PELVIC PAIN Flashcards
What is the estimated prevalence of endometriosis (ESHRE 2022)
2-10%
50% in infertile women
What are the symptoms associated with endometriosis (12)
- dysmenorrhea
- deep dyspareunia
- dyschezia
- dysuria
- painful rectal bleeding
- haematuria
- shoulder tip pain
- Catamenial pneumothorax
- cyclic cough/haemoptysis
- cyclic scar swelling
- fatigue
- infertility
What radiological modalities can assist in the diagnosis of endometriosis
Ultrasound and MRI
Negative result does not exclude endometriosis
When is laparoscopy indicated
- negative imagine
- failed/inappropriate emperic treatment
What hormonal therapies are used for treatment of endometriosis
- COCP
- Progestogens
- Gnrh agonist
- Gnrh antagonist
What other drug can be used in refractory endometriosis
- Aromatase inhibitors (letrozole) in combination with hormonal therapy
What is the role of LUNA (laparoscopic uterosacral nerve ablation)
No longer recommended as offers no additional benefit over surgery only
What is the role of PSN(presacral neurectomy)
Beneficial for midline endometriosis pain as an adjunct to surgery
What are the complications of PSN
-Increased intraoperative bleeding
- Postoperative constipation
- Urinary urgency
- Painless first stage of labour
What are the guidelines on post operative ovarian suppression
- should not used in patients seeking immediate fertility as it does not improve pregnancy rate
- can be used I patients with no immediate fertility desires as improves pain outcomes and does not affect fertility
What are the parameters of the estimated endometriosis fertility Index
Historical factors
- age
- length of infertility
- previous pregnancy
Surgical factors
- AFS classification of endometriosis
- AFS endometriosis lesions
- least functional score post op - fallopian tubes, fimbriae and ovaries
What factors guide the decision for operative laparoscopy
- presence or absence of pain
- age
- prev surgery
- presence of other infertility factors
- ovarian reserve
- Estimated EFI
What ART should be offered to patients with stage 1/11 endometriosis
IUI with ovarian stimulation
- increases pregnancy rates compared to IUI alone or expectant management
weak recommendation
Recommendations for prevention of postoperative endometriosis recurrence
- LNG IUS 52mg 18-24 mnths
- longterm COCP
What cancers has endometriosis been linked to
- ovarian
- breast
- thyroid
Absolute risk compared to general population is low
