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ENDOMETRIOSIS (COMMON PRESENTING SYMPTOMS: (ovulation pain, cyclical or…

- - - - Recurrence up to 30%
      - cystectomy rather than drainage and coag should be performed for ovarian endometrioma >3cm
    - - for women who have completed their childbearing. this is usually curative. HRT will be needed - although this may activate residual disease, minimise it by using combined preparation than an oest only form
  - - - progestogens [medroxyprogesterone acetate- 90days], COC[induce amenorrhoea- use for years]
    - - GnRH anslogue [SECOND LINE] - nasal spray/implant/injection USE 4-6MONTHS AND HAVE ADD BACK HRT TO AVOID MENOPAUSE EFFECTS
        
        in turn the analogue causes a reduction in gonadotrophin release, hence ovarian steroid secretion
- - - - usually lies within peritoneal cavity and predominantly in pelvis - commonly uterosacral ligaments behind the uterus
      - rarely in distant sites:
        
        umbilicus
        
        abdo scars
        
        perineal scars
        
        pleural cavity
        
        nasal mucosa
      - responds to cyclical hormonal changes - bleeds at menstruation
      - More common in infertile women and diagnosed mostly aged 25-35y/o
        
        symptoms of endometriosis can present as early as onset of puberty
        
        as it is oestrogen dependent = rarely diag postmenopausally - but may recur due to HRT
      - Commonest cause of secondary dysmennorrhoea
    - - when there is endometrial tissue within the myometrium of uterus
      - uterus is enlarged and feels "boggy"
      - painful and heavy menstruation