Pelvic pain/endometriosis

Question 1

Primary dysmenorrhoea and contraception not required, what to give?

Answer 1

NSAIDS

Question 2

Recurrence endometriosis after Tx

Answer 2

40-45%

Question 3

After Sx Tx of endometriosis, recurrence of surgery within 5 years

Answer 3

30%

Question 4

Incidental finding of thickened endometrial lining but not PMB, what cut off should be used whether need further Ix

Answer 4

11mm on TVUS
If >11mm risk cancer 6.7%

Question 5

According to NICE 1st line non hormonal and hormonal treatment>

Answer 5

1st Non hormonal NSAIDs/Paracetamol

2nd COCP or progesterone

If not controlled → GOPD

Question 6

At diagnostic Laparoscopy, what further surgery should be completed if disease seen?

Answer 6

Lap treatment of peritoneal endometriosis (not involving bladder, bowel, ureters)

Treatment ovarian endometrioma - excision > drainage

Hormonal Tx post op

Question 7

Prevalence of endometriosis in infertile women

Answer 7

25-40%

Question 8

Prevalence of endometriosis in fertile women

Answer 8

0.5-1%

Question 9

How does an endometrioma appear on USS?

Answer 9

Adnexal mass in a premenopausal patient

2. Ground glass echogenicity of the cyst fluid
3. One to four locules and
4. No papillary structures with detectable blood flow / no solid parts

Question 10

Side effects of danazol

Answer 10

Side-effects include nausea, dizziness, skin reactions and photosensitivity, mood changes, changes in libido, vertigo, fatigue, androgenic effects (acne, reduced breast size, voice changes, oedema, oily skin, hirsutism), vaginal spotting, weight gain and muscle cramps
Virilistion - voice and hair changes, depression

No longer can prescribe in UK

Question 11

After laparoscopy what can be done intraoperatively to prevent adhesions?

Answer 11

Oxidized regenerated cellulose

Question 12

When should ovarian cystectomy for endometrioma be offered

Answer 12

> 3cm
Pain
No ART

Question 13

Women should be referred to a gynaecology service for an ultrasound or gynaecology opinion if:

Answer 13

1. they have severe, persistent or recurrent symptoms of endometriosis
2. they have pelvic signs of endometriosis or
3. initial management is not effective, not tolerated or is contraindicated

Question 14

In primary care, if concerns deep infiltrating endometriosis, what should be done?

Answer 14

Refer to endometriosis centre.

Pelvic USS or MRI