Endometriosis

Question 1

What is endometriosis?

Answer 1

Implantation of endometrial tissue outside the uterus

Question 2

What is the epidemiology of endometriosis?

Answer 2

20-40 years

Asian and Caucasian women

Question 3

What are the risk factors of endometriosis?

Answer 3

Unknown, thought to be:
Retrograde mentration
Coelomic metaplasia
Iatrogenic implantation following surgery
Hematogenic and lymphogenic dissemination of endometrial cells

Question 4

Where are the common site of endometriosis?

Answer 4

Ovaries, fallopian tubes, cervix or less commonly, the extrapelvic organs

Question 5

What are the clinical features of endometriosis?

Answer 5

1/3 asymptomatic
chronic pelvic pain
dysmenorrhea
pre/post menstrual bleeding

Question 6

How is endometriosis diagnosed?

Answer 6

Clinical features
Physical examination (rectovaginal tenderness, adnexal mass)
Transvaginal ultrasound (non-enlarged uterus, chocolate cyst)
Laparoscopy (confirmatory test)

Question 7

What are the differential diagnosis of endometriosis?

Answer 7

Fibroids

Question 8

What is the treatment of endometriosis?

Answer 8

Medical/Surgical
Medical: (Mild) NSAIDs + hormonal contraceptives (oestrogen-progesterone or progesterone only
Only NSAIDs if pregnancy desired
(Severe) GnRH agonist
Surgical: (1st) Laparoscopic excision and ablation
(2nd) Open surgery with hysterectomy with/without salphingo-oophorectomy

Question 9

What are some of the complications of endometriosis?

Answer 9

Anemia
Endometrial adhesions
Gastrointestinal obstruction, constipation, intussusception