Endometriosis – ectopic endometrial tissue #2
Contents:
Definition
Risk factors
Sites of lesion
Classification
Clinical presentation
Physical examination
Investigations
Differential diagnosis
Management
Complications
Follow up
Prognosis
Clinical presentation:
Most cases present with classic triad of dysmenorrhea, dyspareunia and infertility.
• Asymptomatic in 20-30% of women
• Infertility (30-40% of patients with endometriosis)
• Dyspareunia (painful sexual intercourse due to rectovaginal or uterosacral involvement)
• Dysmenorrhea (painful menstruation)
• Dyschezia (painful defecation)
• Chronic pelvic pain
• Intermenstrual bleeding (Per vaginal bleeding in between normal menstrual cycle)
• Premenstrual spotting
• Abdominal swelling due to endometrioma
• Spontaneous abortion (theoretic)
• Luteinized unruptured follicle syndrome
• Bowel and urinary symptoms if there is involvement of these particular organs
Findings of physical examination:
• Pelvic mass due to endometrioma
• Tenderness on bimanual examination or during rectovaginal examination (particularly during menstruation
• Fixity of pelvic organs with retroverted uterus
• Tender and nodular uterosacral ligaments
Investigations:
• No particular laboratory test is useful to reach for diagnosis
• Cancer antigen 125 (CA 125) may be elevated –it is often done to rule out epithelial ovarian malignancy. The level is usually mildly elevated in severe disease.
• Vaginal/abdominal ultrasound – may be seen in endometriomas of ovaries
• MRI (Magnetic Resonance Imaging) – highly accurate to look for pelvic masses (endometriomas). However it has limited sensitivity in detecting diffuse endometriosis.
• Hysterosalphingography (HSG) for tubal occlusions proximally or distally and periadnexal adhesions
• Diagnostic laparoscopy (biopsy of endometriotic lesions usually demonstrates both endometrial glands and stroma.
• Colonoscopy if rectal bleeding is present
• Patients should be monitor serum estradiol levels until <10pg/ml (37pmol/L) when using GnRH analogs
• Monitor patients for pain response and size of ovarian endometriomas with ultrasound 8-12 weeks
Some differential diagnosis:
• Causes of acute abdomen (e.g.: acute appendicitis)
• Complications of intrauterine and extrauterine pregnancy (ectopic pregnancy)
• Urinary tract infection
• Irritable bowel syndrome
• Ulcerative colitis
• Crohn’s disease
• Pelvic adhesions
• Pelvic inflammatory disease (PID)
• Acute salphingitis
• Ruptured ovarian cyst
• Hemorrhagic cyst
• Hernia
• Intussusceptions
• Malignancies
• Uterine leiomyomata
• Adenomyosis
• Psychologic disorder
• Nerve entrapment syndrome
• Scoliosis
• Muscular skeletal strain
• Interstitial cystitis
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Tags: contraceptive oral pill, dysmenorrhea, dyspareunia, endometrioma, endpmetriosis, infertility, intussusceptions, mirena, pelvic pain
Technorati Tags: contraceptive oral pill, dysmenorrhea, dyspareunia, endometrioma, endpmetriosis, infertility, intussusceptions, mirena, pelvic pain
