Endometriosis and Chronic Pelvic Pain Flashcards
what is the prevalence and peak population of endometriosis?
1-2% and 30-45
what is the pathology of endometriosis?
oestrogen dependent endometrioma growth occuring anywhere in the pelvis - most commonly the ovaries and uterosacral ligaments causing chronic inflammation, pain and progressive fibrosis with adhesions
what is the aetiology of endometriosis
retrograde menstruation
impaired immune system
some genetic component
what are the clinical features of symptomatic endometriosis
chronic cyclical pelvic main dysmenorrhea - starting before menstruation deep dysparenuia (painful sex) subfertility painful passing of stools in menses menstrual issues
rarely there may be: ovarian cyst rupture, cyclical haematuria, rectal bleeding and umbilical bleeding
what do you tend to find on examination in patients with endometriosis
tenderness/thickening of the posterior uterus
immobile uterus in advanced cases
adhesions may be seen if severe
how do you investigate suspected endometriosis
laporoscopy + biopsy
transvaginal USS for exclusion of adenomyoma/ovarian endometrioma
MRI + intravenous pyelogram + barium study for suspected deep invasive endometriosis, looking for ureter/bladder/bowel involvement
how do you manage endometriosis
dont treat if asymptomatic
Medical management: hormonal management (COCP, Progestogens, GnRH, IUS), NSAIDS for pain relief
Surgical: laporoscopic destruction of lesion
radical surgery if advanced (with adhesions)
when treating endometriosis, who shouldnt you give the COCP to
elderly
smokers (or anyone with vascular risk factors/HTN)
what are side effects of progestogens
fluid retention
weight gain
erratic bleeding
PMS
what is examples of progestogens
medroxyprogesterone acetate and norethisterone
in what % of women laporoscopically investigated for subfertility is endometriosis found
25%
what is the definition of chronic pelvic pain
intermittent or constant pain in the lower abdomen or pelvis for >6 months not occuring exclusively with sex or menstruation
what % of adult women have chronic pelvic pain
15%
what are possible causes of chronic pelvic pain
endometriosis adenomyosis IBS interstitial cystitis psychological disorders (large amount of CPP patients have reported sexual abuse)
management of chronic pelvic pain
therapeutic trial of COCP/GNRH analogues (consider progestogens/HRT)
if unresolved diagnostic laporoscopy done
counselling/psychotherapy also effective with some pain management programmes
if no organic cause it is considered a functional disorer and amitryptilline and gabapentic tend to be used
