Endometriosis & Dysmenorrhoea

Question 1

list three to four common presenting symptoms each for endometriosis and adenomyosis

Answer 1

Endometriosis / Adenomyosis

• Cyclical Pain: dysmenorrhoea, dyschezia, pain with urination (at time of period)
• Provoked Pain: dyspareunia, pain with tampons & on PV exam

Endometriosis

• Infertility
• Bowel/bladder: diarrhoea, constipation, haematuria, bloody stools

Adenomyosis
- Bleeding: menorrhagia more with Adenomyosis

Question 2

explain the roles of investigations/tests used to diagnose endometriosis and adenomyosis

Answer 2

Endometriosis

• US
• MRI (cost, not as accurate)
• Laparoscopy: Gold standard - look for endometriosis around uterosacral ligament, Pouch of Douglas, ovaries

Adenomyosis

• US
• definitive dx needs histopathology requiring hysterectomy

Question 3

describe the medical and surgical treatments that are currently available and the impact of desire for pregnancy on these choices

Answer 3

Medical

• Drugs: OCP, Progestin, Mirena, Implanon, GnRH-analogues (suppress oest)
• NSAID’s

Surgical

• ablation of endometrial tissue
• radical surgery: hysterectomy/myomectomy in women no longer wanting children

Treatment considerations

• consider reason for tx (syx relief or cure dx)
• family planning: still need fertility? fertility planning early, considerations IVF
• empower pt with all tx options (including no tx as option)