Endometriosis

1. Big picture

Endometriosis is a chronic, oestrogen-dependent inflammatory disease in which endometrial-like tissue grows outside the uterine cavity. It is one of the classic causes of:

• Secondary dysmenorrhoea
• Chronic pelvic pain
• Deep dyspareunia
• Infertility
• Ovarian endometrioma
• Adhesions and distorted pelvic anatomy

The examiner usually wants you to recognize this pattern:

Young reproductive-age woman
+ progressive cyclical pelvic pain
+ dysmenorrhoea
+ deep dyspareunia
+ infertility
± endometrioma on ultrasound
= endometriosis

The most important clinical logic:

Symptoms suggest endometriosis
↓
Exclude pregnancy and acute emergencies if pain is acute
↓
Pelvic examination
↓
Transvaginal ultrasound ± MRI
↓
Medical treatment for pain
↓
Surgery or assisted reproduction if infertility, endometrioma, deep disease, or failed medical therapy

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