Endometriosis

Question 1

Endometriosis Definition

Answer 1

Chronic oestrogen dependent condition characterised by the growth of endometrial tissue in sites other than the uterine cavity most commonly the pelvic cavity, uterosacral ligaments, pouch of Douglas, colon, bladder, ureter

Question 2

Endometriosis Epidemiology

Answer 2

• 10-15% of women

- Almost exclusively in women of reproductive age, uncommon under 20

Question 3

Endometriosis RFs

Answer 3

• Early menarche, late menopause, short menstrual cycles
• Obstruction to vaginal outflow (FGM, defects, hydrocolpos)
• Genetic factors; FHx

Question 4

Endometriosis Aetiology

Answer 4

• Genetic
• Immune factors (cannot fight it off)
• Retrograde flow deposits tissue e.g. in Fallopian tube, obstructive defects

Question 5

Endometriosis Presentation

Answer 5

• Cyclical pelvic pain is most common presentation
• Dyspareunia
• Subfertility
• Bloating, lethargy, constipation, low back pain
• Examination often normal

Question 6

Endometriosis Differentials

Answer 6

PID, ectopic, torsion, appendicitis, IBS, fibroids

Question 7

Endometriosis Ix

Answer 7

• Transvaginal USS is useful
• Laparoscopy is gold standard, use if still suspicion but USS unclear
• MRI can be useful should not be used a primary investigation

Question 8

Endometriosis Management

Answer 8

• Individually based
• Suppression of ovarian function for at least six months using COCP, lesions may atrophy
• Surgical ablation if severe
• Pain management (NSAIDS, paracetamol)
• Avoid treatment for women who are trying to conceive

Question 9

Endometriosis Complications

Answer 9

-Increased risk of cancer, autoimmune disorders, atopic disorders, infertility, IBD