Endometriosis

Question 1

A 36 year old woman presents to her GP as she is worried about her failure to become pregnant. She and her husband have been trying for a baby for approximately 18 months with no success. Your initial history, examination and investigations lead you to suspect endometriosis in the woman as a cause of the infertility.

a. Suggest 2 other symptoms that might be suggestive of endometriosis (2)

Answer 1

DDDD:

1. Dysmenorrhoea (2˚)
2. Dyspareunia
3. Dyschezia (difficulty defecating)
4. DAMN THAT HURTS – Chronic Pelvic Pain

Question 2

b. Name 1 treatment option available for mild/moderate endometriosis, which will increase increase the chances of conception. (1)

Answer 2

1. Controlled ovarian hyper-stimulation e.g. Clomiphene therapy
2. *Surgical rx of endometrial lesions (coagulation, diathermy, laser ablation) and removal of endometriomas

Question 3

c. List 2 features you would find on biopsy of endometriosis. (2)

Answer 3

1. Endometrial glands
2. Endometrial stroma
3. Evidence of haemorrhage
4. Scarring or fibroids
5. Haemosiderin-Laden macrophages

Question 4

d. List 2 other causes of blockages of the Fallopian tubes apart from Endometriosis. (3)

Answer 4

1. Hydrosalpinx (fluid blockage 2˚ to chlamydia)
2. PID or previous ectopic causing adhesion

Question 5

e. In vitro fertilisation is proposed for the patient. List 3 issues that should be discussed with the couple before a decision is made. (3)

Answer 5

1. Success rate
2. Alternatives e.g. adoption
3. Consent to use fertilised ovum if relationship breaks up
4. Decision subject to psychological assessment and age
5. Limited attempts on NHS (2005 NICE guidelines state “up to 3 cycles” if couples deemed suitable)