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
