Endometriosis/meorrhagia/PMS Flashcards
Regarding endometriosis:
a. A score of clinical symptoms should be used to confirm diagnosis
b. Treatment should not be started until histological or imaging diagnosis is confirmed
c. The reliability of clnical examination in detecting pelvic endometriosis reduces during menstruation
d. Vaginal examination has a high sensitivity for the detection of endometriosis
e. Findings of an immobile uterus and adnexal mass on pelvic examination have similar diagnostic accuracy to transvaginal ultrasound
a) They have been attempted, but predictive power is suboptimal. The symptoms most predictive of endometriosis were dysmenorrhea, deep dyspareunia, dysuria, dyschezia, painful rectal bleeding or haematuria, shoulder tip pain, catamenial pneumothorax, cyclical cough/haemoptysis/chest pain, cyclical scar swelling and pain, fatigue, and infertility.
b) Empirical treatment should be considered prior to surgery/ diagnostic confirmation. Patient’s views and preferences should be taken into account
c) It improves
d) It doesn’t. It can perform better for the detection of deep endometriosis in the vagina, uterosacrals etc, but variable
e) Correct - ESHRE
C
Regarding endometriosis
a. Deep endometriosis is defined as affecting >10mm below the serosal/peritoneal surface
b. CA-125 is an unreliable biomarker for superficial endometriosis, but recommended for the detection of stages III/IV endometriosis
c. Pelvic ultrasound has a high sensitivity do detect superficial endometriosis
d. A negative histological examination after laparoscopy can rule out endometriosis
e. Pelvic ultrasound has a good performance in detecting ovarian endometriosis
a. >5mm (ESHRE)
b. CA-125 performs slightly better for stages III and IV, but still not recommended
c. For overall endometriosis, ultrasound has poor performance
d. ESHRE: “The GDG recommends that laparoscopic identification of endometriotic lesions is
confirmed by histology although negative histology does not entirely rule out the
disease. “
e. Correct. “ESHRE: “Overall, these data suggest that transvaginal ultrasound and MRI have a similar or slightly better
specificity and sensitivity than surgery for ovarian and deep endometriosis. When it comes to superficial
disease, these or any other imaging modalities do not seem to have a superior diagnostic value
compared to laparoscopic surgery “
E
Recommendation:
* Clinicians are recommended to use imaging (US or MRI) in the diagnostic work-up for endometriosis, but they need to be aware that a negative finding does not exclude endometriosis, particularly superficial peritoneal disease.
* In patients with negative imaging results or where empirical treatment was unsuccessful or inappropriate, the GDG recommends that clinicians consider offering laparoscopy for the diagnosis and treatment of suspected endometriosis.
* The GDG recommends that laparoscopic identification of endometriotic lesions is confirmed by histology although negative histology does not entirely rule out the disease.
Regarding endometriosis:
a. Diagnostic laparoscopy is superior than empirical treatment in women with no evidence of endometriosis on ultrasound
b. The recurrence rate of endometriosis is reported as 20-50% within 5 years
c. Women with superficial endometriosis should be followed-up yearly; whilst those with deep or ovarian endometriosis should be seen by an appropriate team every six months
d. Continuous use of combine contraceptives for the management of endometriosis symptoms is assocated with a decerase in bone mineral density when compared to cyclical use
a. Both diagnostic laparoscopy and imaging combined with empirical treatment (hormonal contraceptives or progestogens) can be considered in women suspected of endometriosis. There is no evidence of superiority of either approach and pros and cons should be discussed with the patient.
b. Correct (from ESHRE)
c. ESHRE: The appropriate frequency and type of follow-up or monitoring is unknown and should be individualised based on previous and current treatments and severity of the disease and symptoms.
d. It is considered safe. No impact of coagulation, metabolism, bone metabolism or BMD when continuous
b
What is the risk of ovarian failure after bilateral endometrioma removal
a. 12%
b. 15%
c. 7.8%
d. 3.2%
e. 2.4%
E - 2.4%
Regarding the management of endometriomas
a. Cystectomy has a similar impact on endometriosis-associated pain as drainage and coagulation
b. Cystectomy should not be offered to women above the age of 35
c. Cystectomy is the first-line treatment approach, and CO2 vaporisation should be avoided
d. CO2 vaporisation is associated with earlier recurrence of endometriomas
e. Cystectomy is associated with a lower recurrence rate 1 year after treatment in comparison to CO2 vaporisation
a. ESHRE: When performing surgery in women with ovarian endometrioma, clinicians should perform cystectomy instead of drainage and coagulation, as cystectomy reduces recurrence of endometrioma and endometriosis-associated pain.
b. No
c. ESHRE: When performing surgery in women with ovarian endometrioma, clinicians can consider both cystectomy and CO2 laser vaporisation, as both techniques appear to have similar recurrence rates beyond the first year after surgery. Early post-surgical recurrence rates may be lower after cystectomy.
d. True. Although both approaches have the same recurrence rate after one year, recurrence seems to occur earlier with vaporisation
e. Both cystectomy and CO2 vaporisation have similar recurrence rates after 1 year, but recurrence tends to be earlier in CO2 vaporisation
D
A 29-year-old woman with a history of endometriosis is referred to gynea
a. GnRHa for six months
b. Presacral neurectomy
c. Combine oral contraceptive pill
d. Progesterone-only pill
e. Letrozole
- POP is better when RVS endometriosis is present
D
A 30-year-old woman with deep infiltrating endometriosis (DIE) involving the bowel has persistent pain despite hormonal therapy. She is considering surgery. What is the primary surgical aim?
a) Complete excision of all visible disease
b) Preservation of ovarian function
c) Resection of the affected bowel segment
d) Pain reduction and quality of life improvement
e) Avoidance of recurrence
- Pain reduction and QOL improvement is the primary aim. Excision of all visible disease should not be done if not to achieve this aim.
D
A 29-year-old woman with a history of infertility is diagnosed with an ovarian endometrioma measuring 6 cm. What is the best treatment approach to optimize fertility outcomes?
a) Drainage of the endometrioma
b) Ablation of the cyst wall
c) Excision of the endometrioma
d) GnRH antagonist therapy
e) IVF without prior surgical intervention
If IVF is planned, excision should not be routinely carried out unless it is necessary to improve pain or accessibility to the ovaries.
WIhtout ART, then excision may be considered as it can improve spontaneous pregnancy rate
C
A 26-year-old woman with DIE is undergoing laparoscopic surgery. During the procedure, extensive adhesions involving the ureters and bowel are noted. What is the best approach to minimize complications?
a) Radical excision of all lesions
b) Multidisciplinary surgical approach
c) Intraoperative placement of GnRH agonists
d) Avoidance of ureterolysis
e) Immediate post-operative GnRH antagonist therapy
B
A. Prevalence is 50% in infertile women
B. There are no approved biomarkers
C: MRI and USS are not sensitive for superficial, peritoneal endometriosis. It cannot be ruled out with imaging or examination alone
D. Correct
E. No. ESHRE says that even without histological combination it cannot be fully ruled out
D
C - should have no papollary projections
D
A. It is effective. LUNA is not recommended
B. intra-operative complication in 2-10%.
C. Should be done when 3cm (consider)
D. Correct
E. ???? this should be correct
D
Surgery for DIE does not increase ART success, but may improve spontanesous pregnancy rate. Therefore by exclusion it is B
B
A
There are associations between endometriosis and Ovarian, Breast and Thyroid cancers. There is no association with bowel, and cervical seems to be reduced in women with endometriosis. The overall increase against the general population, however, is minimal. If in a question, choose ovarian.
Ovarian: All = 1.3%; Endo = 2.5%
Breast: All = 12.8%; Endo = 13.3%
Thyroid: All = 1.3%; Endo = 1.8%
The ovarian cancer is endometrioid adenocardinoma. It is now the second commonest type.
D
