endometriosis

Question 1

what is endometriosis?

Answer 1

a common condition characterised by the growth of ectopic endometrial tissue outside of the uterine cavity

Question 2

what are the clinical features of endometriosis?

Answer 2

• chronic pelvic pain
• dysmenorrhoea (pain starts days before bleeding)
• deep dyspareunia
• subfertility
• non-gynaecological: urinary sx, dyschezia (painful bowel movements)

Question 3

what can be seen on pelvic examination for endometriosis?

Answer 3

• reduced organ mobility
• tender nodularity in posterior vaginal fornix
• visible vaginal endometriotic lesions

Question 4

what are the investigations for endometriosis?

Answer 4

gold-standard: laparoscopy

Question 5

how is endometriosis managed?

Answer 5

depends on clinical features

1st line: NSAIDs +/- paracetamol for symptomatic relief

if analgesia doesn’t help, try hormonal rx: COCP e.g. medroxyprogesterone acetate

Question 6

when should a pt with endometriosis be referred to 2˚care?

Answer 6

if analgesia/hormonal rx doesn’t improve sx or if fertility is a priority

Question 7

what would 2˚ rxs for endometriosis include?

Answer 7

• GnRH analogues

- surgery: laparoscopic excision and laser rx of endometriotic ovarian cysts may improve fertility