Endometriosis

Endometriosis is defined as the presence of endometrial like tissue outside the uterus , which includes a chronic , inflammatory reaction ( Kennedy et al 2005 )

Thought to affect 6 to 10 % of the general population.

Pathophysiology -Chronic estrogen or progestogen responsive inflammatory disease associated with pain symptoms and infertility ( Barra F et al 2018 ) Other theories○ retrograde menstruation○ metaplasia○ implantation theory○ induction theory○ immune dysfunction○ stem cell ○ genetics○ apoptosis suppression and alteration of endometrial cell fate

When to suspect -chronic pelvic pain period related pain ( dysmenorrhoea ) affecting daily activities and QOL deep pain during or after sexual intercourse period-related or cyclical gastro-intestinal symptoms , in particular , painful bowel movements period related or cyclical urinary symptoms , in particular , blood in urine or passing urine infertility in association with 1 or more of above

Referral -they have severe , persistent or recurrent symptoms of endometriosis pelvic signs of endometriosis OR initial management is not effective , not tolerated or in contraindicated if they have suspected or confirmed deep endometriosis involving the bowel , bladder or uterus consider referring young women ( aged 17 & under ) with suspected or confirmed endometriosis...