Endometriosis and Dysmenorrhoea

Question 1

What are the types of dysmenorrhoea

Answer 1

Primary (unknown ? PG release causing uterine ‘angina’

Secondary (endometriosis, adenomyosis, mass lesion in cavity e.g. polyp or fibroid)

Question 2

Types of dyspareunia and DDx

Answer 2

Superficial (thrush, skin condition, vestibulodynia)
Deep (endo/adeno, adhesions, ovarian cyst)
Midway (pelvic floor spasm)

Question 3

Common presentations of Endometriosis

Answer 3

-Cyclical Pain worse during period
-Provoked pain
-Infertility (1/3 of patients)
-Incidental finding
(SYMPTOMS DO NOT CORRELATE W DISEASE BURDEN)

Question 4

Signs of endometriosis

Answer 4

• lower abdo tenderness
• PV tenderness on examination, esp. lateral fornicies and Pouch of Douglass
• ‘fixed’ uterus
• palpable nodules or adnexal masses (endometrioma)

Question 5

Diagnosis of endometriosis

Answer 5

60-70% is clinical
Ultrasound
MRI (poor)
Laparoscopy is gold standard (visualise and histo)

Question 6

Treatment options for endometriosis

Answer 6

• Do nothing
• Analgesia (NSAIDs, no narcotics!)
• OCP/progestins/IUD
• GnRH analogues
• Surgical (ablate/excise - 80% improve)

Question 7

Management of infertility in endometriosis

Answer 7

Exclude other causes of infertility
Surgery (remove lesions larger than 3cm and any hydrosalpinges)
Early IVF

Question 8

What is the most common site of endometriosis?

Answer 8

Pouch of Douglass