Obs. and Gynae. Forum

I've just reached 9K followers! Thank you for continuing support. I could never have made it without each one of you. 🙏🤗🎉

Big shout out to my newest top fans!

Chimuanya Anaesthesia you are just wonderful
Thanks you for following us...!!!

Endometriosis
DEFINITION Presence of endometrial tissue outside the uterus.
AETIOLOGY Suggested theories include: (i) retrograde menstruation (Sampson�s theory), the
passage of endometrial tissue through the fallopian tubes into the pelvis during
menstruation; (ii) metaplasia of coelomic epithelium into endometrial glands (Meyer�s
theory); (iii) vascular and lymphatic dissemination; (iv) immune; (v) genetic.
ASSOCIATIONS/RISK FACTORS Nulliparity, family history, short menstrual cycle, long
periods.
EPIDEMIOLOGY Affects 10–15% of women of reproductive age.
HISTORY Cyclical dysmenorrhoea (starting premenstrually and reaching peak at onset of
menstruation), dyspareunia, chronic pelvic pain, infertility. Rarely symptoms of involvement
of other organs/distant sites: cyclical haematuria, PR bleed, epistaxis, haemoptysis.
EXAMINATION
Vaginal: (Often unremarkable) pelvic tenderness, immobile uterus, tender uterosacral
ligaments, palpable uterosacral nodules.
PATHOLOGY/PATHOGENESIS Ectopic endometrial tissue induces a chronic, inflammatory
reaction. Can cause fibrosis/adhesions. Classic ‘Powder-burn’ or ‘gun-shot’ lesions seen on
pelvic surfaces. On the o***y, an endometriotic cyst can form which enlarges with blood
during each menstrual cycle (endometrioma/chocolate cyst).
INVESTIGATIONS
USS: Endometrioma, differential diagnosis.
Laparoscopy: Gold standard for diagnosis.
MANAGEMENT
Medical: Analgesia (NSAIDs), suppression of ovulation (COCP, progestogens, Mirena IUS,
GnRH analogues).
Surgical: Laparoscopic ablation/excision of lesions, adhesiolysis, ovarian cystectomy, rarely
TAH/BSO (last resort).
COMPLICATIONS Ovarian cyst accident (endometrioma), infertility, chronic pelvic pain,
adhesions, s*xual dysfunction.
PROGNOSIS Medical management improves symptoms in 80–90%, but recurs if treatment
stopped. Symptoms subside in pregnancy and menopause.

Dysmenorrhoea
DEFINITION Painful menstruation.
AETIOLOGY
Primary: Occurs in the absence of pathology
Secondary: Identifiable underlying pathology.
ASSOCIATIONS/RISK FACTORS
Primary: Time period shortly after menarche.
Secondary: Endometriosis, adenomyosis, PID, pelvic congestion syndrome, menorrhagia,
fibroids.
EPIDEMIOLOGY Affects 45–95% of women of reproductive age.
Primary: Commonly young girls soon after establishing me**es.
Secondary: Any time after menarche, commonly in 20s or 30s.
HISTORY Spasmodic cramping lower abdominal pain, may have radiation to thighs/lower
back.
Primary: Onset with menstruation or within 24 hours, resolves within 8–72 hours.
Secondary: May occur prior to and peak with onset of menstruation.
EXAMINATION
Primary: Abdominal/vaginal examination often unremarkable.
Secondary: Findings are specific to underlying cause.
PATHOLOGY/PATHOGENESIS
Primary: Prostaglandin F2a causes uterine hypercontractility and myometrial ischaemia,
uterine contractions cause further ischaemia.
Secondary: Dependent on cause (also likely to be related to prostaglandins).
INVESTIGATIONS
Microbiology: HVS, endocervical/Chlamydia swabs (exclude infection).
Imaging: Pelvic USS (?fibroids, assess endometrium if associated menorrhagia).
Other: Laparoscopy (endometriosis).
MANAGEMENT
Analgesia: NSAIDS (e.g. mefenamic acid), paracetamol and codeine preparations.
Hormonal methods: COCP, progestogens, GnRH analogues (e.g. severe endometriosis).
Surgery: Laparoscopic ablation of endometriosis, hysterectomy rare (severe intractable cases
if family complete).
COMPLICATIONS Limitation of activities of daily living.
PROGNOSIS Primary – excellent with simple methods; secondary – dependent on cause.