Disease and Aetiology
Is endometriosis inflammatory or non-inflammatory?
Inflammatory
What is the most common SYMPTOM of endometriosis?
Pelvic pain
At what age(s) does endometriosis effect patients?
From Menarche to Menopause
What happens when a patient first presents with Endometriosis-like symptoms?
History and Examination !
What percentage of women world wide of reproductive age are affected by endometriosis? (I will allow +/- 5%)
10%
What hormone is endometriosis dependent on?
Oestrogen
What is the most common SIGN of endometriosis?
Pelvic tenderness
What are some risk factors for endometriosis? (Minimum of 3)
Early menarche
Late menopause
Short menstrual cycles
Heavy/prolonged menstruation
Nulliparity/delayed childbearing
Family History
Low BMI
What are the two main types of imagine used to investigate a possible diagnosis of endometriosis?
Transvaginal Ultrasound
MRI
In women with infertility or chronic pelvic pain, what is the prevalence of endometriosis? (I will allow +/- 5%)
35-50%
What is the aetiology of endometriosis?
There isn’t a clear cause! There are several theories though: Coelomic Metaplasia (Peritoneal calls transform into endometrial-like cells under hormonal/inflammatory influences), Lymphatic/Vascular Irregular spread (Dissemination of endometrial cells via the lymphatic or blood vessels), Immune Dysfunction (Impaired clearance of ectopic endometrial cells), Genetic predisposition (increased risk in first-degree relatives).
When are the symptoms of endometriosis at its worst?
Around the time of the period and worse especially so in the first two days of menstruation.
What are some protective factors from endometriosis?
Multiparity
Prolonged lactation
Use of combined oral contraceptives
How do you definitively diagnose Endometriosis?
Diagnostic Laparoscopy with histological biopsy.
What is the average diagnosis age for patients with endometriosis? (I will allow +/- 2 years)
Approximately 28-35 years of age
Which area(s) does endometriosis commonly affect?
Most commonly on the pelvic peritoneum, ovaries and rectovaginal septum.
How do a lot of patients describe the characteristic of the pain that occurs?
Cramping with occasional sharp shooting pains in the lower abdomen and pelvic area, sides or back.
This is very similar to UTIs and there is often brushed off as this.
How does pain occur from endometriosis?
Inflammation occurs when endometriosis flares up and inflammatory mediators such as prostaglandins and cytokines lead to pain and tissue irritation.
In terms of symptom control, not curative treatment for endometriosis what is given?
NSAIDs
Opioids
Induce pseudo-pregnancy or pseudo-menopause
Hormonal Suppression: combined oral contraceptives, progestins, GnRH agonists/antagonists (to induce hypoestrogenic state).
What are some of the sequelae of endometriosis? (Minimum 3)
Chronic Pelvic Pain
Infertility
Ovarian Endometriomas
Adhesions
Increased risk of ovarian cancer
Psychological impact
Define Endometriosis
Endometriosis is a chronic gynaecological disorder characterised by the presence of endometrial-like tissue (glands and stroma) outside the uterine cavity.
Define: Dysmenorrhea, Dyspareunia, Dysuria and Dyschezia.
Dysmenorrhea - painful menstruation
Dyspareunia - pain during intercourse
Dysuria - painful urination
Dyschezia - painful bowel movements
What can repeated endometrial bleeding cause in the surrounding tissue?
Fibrosis
Adhesions
Scarring
What is the conservative and definitive surgical management of endometriosis?
Conservative: Laparoscopic excision/ablation of implants, adhesiolysis, cystectomy for endometriomas.
Definitive: Hysterectomy with a possible oophorectomy (for severe, refractory disease in women not desiring fertility)
What percentage of women with endometriosis have difficulty conceiving? (I will allow +/-5%)
30-50%