx of endometriosis?
- Chronic pelvic pain
- Cyclical pain
- Dysmenorrhoea before the onset of menstruation
- Deep dyspareunia
- Subfertility
- Dyschezia (pain on passing stools) during menses
Examination signs of endometriosis?
- Vaginal tenderness
- Thickening behind the uterus or adnexa
- Retroverted, immobile uterus
- May feel normally if mild endometriosis
Ix that should be done in endometriosis?
- Laparoscopy
2. Transvaginal US
What is the only way to diagnose endometriosis?
Laparoscopy on visualisation and/or biopsy
Why is transvaginal USS done?
To make and exclude the diagnosis of ovarian endometrioma. Also can check for adenomyosis as differential
Differential diagnosis of endometriosis?
- Adenomyosis
- Chronic PID
- Chronic pelvic pain
- Other causes of pelvic masses
- IBS
In what percentage of women does endometriosis regress and not progress?
> 50%
Medical Tx of endometriosis?
- NSAIDs for pain
- The combined oral contraceptive pill
- Progestogen preparations
- Intrauterine system (IUS)
- GnRH analogues
Who is the COC not suitable for?
Older women and/or smokers
How is COC taken for endometriosis Tx?
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
How do GnRH analogues work?
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
Side effects of GnRH analogues?
Mimic the menopause;
1. Reversible bone demineralisation
How long is GnRH analogue therapy limited to?
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
Surgical Tx for endometriosis?
- Laparoscopic laser ablation / diathermy / scissors and/or adhesiolysis
- Hysteroscopy and bilateral salpingo-oophorectomy
How many laproscopies for Ix of subfertility find endometriosis?
25%
What is the relationship between endometriosis and subfertility?
More severe endometriosis = greater chance of subfertility
