Endometriosis

Chronic condition in which endometrial tissue is located at sites other than the uterine cavity

Aetiology

  • Unclear

Risk factors

  • Early menarche
  • Family history

Pathophysiology

Sites

  • Ovary ('chocolate' cyst)
  • Pouch of Douglas
  • Peritoneal surfaces, including uterus
  • Cervix, vulva, vagina
  • Bladder, bowel etc.

Clinical presentation

Symptoms

  • Cyclical pelvic pain, which occurs at time of menstruation
  • Dysmenorrhoea
  • Dyspareunia
  • Dysuria
  • Dyschezia (difficult, painful defecating)
  • Subfertility
  • Acute abdomen if ruptures

Signs

  • A fixed, retroverted uterus
  • Uterosacral ligament nodules
  • General tenderness

Investigations

  • Laparoscopy for definitive diagnosis
  • Pelvic ultrasound can help determine the severity
  • In the correct clincial context, can also be diagnosed on MRI scans
    • Degradation products cause characteristic MR signal changes

Management

  • Pain management - analgesia, NSAIDS
  • Suppressing ovulation for 6-12 months can cause atrophy of the endometriosis lesions and therefore a reduction in symptoms
    • COCP, norethisterone, Mirena
  • Surgery if symptoms seriously affect patient's life e.g. laser ablation

Complications

  • Adhesions
  • Infertility
  • Ecopic pregnancy
  • Malignancy (endometrioid carcinoma)