Continuing Professional Development

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Endometriosis and Adenomyosis: identification and management in a rural setting

Dr Albert Jung is a gynaecologist specialising in advanced laparoscopic gynaecological surgery. His interests lie in the treatment and management of endometriosis, abnormal uterine bleeding, pelvic pain, uterine fibroids, cysts and infertility. He is a reviewer for the Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG), and serves as a Senior Lecturer and mentor for the University of Queensland Medical School. The recorded workshop also features the perspectives of patients in a presentation delivered by QENDO, the peak organisation for those affected by endometriosis, adenomyosis, PCOS, infertility or pelvic pain. A certificate is available after successful completion of the quiz found below the video.

Learning Outcomes:

Discuss the barriers to healthcare experienced by patients with endometriosis and/or adenomyosis.
Identify and recognise the signs and symptoms of endometriosis and adenomyosis.
Explain the pathophysiology of endometriosis and adenomyosis.
Identify the risk factors of endometriosis and adenomyosis.
Interpret investigations into endometriosis and adenomyosis.
Assess the need for referral of patients with suspected or diagnosed endometriosis and/or adenomyosis.

Resources and Links

Endometriosis and Adenomyosis: identification and management in a rural setting

Please complete this quiz in order to receive your certificate

1 / 20

What percentage of women with pelvic pain have endometriosis?

90%

40%

70%

20%

2 / 20

What are the benefits of an MRI scan when compared to an Ultrasound scan?

Patients prefer MRIs

MRIs are cheaper than Ultrasounds

MRIs are better at picking up deeply infiltrating endometriosis and thoracic endometriosis

3 / 20

Endometriosis is pre-cancerous

True

False

4 / 20

Endometriosis is ectopic endometrial glands and stroma outside of the uterine cavity.

False

True

5 / 20

Which factors influence the risk of recurrence?

Age of resection

Complete resection

Ovarian suppression

Severity of disease

All of these

6 / 20

Why is excision considered preferable to ablation as a surgical intervention for endometriosis?

Excision allows histological diagnosis

Excision has lower risk of recurrence

Excision is better for deeply infiltrating endometriosis

Excision allows removal of disease from over the ureter, blood vessels and bowel

Excision is better for dyschezia

All of these

7 / 20

Which of the following should be avoided when managing endometriosis?

Conservative measures such as heat packs, stretches and exercises, and TENS machines

Prescription opioids

Simple analgesia

Hormonal suppression such as the combined oral contraceptive pill and Mirena

Neuromodulators such as Amitriptyline, Gabapentin and Pregabalin

8 / 20

Which is the most recent theory to explain the pathophysiology of endometriosis?

Neonatal uterine bleeding

Samson's theory of retrograde menstruation

Theory of Müllerianosis

9 / 20

In the QENDO survey, what was the most common answer (46.2%) to this question: "How many GPs did you need to see to get assistance with your period?"

5 or more

10 / 20

Endometriosis affects 1 in every ____ women

100

11 / 20

Which of the following is NOT a possible symptom of endometriosis?

Increased urinary frequency

Shoulder tip pain and chest pain

Painful periods

These are all possible symptoms

Infertility

12 / 20

Which of the following is suggestive of Adenomyosis?

Bulky, tender uterus on examination

Ultrasound scan shows venetian blind appearence, heterogenous myometrium

All of these

Bulky, globular appearance of uterus when viewed with laparoscopy

Dysmenorrhea and heavy menstrual bleeding

13 / 20

A multidisciplinary approach reduces ED presentation and reduces opioid use in patients with endometriosis.

True

False

14 / 20

Adenomyosis is ectopic endometrial-type tissue in the uterine wall.

True

False

15 / 20

What factors can hinder rural patients in receiving treatment for endometriosis and adenomyosis?

Travel

Cost

Co-morbidities

All of these

16 / 20

If an ultrasound scan identifies bilateral endometriomas, there is a <1% chance that there is only ovarian involvement.

True

False

17 / 20

Pregnancy is a treatment for endometriosis

False

True

18 / 20

What are the four main pain symptoms of endometriosis?

dysmenorrhea, dysphasia, dyspareunia and dyschezia

dysuria, allodynia, dysphoria and dysmenorrhea

dysmenorrhea, dyschezia, dysuria and dyspareunia

dyschezia, dysuria, dyspepsia and dysphasia

19 / 20

Women who have a ______ diagnosed with endometriosis are 7 times more likely to also have a diagnosis of endometriosis.

Partner

Friend

Cousin

Mother

20 / 20

What should you request the sonographer include in their report when investigating endometriosis through ultrasound?

Sliding sign, obvious nodules and abdomen tenderness

Ovaries (cyst, movement, tenderness), USL (tenderness) and sliding sign

Obvious nodules, overies (cyst, movement, tenderness) and sliding sign

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