Endometriosis (Complete) Flashcards
Define endometriosis
Condition characterised by growth of endometrial tissue outside the uterine cavity
What is the epidemiology of endometriosis?
Affects around 10% of woman in their reproductive years
What is the pathophysiology of endometriosis?
Unknown but theories include:
Retrograde menstruation
Coelom is metaplasia
Lymphatic or vascular dissemination of endometrial cells.
What are the main signs and symptoms of endometriosis? (Not complete)
Presentations are typically cyclical:
Secondary dysmenorrhea (pain often starts days before bleeding)
Deep dyspareunia (deep pain during or after sexual intercourse)
Subfertility (30-50% of women)
Cyclical GI symptoms:
* Pain during defecation
* Rectal bleeding
* Painful bowel movements
Cyclical urinary symptoms:
* Dysuria (Pain passing urine)
* Haematuria
Chronic pelvic pain (lasting more than 6 months)
What findings on examination may be seen in patients with endometriosis?
Tender modular masses on ovaries or ligaments surrounding uterus
What differential diagnoses should be considered alongside endometriosis?
Primary dysmenorrhea
Uterine conditions (e.g. fibroids)
Adhesions: pelvic pain and bowel obstruction
Pelvic inflammatory disease
How does endometriosis differ from primary dysmenorrhea?
Pelvic pain in endometriosis can occur days before onset of menses whereas in primary dysmenorrhea pain presents on onset.
Primary dysmenorrhea would have no identifiable pelvic pathology on examination
How does endometriosis differ to other uterine conditions (e.g. fibroids)
Fibroids associated with heavy menstrual bleeding
Fibroid less likely to have cyclical presentations and can be constant
Fibroid symptoms more likely to be localised
What differentials should be considered for woman presenting with GI symptoms
Adhesions
How does adhesions differ to endometriosis?
Could present with possible bowel obstruction
How does endometriosis differ to pelvic inflammatory disease?
Pain:
Endometriosis: Cyclical
PID: Acute or subacute with signs of infection
Associated symptoms:
PID: Recent STI history, fever, abnormal discharge
What investigations should be considered in patients with endometriosis?
Bloods:
Ca-125: Can be elevated in endometriosis but normal levels doesnt exclude diagnosis
Imaging:
Tranvaginal US: First-line
Diagnostic laprascopy: Gold-standard
What findings on transvaginal US are suggestive of endometriosis?
Typically normal however may be able to identify an ovarian endometrioma (aka chocalate cyst)
N.B. Is a cyst made of endometrial tissue in ovary
What is gold-standard investigation for endometriosis?
Diagnostic lapraoscopy
Why is diagnostic laproscopy not considered first-line?
Carries small risk of complications (e.g. bowel perforation)
