Ian Chilcott Hillingdon Hospital Defined as the presence of - - PowerPoint PPT Presentation

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Nov 09, 2022 266 likes •420 views

Ian Chilcott Hillingdon Hospital Defined as the presence of endometrial- like tissue outside the uterus, which induces a chronic, inflammatory reaction Most common sites Ovaries Pouch of Douglas Uterosacral ligaments Pelvic peritoneum

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Ian Chilcott Hillingdon Hospital

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Defined as the presence of endometrial- like tissue outside the uterus, which induces a chronic, inflammatory reaction

Most common sites Ovaries Pouch of Douglas Uterosacral ligaments Pelvic peritoneum Prevalence 8-10% est

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Aetiology

Retrograde menstruation Coelomic metaplasia Genetic Altered immune function

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Symptoms

Dysmenorrhoea Deep dyspareunia Chronic non menstrual pain Dyschezia Cyclical rectal bleeding Infertility

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Association with infertility

Endometriomas/ severe anatomical distortion accepted Minimal/mild peritoneal disease less clear

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Association with ovarian cancer

Lancet Oncology Feb 2012 Meta analysis of 13 case control studies 13000 controls 8000 with ovarian cancer Relative Risk of clear cell carcinoma 3 low grade serous 2 endometrioid 2

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Diagnosis Examination

pelvic tenderness fixed retroversion tender USL visible lesions vagina cervix Exam may be normal

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Diagnosis Investigations

Ultrasound – endometriomas MRI CA-125 Laparoscopy – gold standard

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Treatment

Based on

symptoms
presence/absence of endometriomas
concern re fertility

Empirical treatment without referral may be appropriate

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Medical treatment

Analgesia Hormonal treatment COCP Continuous until wish to conceive Cileste, Yasmin POP Cerazette Mirena If breakthrough bleeding, add cerazette or Cileste GnrH analogues +/- addback Danazol

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Referral criteria

Endometrioma on U/S Infertility Pt wanting definite diagnosis Failure of empirical treatment

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Surgery

Laparoscopic preferred At time of diagnostic lap Ablation/excision stage I-III – reduces pain at 6/12 compared to no treatment Fertility ablation & adhesiolysis I-II enhances fertility more than no treatment (Cochrane 2010)

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Endometriomas Endometriomas

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Hysterectomy /BSO Assisted reproduction IUI I-II IVF

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Subfertility

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Endometriomas

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Patient prefers definite diagnosis

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Failure of empirical treatment Suitable empirical treatments

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NSAIDS

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COCP – continuously

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POP

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