Endometriosis and Chronic Pelvic Pain Flashcards
What is endometriosis?
Growth of endometrium outside of the uterus
Oestrogen dependent therefore regresses after monopause and during pregnancy
Inflammation with progressive fibrosis and adhesions
Where does endometriosis commonly affect?
Uterosacral ligaments Ovaries Pouch of Douglas Umbilicus Abdominal wound scars Vagina Bladder Rectum Lungs
What is an endometrioma?
Accumulated altered dark brown blood -chocolate cyst
Covered in thick white capsule
Adhesions on tubes
Can rupture causing peritonitis
What causes endometriosis?
Retrograde menstruation, lymphatic, blood bourne?
?Genetic
How does endometriosis present?
Chronic pelvic pain - cyclical, worse on movement Dysmenorrhoea Deep dyspareunia Subfertility Acute pain when chocolate cyst ruptures
Bladder and bowel symptoms (dyschizia)
How is endometriosis diagnosed?
Rule out UTI and STI
Laparoscopy + biopsy
- red vesicles are active
- white scars or brown spots are less active
Transvaginal USS excludes ovarian endometrioma and presence of adenomyosis
What is the medical management of endometriosis?
50% regress
NSAIDS + paracetamol + opiates
COCP - back to back
Progestogen - cyclical or continuous or IUS
GnRH analogues - induce temporary menopause (+ HRT to use for >6 month)
Danazol/gestrinone - androgenic effects (severe SE)
What is the surgical treatment of endometriosis?
Scissors, laser or bipolar diathermy at time of laparoscopic diagnosis
Dissection of adhesions, removal of ovarian endometriomas cysts
Hysterectomy with BSO
What is chronic pelvic pain?
Intermittent or constant pain in lower abdomen or pelvis of at least 6 months
What are causes of pelvic pain?
Endometriosis Adenomyosis PID Adhesions - esp if ovarian tissue is trapped IBS Constipation Interstitial cystitis Depression Sleep disorder
How is chronic pelvic pain managed?
Dietary change and antispasmodics
COCP or GnRH+HRT for cyclical pain
