Endometriosis Minimal

(score 1 5)
adnexal implants (<1 3cm)
Filmy adhesions
Definition Stage II Lesions >3cm
Mild Some lesions deeply infiltrating
Presence of endometrial glands and stroma outside
(score 6 15)
the endometrial cavity & uterine musculature Stage III Larger lesions
Moderate More infiltration
Epidemiology
(score 16 40) Partial cul-de-sac obliteration
Affects ~10% of women Dense adhesions involving adnexa
Typically occurs in women of reproductive age Stage IV Deep ovarian lesions
Incidence peaks at 40yo. Severe (endometrioma)
(score >40) Dense adnexal adhesions
Risk factors/aetiology Cul-se-sac obliteration
Diagnosis
Reproductive age group
Positive FHx Test Findings
Nulliparity Trans-vaginal U/S Ovarian endometrioma
Caucasian women (1st line) Deep pelvic endometriosis e.g.
Low BMI uterosacral ligament
involvement
Signs & symptoms Hystero- Useful for suspected mullerian
salpingography anomaly e.g. unicorunate
Dysmenorrhoea (more in early stage disease, uterus or uterine didelphys
where prostaglandin production is ) (double uterus)
Pelvic pain (due to fibrosis & distorted normal MRI Hypo-intense
anatomy) Irregular thickening/ass of
utero-sacral ligament
Dyspareunia
Replacement of fat tissue plane
Sub-fertility (up to 40% of women who
between uterus &
present with unexplained infertility) rectum/sigmoid with tissue
Uterosacral ligament nodularity guitar mass
string texture + tenderness Diagnostic lap + Confirms endometrial
Pelvic mass chocolate cyst of ovarian histology glands/stroma outside uterine
endometrioma (gold standard) cavity
Uterine tenderness Management
Fixed, retroverted uterus frozen pelvis
1. Stage I II disease (mild)
Bladder symptoms (dysuria, flank pain)
o COCP (atrophy of ectopic implants)
Bowel symptoms (painful bowels, blood in
o NSAIDs (pain relief + COX-2 inhibition)
stools)
Mefenamic acid acts in
Criteria uterus
Tranexamic acid for
Score is based on: menorrhagia
Appearance, size and depth of peritoneal and o GnRH agonists (leuprorelin +
ovarian implants oestrogen + medroxyprogesterone)
Presence, extent and type of lesions (red, red- suppresses oestrogen
pink and clear, white, peritoneal defects and o +/- surgical management
black) 2. Stage III IV disease (severe)
Presence, extent and type of pelvic adhesions o Radical excision of affected areas
(ovaries and tubes) and degree of cul-de-sac o Post-surgical HRT (GnRH agonist)
obliteration androgen

Gold standard: hysterectomy + bilateral salpingo-

oophorectomy with excision of visible peritoneal
disease
Staging Features
Stage I Small, superficial peritoneal or