Subfertiltiy: Endometriosis Flashcards
What is endometriosis ?
Endometriosis is the presence of tissue that normally grows inside the uterus i.e, endometriotic tissue, outside of it
Endometriosis is hormonally driven, i.e. by …. and so affects women of reproductive age that … ?
Endometriosis is hormonally driven, i.e. by oestrogen and so affects women of … reproductive age that … ?
What are the 3 theories behind endometriosis?
- Retrograde menstruation that implants, 2. Metaplasia of mesothelial cells, 3. Impaired immunity
There may be genetic susceptibility, is this true ?
Yes
What are the 3 common sites for endometriosis ?
Uterosacral ligaments, ovaries and Pouch of Douglas
What is the mnemonic for the symptoms of endometriosis?
CDS
What are the symptoms for endometriosis, including main and associated ? (7)
Cyclical pain prior to menstruation, chronic pelvic pain, dysmenorrhea and deep dyspaenuria; dyschezia with/without rectal pain or bleeding and dysuria; Subfertilty
What examination would you do in a patient suspected of endometriosis?
Bimanual vaginal examination
What is a classical sign found on examination in a patient with endometriosis?
A fixed and retroverted uterus is a classical sign of endometriosis
What will you find on palpation of uterosacral ligaments ? (2)
Adnexal tenderness or mass on palpation of uterosacral ligaments
What is the gold standard for diagnosis of endometriosis?
Laparoscopy with/without a biopsy for histological confirmation
What 2 other tests can you do in endometriosis ?
TVUSS and MRI
What is the purpose of performing a TVUS in a patient with endometriosis ?
TVUSS to exclude cancers (endometrial/cervical) and ovarian cysts/abscess
What is the purpose of performing an MRI in patient with endometriosis?
To detect extent of endometriosis
What chemical is increased in endometriosis but is not used as a screening tool ?
CA125
Treatment of endometriosis depends on 3 things, what are they ?
Severity, pain and subfertility
Can you treat endometriosis empirically without a laparoscopic diagnosis if fertility is not the issue ?
Yes
What can you treat endometriosis empirically without a laparoscopic diagnosis ?
COCP or Progestogens
What is first line medical treatment for endometriosis (3) and (1) medical treatment can be used short-term (<6months) and must be followed with HRT ?
COCP, progestogens (oral, IM or SC), Mirena IUS and GnRH analogues used short term <6 months a must be followed with HRT
What medical treatment is also used in subfertile couples but does not generally improve fertility?
GnRh analogues
What is important to note about medical treatment for endometriosis after its cessation?
It will comeback
When is surgical treatment used ?
If medical treatment fails
What is the mnemonic for techniques that can be performed under laparoscopy ? (3)
ACE
The common surgical procedures performed for endometriosis is laparoscopy. What techniques can be performed under laparoscopy ? (3)
ACE: Ablation, coagulation and excision
Laparoscopy can be performed with/without what surgical produce?
Adenolysis
What other surgical procedure can be performed and why is it performed ?
Ovarian cystectomy for excision of endometrial cysts (chocolate cysts)
What surgical procedure is used as the last resort for endometriosis ?
Total hysterectomy and bilateral salpingo-oophrectomy
What Surgery is performed for older women with severe endometriosis ?
Total hysterectomy and bilateral salpingo-oophrectomy
What surgery can be used to improve fertility in endometriosis ?
Laparoscopic ablation with/without adenolysis
Medical treatment does not generally improve what ?
Medical treatment does not generally improve fertility
