Endometriosis

Question 1

What is endometriosis?

Answer 1

Presence of endometrial tissue + storm outside the uterus.

Endometriosis is oestrogen dependent.

Question 2

What is the term for the presence of ectopic endometrial tissue in the muscle/myometrium of the uterus?

Answer 2

Adenomyosis

Question 3

What are the 4 theories behind endometriosis?

Answer 3

1. Retrograde menopause
2. Impaired immunity
3. Metaplasia of mesothelial cells
4. Benign metastesis

Question 4

Name four risk factors for endometriosis

Answer 4

1. FH
2. Nulliparity
3. Early menarche
4. Late menopause

Question 5

Name 4 conditions/symptoms that predispose patients to endometriosis

Answer 5

1. Dysmenorrhea
2. Infertility
3. Steriliation
4. Chronic pelvic pain

Question 6

What is the mechanism of infertility in Endometriosis?

Answer 6

1. production of oestrogen via aromatase enzyme blocking ovulation
2. Production of pro-inflammatory proteins causing inflammation and adhesion of reproductive structures

Question 7

Name 6 symptoms patients with endometriosis present with

Answer 7

1. Dysmenorrhea 2. Dyspareunia
2. Dyschazia
3. Chronic pelvic pain
4. Infertility
5. Fatigue

Question 8

How is endometriosis diagnosed?

Answer 8

1. TVS2. MRI

3. Laparoscopy + biopsy (GS)

Question 9

How is endometriosis treated medically?

Answer 9

1. NSAID - pain
2. COCP/POP
3. HRT (post-op): five years.
4. GnRH analogue (post-op) to prevent relapse for 1-2 years
5. Clonidine: alpha blocker for hot flushes
6. Ruloxitine: SERM

Question 10

How is endometriosis treated surgically?

Answer 10

1. Small surgery - excision, ablation and coagulation

2. Hysterectomy (last resort)