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Endometriosis, Online or face to face support groups and community…
Endometriosis
Pathophysiology
Benign uterine disorder where endometrial glands and stroma grow outside the uterus.
(1)
Ectopic tissue in the peritoneal cavity bleed cyclically, causing inflammation and pain. (2)
Inflammation and seepage of blood leads to widespread fibrosis and adhesions. (3)
No concrete evidence to suggest why this happens. Theories include retrograde menstruation, metaplastic theory, vascular or lymphatic dissemination. (3)
Oestrogen dependent disorder. Abnormal endometriotic tissue outside the uterus with increased inflammatory mediators (prostaglandin E2) and hyperoestrogenism. (2)
Epidemiology
Affects 11.4% of woman by the age of 44yrs. (5)
Diagnosis take an average of 6.7years with majority of women aged between 30 and 34yrs. (1)
Endometriosis is present in up to 50% of infertile woman. (5)
In 2017, loss productivity in Australia was $9.3billion. (1)
Risk Factors
Family history of endometriosis - 1st or 2nd degree relative. (1)
Early age of menarche. (1)
Lean body size. (1)
Uterine trauma causing hyperperistalsis and increased oestrogen production. (6)
Short menstrual cycles. (1)
Physical Exam Findings
Reduced organ mobility or enlargement. (4)
Abdominal tenderness or gaurding. (4)
Ovarian mass (4)
Palpable nodules pouch of Douglas, retrovaginal septum. (4)
Fixed uterine retroversion (4)
Diagnostic Findings and Tests
Transvaginal ultrasound (1)
Possible MRI for deep infiltrating endometrial tissue affecting the bowel and bladder. (1)
Gold standard: Laparoscopy with biopsy (1)
Benign uterine disorder where endometrial glands and stroma grow outside the uterus.
(1)
Treatment
Medication
Hormone Therapy: COCP, progestins (IUD), GnRH (1)
Antifibrinolytic agent: Tranexamic acid. (7)
Analgesics: NSAIDs and Paracetamol (1)
Iron infusion or supplements
Diet rich in vegetables, omega 3 with low red meat (12)
Antidepressants (SSRI), anxiolytics (9)
Chronic Pain management team (1)
Fertility specialist (1)
Psychologist (1)
Support with any depression, anxiety, pain, sleep disturbances, relationship and social challenges. (1)
Antidepressants, anxiolytics (1,9)
Dietician
Gentle exercise: Improves mood, pain, cardiovascular health and fertility. (11)
Weight bearing or strength training for increased risk of bone mineral density loss with GnRH. (1)
Psychosocial considerations
Sleep disorder clinic +/- psychologist (1)
Yoga, breathing or relaxation techniques to improve sleep, management of stress, pain and mood.
Osteopathy
Sleep disturbance from pain, mood and psychosocial stress
Prognosis
Follow up: GP referrals and ongoing care based on individuals symptoms
(1)
GP referrals
Persistant pelvic pain, depression, anxiety, fatigue, bloating, infertility, weight gain, gastrointestinal issues and sexual dysfunction. (1,7)
Reduced quality of life and constraints on activities of daily living. (1)
Chronic, progressive and often debilitating condition. (1)
Ongoing chronic pain with the risk of central sensitisation. (7)
60-70% of woman have successful pregnancies with possible increased risk of placenta previa. (8)
Significant physical, sexual, psychosocial and emotional impact. (7)
Ongoing imaging to monitor progression of the disease. (1)
Signs and Symptoms
Menorrhagia (1)
Dyspareunia (1)
Colorectal surgeon or Urologist to remove adhesions from bowel and bladder. (1)
Gynaecologist: Laparoscopy with excision or ablation of endometrial tissue. Hysterectomy +/- oophorectomy. (1)
Viscera therapy to release scar tissue from adhesions and/or surgery. (10)
Pelvic floor physiotherapist (1)
Anaemia (1)
Chronic pain without menstruation (1)
Infertility (1)
PMT/ premenstrual dysphoric disorder. (1)
Continuous or cyclical SSRI (9)
COCP (1)
Dysmenorrhea (1)
Bowel and bladder dysfunction (1)
Asymptomatic in 30% of cases (1)
Online or face to face support groups and community programs that meet the patient's ongoing priorities and needs.
Irregular menstruation (1)
Improve venous and lymphatic drainage, parasympathetic tone and respiration to support pain, digestion, mood and fertility. (10)