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Flashcards in Endometriosis Deck (59)
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1

What is endometriosis?

A chronic oestrogen dependant condition characterised by the growth of endometrial tissue in sites other than the uterine cavity

2

What sites are most commonly involved in endometriosis?

- Pelvic cavity
- Uterosacral ligaments
- Pouch of Douglas
- Rectosigmoid colon
- Bladder or distal ureter

3

What other sites are more rarely involved in endometriosis?

- Umbilicus
- Scar sites
- Pleura
- Pericardium
- CNS

4

What is the prevalence of endometriosis?

Estimated to effect 10-15% of women of reproductive age

5

Why is it difficult to determine the prevalence of endometriosis?

- Because of diversity of symptoms and their severity
- Endometriosis may be asymptomatic

6

Who does endometriosis have a higher prevalence in?

Infertile women

7

What is the prevalence of endometriosis in infertile women?

25-40%

8

In what age group is endometriosis found in?

Almost exclusively in women of childbearing age

9

At what age does the diagnosis of endometriosis most commonly occur?

30’s

10

What are the risk factors for endometriosis?

- Early menarche
- Late menopause
- Delayed childbearing
- Short menstrual cycles
- Long duration of menstrual flow
- Obstruction to vaginal outflow
- Genetic factors

11

What can cause obstruction to vaginal outflow?

- Hydrocolpos
- Female genital mutilation
- Defects in uterus or Fallopian tubes

12

What indicates that there are genetic factors involved in endometriosis?

The risk of endometriosis in first-degree relatives with severe endometriosis is 6x that of relatives of unaffected women

13

What factors are protective against endometriosis?

- Multiparity
- Use of oral contraceptives

14

What are the main symptoms of endometriosis?

- Dysmenorrhoea
- Dyspareunia
- Cyclic or chronic pelvic pain
- Subfertility

15

What other symptoms may be present in endometriosis?

- Bloating
- Lethargy
- Constipation
- Low back pain

16

What are the less common symptoms of endometriosis?

- Cyclical rectal bleeding
- Menorrhagia
- Diarrhoea
- Haematuria

17

How does the clinical presentation of endometriosis vary?

Some women experience severe symptoms, whereas some women have no symptoms at all

18

What happens to the severity of symptoms of endometriosis with age?

Tends to increase

19

Can endometriosis be asymptomatic?

Yes

20

How might endometriosis be detected if the patient is asymptomatic?

Diagnosed incidentally or during investigations for infertility

21

What proportion of women with infertility have endometriosis?

1/3

22

What % of women with endometriosis are infertile?

40%

23

How does endometriosis cause infertility?

Exact mechanism is unknown, but possible mechanisms include;
- Anatomical distortions and adhesions
- Release of factors from endometriotic cysts which are detrimental to gametes or embryos

24

What is often found on examination in endometriosis?

Examination is normal

25

What findings, if any, might there be on examination in endometriosis?

- Posterior fornix or adnexal tenderness
- Palpable nodules in the posterior fornix or adnexal masses
- Bluish haemorrhagic nodules visible in posterior fornix

26

What are the differential diagnoses of endometriosis?

- Pelvic inflammatory disease
- Ectopic pregnancy
- Torsion of ovarian cyst
- Appendicitis
- Primary dysmenorrhoea
- Irritable bowel syndrome
- Uterine fibroids
- Urinary tract infection

27

What is the gold standard for investigation for most forms of endometriosis?

Laparoscopy

28

What is the problem with laparoscopy in the diagnosis of endometriosis?

Invasive with small risk of major complications

29

Give a complication of laparoscopy

Bowel perforation

30

What other investigations may be performed in endometriosis?

- MRI scan
- Transvaginal ultrasound