Endometriosis (Study Notes)

University:
Stanford University
Course:
PEDS 282 | Pregnancy, Birth, and Infancy
Academic year:

2023
Views:

409

Pages:

1
Author:

Pierre B

Endometriosis Endometriosis - Tissue resembling the endometrium lying outside the endometrial cavity (usually in peritoneum, can be pleural or nasal) Adenomyosis – endometrial tissue within the myometrium (can provoke fibrosis) & affect contraction à menorrhagia. Only diagnosable retrospectively after hysterectomy Incidence – 1-2% of women of reproductive age (higher among infertile), rare postmenopausally (oestrogen dependent) but recurs with HRT Presentation Extent of disease does not correlate to severity of symptoms Most common cause of 2o dysmenorrhoea Continuous, non spasmodic pain, worse immediately before and during 1st day of period Colicy dysmenorrhoea with heavy menstrual loss & clots Dyspareunia if deposits in pouch of Douglas All deposits bleed cyclically so can get epistaxis, rectal bleeding, haemothoraces Examination – these point towards but are not diagnostic Thickened pelvic ligaments (uterosacral ligaments like “string of beads”) Fixed retroverted uterus Uterine / Ovarian enlargement Tenderness in lateral & posterior fornices Diagnosis Laparoscopy – “chocolate cysts” or “burnt match heads” Management Medical treatment provides symptomatic relief but acts as contraception. Treatment limited to 3-6 months Continuous progestogen therapy - suppress proliferation GnRH analogues (inc danazol) – desensitise the pituitary to GnRH à suppresses axis (causes menopausal Ses) Surgical treatment - laser or diathermy ablation or hysterectomy with oophorectomy Infertility??? Mechanism unclear but higher incidence found in infertile women ? dyspareunia à reduced frequency of intercourse ? inactivation of sperm by antibodies & macrophages ? fibrial damage to tubes or reduced tubal motility ? anovulation, altered release of gonadotrophins, luteinized unruptured follicle syndrome