W1 - Pelvic Pain and Endometriosis Flashcards
what is the definition of chronic pelvic pain
Intermittent or constant pain in the lower abdomen or pelvis of a woman of at least 6 months
not necessarily associated with menstruation, intercourse or pregnancy
what conditions can cause CPP
OPENINg AP
ovarian cysts
pelvic inflammatory disease
adhesion
endometriosis
pelvic congestion syndrome
nerve entrapment
interstitial cystitis
IBS
no clear cause - 30-50%
which STIs are known to cause pelvic pain
chlamydia and gonorrhoea
what is endometriosis
benign, oestrogen dependent, chronic gynaecological disorder
Presence of endometrial tissue outside normal location
where is endometrium tissue found commonly in endometriosis
Pelvic peritoneum
Ovaries
Recto-vaginal septum
pericardium, pleura, brain - rare
what are some symptoms of endometriosis
- Painful periods
- excessive bleeding
- Chronic pelvic pain
- Dyspareunia - painful intercourse
- Bowel dyschesia - painful bowel movements
- Dysuria - painful urination
- Fatigue
- Depression and/or anxiety
- Abdominal bloating
- Infertility
what are some of the suspected causes of endometriosis
- retrograde menstruation
- epithelial-mesenchymal transition
- stem
- immune response
how does endometriosis cause pain
Inflammation
Adhesions/scarring
Cysts (endometrioma - 1 in 8
how does endometriosis cause fertility problems
‘Mopping-up’ of sperm
Adhesions/scarring
Tubal blockage
what are the different types of endometriosis
red
blue
endometrioma
ovarian endometriosis
what are the managing options for endometriosis
medical
surgical
prevent recurrence
what is medical management trying to do for endometriosis
Suppression of menstruation
Cessation of oestrogen stimulation
what medicine is offered in endometriosis
Analgesia:
- NSAIDs
- Paracetamol/Codeine/Opiates
Cycle control:
- COCP/Tricycling
Progesterone:
- POP
- LNG-IUS/Depo MPA
HPO Axis suppression:
- GnRHa +/- add-back HRT
what other medical treatment can be offered
psychological support
CBT
Group therapy
Patient support groups
Mindfulness
what are some problems with progesterone management
irregular bleeding
weight gain
headaches
mood disturbance
what are some problems with Hypo-oestrogenic therapy
Menopausal side effects:
- hot flushes/night sweats
- changes in libido/energy levels
- mood disturbance
Osteopenia/osteoporosis
what are some problems for GnRHa
Effective
Chemical menopause
GnRHa flare
Problem:
Young
Sudden change
what surgical options are available for endometriosis
Heat treatment- diathermy
Peritoneal excision
Adhesiolysis
Ovarian cystectomy
Excision of DIE/uterosacral disease
Salpingo-oophorectomy
Bowel: shave/disc excision/resection
Partial cystectomy + ureteric re-implantation
if there is a uterus what HRT do you give
combined oestrogen and progesterone
why do you NOT give oestrogen only HRT in someone who has a uterus
it causes hyperplasia and uterine cancer
