Endometriosis

Endometriosis is a common condition characterised by the growth of ectopic endometrial tissue outside of the uterine cavity. Up to 10-15% of women have a degree of endometriosis

Clinical features

• chronic pelvic pain
• dysmenorrhoea - pain often starts days before bleeding
• deep dyspareunia
• subfertility

Less common features

• urinary symptoms e.g. dysuria, urgency
• dyschezia (painful bowel movements)

Investigation

• laparoscopy is the gold-standard investigation
• there is little role for investigation in primary care (e.g. ultrasound)- if the symptoms are significant the patient should be referred for a definitive diagnosis

Management depends on clinical features - there is poor correlation between laparoscopic findings and severity of symptoms

• NSAIDs and other analgesia for symptomatic relief
• combined oral contraceptive pill
• progestogens e.g. medroxyprogesterone acetate
• gonadotrophin-releasing hormone (GnRH) analogues - said to induce a 'pseudomenopause' due to the low oestrogen levels
• intrauterine system (Mirena)
• drug therapy unfortunately does not seem to have a significant impact on fertility rates

Surgery

• some treatments such as laparoscopic excision and laser treatment of endometriotic ovarian cysts may improve fertility