Endometriosis - refers to a chronic estrogen-dependent chronic inflammatory process that commonly affects women with the age group of 25-40

1. ENDOMETRIOSIS: @WinnerzKlub21

2. ABBREVIATIONS:
BMI – Body Mass index
QOL – quality of life
CNS – central nervous system
IBD – Inflammatory bowel disease
IBS – Irritable bowel syndrome
FH – family history
VE – vaginal examination
r/o – rule out
PE – physical examination
USS – ultrasound scan
TVUS – transvaginal ultrasound
TAUS – transabdominal ultrasound
Rx – Treatment
Mx – Management
COCs – Combined oral
contraceptives

3. WHAT IS ENDOMETRIOSIS?
Endometriosis is a complex syndrome characterized by an estrogen-
dependent chronic inflammatory process that primarily affects the
ovaries.
Occurs when shed endometrial tissue (menstrual cycle) travels
retrograde into the lower abdominal cavity.
It is the most common cause of chronic pelvic pain in women and is
associated with infertility.

4. EPIDEMIOLOGY:
Endometriosis carries a significant burden on the QOL of women,
their families and the healthcare systems, both locally and globally.
Prevalence stood at 10.8 per 1000
 (involving 6146 women – mean age of 40.4 +/- 8 years)
 Women aged 40-44 had the highest prevalence.
 Peak of disease incidence (in another study) was higher
in women between 25 and 29 years of life.

5. INTRO:
•Endometriosis is a chronic gynecologic disease characterized by the
development + presence of endometrial tissue (and similar glands &
stroma) in anatomical positions and organs outside of the uterine
cavity.
•The locations can vary: (in descending order)
• Ovaries
• Posterior broad ligament
• Anterior cul-de-sac
• Posterior cul-de-sac
• Uterosacral ligament.
• *endometriosis is not limited to the pelvis – has potential to affect extra pelvic
structures (pleura, pericardium, or the CNS)

6. RISK FACTORS:
i. Late menopause
ii. Low BMI
iii. Early age at menarche
iv. Taller height
v. Mullerian anomalies
vi. Shorter lactation intervals
vii. Nulliparity
viii. Shorter menstrual cycles
ix. Caucasians
x. Alcohol use + caffeine intake

7. PATHOGENE
SIS:

8. CLINICAL FEATURES:
Dyspareunia
Dyschezia
Dysmenorrhea
Dysuria
Frequency & urgency
Cyclical menstrual pain – chronic & progressive (exacerbating over time)
INFERTILITY
Nodule/Cyst formation
Frequency + Urgency
Hyperalgesia – application of a nonpainful stimuli will cause intolerable pain
(neuropathic pain)
• Bowel endometriosis: GIT symptoms –
diarrhea, constipation, bloating,
abdominal pain mimicking other
conditions like IBD or IBS.
• Rectal bleeding which may co-exist
with menstrual bleeding

9. DIAGNOSIS:
A detailed history should be taken: (most women have a normal PE)
 Positive FH, pelvic pain, benign ovarian cysts, pelvic surgeries, + infertility issues
Followed by a gynecological physical examination:
 Variable findings – depending on size + location of endometriotic mass/lesion.
 Tenderness on VE, palpable nodules in the posterior fornix, adnexal masses, &
immobility of the uterus
 *Absence of physical findings does not r/o endometriosis.
 Tenderness on palpation of the posterior fornix (a common finding)
 Other causes of pelvic pain to be r/o (via urinalysis, pregnancy test, vaginal +
endocervical swabs and Pap smear).
Pelvic USS (r/o endometriomas, ovarian cysts, and fibroids).
 TVUS + TAUS
Gold standard: Laparoscopic inspection + biopsy (histology)

10. RX/MX:
Mx requires a multidisciplinary approach.
i. Surgical diagnosis + debulking of disease load
ii. Hormonal Rx: to suppress + delay recurrence and progression of disease
iii. Pain management – may be individualized
Medical Rx:
i. NSAIDs & low-dose COCs – 1st line (duration: 3 months)
ii. Progestins (oral, injectables, or intra-uterine), androgens, GnRH – 2nd line
Surgical Rx:
i. Excision/removal of endometrial implants
ii. Ablation of uterosacral nerves
iii. Laser treatment
iv. Hysterectomy with bilateral salpingooophorectomy.

11. DIFFERENTIALS:
Genital system: GIT: Other:
Pelvic inflammatory
disease
IRS Neurologic ?
Adhesions Constipation Psychosomatic?
Endometritis IBD
Cervical stenosis
Primary + secondary
dysmenorrhea
Urinary system – interstitial
cystitis, chronic urinary
inflammation

12. PROGNOSIS:
Patients – infertility and high risk of miscarriages + ectopic
pregnancy.
Lesion spontaneously regress in one-third of affected women –
without Rx.
Recurrence rate after surgery: 6 – 67 %
Pain recurrence has been reported in 17-34 % of cases.
Surgery – benefit for infertility associated with endometriosis is to
enhance the probability

13. THE END: