Endometriosis and Adenomyosis Flashcards
What is Adenomyosis?
Definition – functional endometrial tissue in the myometrium
What are the risk factors for Adenomyosis?
Pregnancy and childbirth – high parity C-Section Uterine surgery Surgical management of miscarriage Family history
How does Adenomyosis present?
Menorrhagia
Dysmenorrhoea
Deep dyspareunia
Irregular bleeding
Present with fibroids
On Histology – adenomyomas – collection of endometrial glands clearly visible
Symmetrically enlarge uterus
What differentials should be considered when making a diagnosis of adenomyosis
Endometriosis Endometrial cancer/hyperplasia Polyps PID Hypothyroidism Coagulation disorders
How should adenomyosis be investigated for and managed?
Gold standard is hysteroscopy and biopsy
TVUSS
MRI can sometime illicit signs
NSAIDs
Hormone contraceptive
Uterine artery embolization is a possibility
Only cure is hysterectomy
What is the definition of endometriosis
Abnormal growth of endometrium outside of the uterus, most commonly seen on the ovaries, fallopian tubes and around the external tissues of the uterus.
What causes endometriosis?
Uncertain but most widely accepted theory is retrograde menstruation. Some suggest it could be travel through the lymphatic system.
What are the risk factors for endometriosis?
Early Menarche and late menopause Nullparity Family History of Endometriosis Longer duration of bleeding ( > 7 Days) - Short Menstrual Cycles
How does endometriosis usually present?
Pelvic pain - symptoms are cyclical May be constant pain due to adhesions Dysmenorrhoea Subfertility Dyspareunia Dysuria Diarrhoea or constipation Dyschezia – painful defecation Nausea and vomiting If in Lungs then features of a haemothorax
What differentials do we need to rule out when suspecting endometriosis and how should suspected endometriosis be investigated?
Want to rule out: PID, ectopic pregnancy, fibroids and IBS
Bimanual examination – adnexal masses, tenderness and a fixed retroverted uterus
Speculum examination
USS
Laparoscopy – looking for chocolate cysts, adhesions and peritoneal deposits. This shouldn’t be performed until 3 months after hormonal treatment. Indications include: NSAID resistant, pain affecting daily living and infertility.
What is the staging system for endometriosis?
Endometriosis is staged 1-4 in severity Stage 1 (Minimal) – superficial lesions Stage 2 (Mild) – additional deep lesions Stage 3 (Moderate) – endometriomas on the ovary and more adhesions Stage 4 (Severe) – large endometriomas and extensive adhesions
How is endometriosis managed?
Pain management with NSAIDs or stronger
Suppression of ovulation to cause atrophy of the endometrium i.e. combined contraceptive or 6-month GnRH analogue
Progesterone contraceptives – usually progesterone tricycled
Surgery – laser ablation, hysterectomy
What are the complications from endometriosis?
Scaring and adhesions
Cysts of the ovaries and pelvic cavity
Pregnancy complications
If endometrial tissue spread to the lungs this can cause recurrent pneumothoraces called catamenia pneumothorax.
