obgy

1. Endometriosis
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2.  Definition
 Types
 Sites
 Clinically
 Management
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3.  Presence of endometrial tissue in sites
other than the uterine cavity
 Types
 In internal endometriosis(adenomyosis)
the ectopic endometrium is confined
to the myometrium
 External endometriosis,
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4. External endometriosis
 Features
 asymptomatic
 nulliparous women or those of low
parity at between 30 and 45 years of
age
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5.  Characteristic symptoms are :
 Heavy ,often irregular menses
 Secondary dysmenorrhoea
 Dyspareunia
 Pelvic pain between menses
Fertility issues
 Symptoms do not correlate well
with size of lesion
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6. pathogenesis
 Several theories for development of
external endometriosis
 Metaplasia-both epithelial and stromal
cells of the endometrium have a
common precursor in the coelomic
epithelium and adjacent mesenchyme.
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7. Pathogenesis
the most widely
embraced theory
involves retrograde
menstruation5
Retrograde menstruation

8.  Retrograde menstruation and implantation of
viable cells on ,for example ,the ovaries and
peritoneum of the pouch of Douglas
 Mechanical implantation into scars at the time
of surgery ,eg hysterectomy or hysterotomy. It
very rarely follows caesarean section
 Venous or lymphatic metastasis. This (or
metaplasia) could account for rare pulmonary
endometriosis
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9. Common site of endometriosis

10.  The commonest sites:
 Both ovaries
 broad ligament
 Pouch of Douglas
 uterosacral ligaments
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11.  The rectum ,urinary tract or lungs
may occasionally be involved
 Fertility can be compromised by
tubal and ovarian damage and
pelvic adhesions.
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12.  Diagnosis
 Full history
 laparoscopy is essential for proper
diagnosis,
 Histology
endometriosis 12

13.  Medical treatment
 Aimed at suppressing enogenous
cyclical changes in oestrogen and
progesterone to prevent menses
 Use of progestogen or the oral
contraceptive pill for 6-9 months
 Gonadotropin-releasing hormone
(GnRH) agonist
endometriosis 13

14. 14

15.  Surgical treatment
 Conservative surgery by laparoscopy or
laparotomy:
 small deposits can be diathermised,
exercised or vaporised using a CO2
laser .
 Large chocolate cysts require excision
endometriosis 15

16. adenomyosis
 Islets of endometrial tissue,glands
and stroma are found deep in the
uterine wall ,which responds by
hyperplasia of muscle and fibrous
tissue

endometriosis 16

17. Features
 Older women,
 multiparous women (in constrast to
external endometriosis)
 Increasingly severe dysmenorrhoea
 Secondary dysmenorrhoea
 Gradually enlarging tender uterus
endometriosis 17

18.  Adenomyosis difficult diagnose definitely other
than by histology after hysterectomy
 Treatment –TAH with conservation of ovaries
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