Endometriosis

Question 1

Endometriosis

Answer 1

Endometrial tissue lying outside the endometrial cavity

- found within the peritoneal cavity

Question 2

Pathophys of endometriosis

Answer 2

Responds to cyclical hormonal changes and undergoes bleeding

Repeated bleeding leads to fibrosis

Fibrosis leads adhesions causing pain and infertility

Question 3

Describe pain in endometriosis

Answer 3

1. Cyclical
2. non colicky
3. Around the time of menstruation
4. Pelvic pain

Question 4

Dyspareunia is caused by;

Answer 4

1. Deep pain with intercourse indicates endometriosis in the

Pouch of Douglas

Question 5

Symptoms of endometriosis

Answer 5

1. Dysmenorrhoea
2. Dyspareunia
3. Low abdo/ pelvic pain

Question 6

Physical examination of Endometriosis may show

Answer 6

1. Thickening or nodularity of uterosacral ligaments
2. Tender in pouch of Douglas
3. Adenexal mass

Question 7

Ultrasound of endometriosis shows

Answer 7

1. chocolate cysts

Question 8

Conditions associated with endometriosis

Answer 8

1. Irritable bowel disease

2. Constipation

Question 9

Medical management of Endometriosis

Answer 9

1. Analgesics
2. Combined oral
   contraceptives
3. Progestogens
4. Danaxol/gestrinone
5. Gnrh agonist

Question 10

Combined oral contraceptive agents uses

Answer 10

1. Prescribed for 6 months to render the patient amenorrhoeic
2. Check if symptoms of pelvic pain disappear (if not then there may be assoc IBS/constipation)
3. If sufficient symptomatic relief, continue using indefinetly

Question 11

Progestogens

Answer 11

e. g. Cerazette
1. Synthetic progesterone to induce amenorrhea
2. Results in symptomatic relief

Question 12

Gonadotrophin releasing hormone agonist

Answer 12

1. Induces state of hypogonadotrophic hypogonadism

2. Pseudo - menopause stimulated by low levels of oestrogen

Question 13

Side effects of Gonadotrophin releasing hormone agonist

Answer 13

1. Menopause - hot flushes and night sweats

2. Drug induced osteoporosis
low dose HRT should be administered

Question 14

Surgical management of Endometriosis

Answer 14

1. Laproscopic surgery to excise endometrial tissue
2. Definitive surgery
   - Hysterectomy and bilateral saplingoophorectomy
   ( removal of ovaries is essential for long term symptom relief)

Question 15

non-gynaecological symptoms

Answer 15

1. urinary symptoms e.g. dysuria, urgency, haematuria. 2. Dyschezia (painful bowel movements)

Question 16

Gold standard Ix

Answer 16

laparoscopy is the gold-standard investigation

Question 17

Tx lines for endometriosis

Answer 17

1. NSAIDs and/or paracetamol are the recommended first-line treatments for symptomatic relief

if analgesia does help then hormonal treatments such as the

2, Second line - combined oral contraceptive pill or progestogens e.g. medroxyprogesterone acetate should be tried