Endometriosis and chronic pain Flashcards
What is endometriosis?
Presence and growth of endometrial tissue outside the uterus.
What affects growth of endometriosis?
Oestrogen, hence relief during pregnancy and after the menopause.
What is the aetiology of endometriosis?
Most likely due to retrograde menstruation, or mechanical / lymphatic / blood spread to distant areas.
How does endometriosis present?
Cyclical pelvic pain: dysmenorrhoea before menstruation, deep dyspareunia, subfertility, pain on passing stool during menses.
Ruptured chocolate cyst may present with acute pain.
Severe disease suggested by cyclical haematuria, rectal bleeding or bleeding from the umbilicus.
How would you investigate endometriosis?
Laparoscopy, +- biopsy. Need to visualise to diagnose. If extensive disease, may need MRI.
How would you medically treat endometriosis?
Asymptomatic: no treatment required. Unless endometrioma seen - then removal.
Analgesia (NSAIDs +- paracetamol / opiates), suppress oestrogen (COCP, progestogens, or GnRH analogues).
COCP - take 3 packs back to back then break.
Progestogens used cyclically. S/E fluid retention, weight gain, erratic bleeding, PMS.
GnRH S/E menopause.
How would you surgically treat endometriosis?
Laparoscopy and destruction of ectopic endometrial tissue.
What are the possible cause of chronic pelvic pain?
Cyclical pain: endometriosis, adenomyosis, adhesions (esp if trapping ovaries).
Postmenopausal: malignancy.
Other: IBS, interstitial cystitis.
Psych: depression, sleep disorders, abuse.
How do you treat chronic pelvic pain?
If ?IBS - dietary +- antispasmodics.
Analgesia.
COCP / GnRH + add back HRT for 6m.
Diagnostic laparoscopy if unresolved.
