Endometrium

Question 1

Dx endometriosis

Answer 1

Laparoscopy + biopsy for histo

Question 2

First line rx for endometriosis stage 1 or 2 (3)

Answer 2

• NSAIDs: anti-PGS
• cocs: atrophy endometrium
• Progestins- medroxyprogesterone, levonorgestrel IUD (mirena), Visanne (dienogest): Inhibit angiogenesis

Question 3

Age group endometrial cancer?

Answer 3

50 - 60

Question 4

Define endometriosis

Answer 4

Extra-uterine presence of functional endometrial-like glands and stroma

Question 5

Define endometrioma

Answer 5

Ovarian cyst formed by deposits of endometrial glandular and stromal tissue on ovary

Question 6

Name 5 common sites endometriosis

Answer 6

• Uterosacral ligaments
• bladder
• distal ureter
• rectosigmoid colon
• pouch of Douglas

Question 7

Signs and symptoms (7) endometriosis?

Answer 7

Symptoms

• dysmenorrhea
• dyspareunia
• cyclic / chronic pelvic pain
• subfertility
• dyschezia (pain/straining / obstructed defacation)
• haematuria
• extrapelvic site bleeds: epistaxis, haemoptysis

Signs

• pelvic nodules, mass

Question 8

Name 8 risk factors endometriosis

Answer 8

Physiological

• early menarche
• late menopause
• long duration menstrual flow
• short menstrual cycles

Patient factors

• delayed childbearing
• history pelvic surgery
• family history

Structural

• uterine anomalies

Question 9

Name 5 theories endometriosis

Answer 9

• Retrograde menstruation (Sampson theory)
• haematogenous spread
• lymphatic spread
• metaplasia
• immunological

Question 10

Name 3 subtypes endometriosis

Answer 10

• Superficial (peritoneal lesions)
• ovarian (endometrioma)
• deep infiltrating endometriosis Die (>5 mm deep lesions)

Question 11

Treatment options endometriosis? (6)

Answer 11

Conservative

• physio,acupuncture, Chinese herbal medicine , psychologist

Pharmacological

• first line: NSAIDs (antiprostaglandin + pain), coc, progestin (dienogest = visanne) (LNG)
• second line: gnrha short term, Danazol (androgenic steroid, ant pituitary suppressant. )
• experimental: aromatase inhibitors (anastrazole, letrozole) , gnrh antagonist

Surgical

• endometrioma: first line.
  → cyst excision (more effective for symptoms)
  → drainage (high risk recurence)
• total abdominal hysterectomy +/ BSO