Endometriosis and Polycystic Ovary Syndrome (PCOS)

Flashcards covering key terms and definitions related to Endometriosis and PCOS from lecture notes.

Endometriosis

A condition where endometrial cells grow outside the uterus, affecting organs such as ovaries and fallopian tubes.

Polycystic Ovary Syndrome (PCOS)

An endocrine disorder characterized by hyperandrogenism, ovulation dysfunction, and polycystic ovarian morphology.

Symptoms of Endometriosis

Painful cramps, chronic pelvic pain, pain during sex, fatigue, and gastrointestinal issues.

Aetiology of Endometriosis

Not well understood but may include hormonal fluctuations, genetic predisposition, and immune dysfunction.

Assessment and Diagnosis of Endometriosis

Confirmed through laparoscopy with inspection and biopsy of endometrial lesions.

Management of Endometriosis

May involve hormonal treatment, analgesics, or surgery depending on symptoms and personal preferences.

Complications of Endometriosis

Can include sub-fertility and the recurrence of symptoms post-treatment.

Adenomyosis

A condition where endometrial tissue grows into the muscular wall of the uterus.

Insulin Resistance in PCOS

A common factor contributing to hormone imbalance and associated complications in many women with PCOS.

Diagnosis of PCOS

Confirmed through specific criteria including ovulatory dysfunction, hyperandrogenism, and ultrasound findings.

Management of PCOS

Emphasizes healthy living, hormonal regulation, and may involve medications like metformin or hormonal contraception.

Risk Factors for Endometriosis

Includes family history, Caucasian ethnicity, and anatomical abnormalities.

Chronic Pain in Endometriosis

Long-term pain affecting quality of life; often linked to hormonal changes throughout the menstrual cycle.

Role of Pharmacists

Educating and supporting patients with endometriosis and PCOS concerning management and complications.

Lifestyle Interventions for Endometriosis

Involves practices such as heat therapy, physiotherapy, and lifestyle management for symptom relief.

Diagnostic Tests for PCOS

Blood tests for hormone levels and an ultrasound to assess ovarian morphology.

"What is endometriosis?"

"Endometrial(-like) cells found outside the uterus; forming lesions that can cause severe symptoms."

"What normally happens to the endometrial lining in a menstrual cycle?"

"It builds up across the cycle and sheds at the end = menstruation."

"Common sites of endometriosis lesions"

"Ovaries; fallopian tubes; bladder, bowel; can be elsewhere (lecture mentions possible lung involvement)."

"What is an endometrioma?"

"An endometriosis lesion on the ovary (ovarian endometrioma)."

"How common is endometriosis in the UK (lecture figure)?"

"~1.5 million women; about 1 in 10."

"Why are diagnoses increasing recently?"

"More awareness + more research + improved referral/recognition (not necessarily true prevalence increase)."

"Typical age range of diagnosis (lecture)"

"Most commonly 30–40 years; partly due to diagnostic delay."

"Average diagnostic delay (lecture)"

"Up to ~7.5–8 years."

"Endometriosis: type of condition"

"Long-term chronic, potentially debilitating, with physical/sexual/psychological impacts."

"Second most common gynaecological condition in UK after what?"

"Fibroids."

"Main symptom of endometriosis"

"Pain (often severe/debilitating)."

"When do endometriosis symptoms usually worsen?"

"Around menstruation."

"Endometriosis pain locations (examples)"

"Pelvis; lower back; bowel pain/urinary pain around periods; pain during/after sex."

"GI symptoms in endometriosis can mimic what?"

"IBS; IBD; ulcers (non-specific intestinal pain)."

"Other symptoms mentioned"

"Fatigue; sleep disturbance; general malaise; spotting/bleeding between periods."

"Not all patients with endometriosis are symptomatic: true/false?"

"True (some are asymptomatic)."

"NICE first steps if endometriosis suspected (lecture)"

"Encourage a symptom diary/tracker to identify patterns (often cyclical)."

"Is the cause of endometriosis well understood?"

"No (still under investigation)."

"Hormone driver highlighted for endometriosis"

"Oestrogen (promotes tissue proliferation; if cells are elsewhere; they respond too)."

"Theory: genetic predisposition"

"First-degree family history may increase risk."

"Theory: retrograde menstruation"

"Menstrual tissue/cells move back up through pelvis/fallopian tubes and deposit elsewhere."

"Theory: abnormal tissue change"

"Pelvic cells may transform into endometrial-like cells."

"Theory: immune dysfunction"

"Possible immune/autoimmune contribution."

"Only definitive confirmation test for endometriosis (lecture)"

"Laparoscopy (keyhole surgery) ± biopsy."

"If laparoscopy biopsy is negative; is endometriosis excluded?"

"No (can still be diagnosed clinically)."

"Why do an ultrasound first?"

"Less invasive; may identify lesions/endometriomas; but a negative scan doesn’t rule it out."

"MRI role in endometriosis"

"Helps assess extent/depth of lesions into tissue."

"Are blood tests highly reliable for endometriosis diagnosis (lecture)?"

"No (hormonal fluctuations vary; not definitive)."

"Is treatment always effective?"

"No; often trial-and-error, long-term.

"Most effective management option mentioned"

"Surgery (remove/destroy lesions outside the womb)."

"Key factors affecting treatment choice"

"Age; symptom severity; desire to conceive; extent of lesions."

"Common early management: hormonal contraception—why?"

"Aims to blunt hormonal cycle effects; endometriosis is oestrogen-driven."

"Is combined hormonal contraception licensed for endometriosis (lecture)?"

"Often unlicensed/off-label; but evidence-supported."

"How should combined pill be taken for endometriosis symptom control (lecture)?"

"Often back-to-back/continuous (reduce hormone drops that worsen symptoms)."

"First-line analgesics mentioned"

"NSAIDs + paracetamol; often trial for ~3 months."

"What’s the concern with opioid use in endometriosis?"

"Not routine guidance; risk of long-term reliance; especially if misdiagnosed/undertreated."

"If combined contraception unsuitable, what hormonal option may be considered?"

Often unlicensed/off-label, but evidence-supported."

"GnRH agonists: main effect"

"Induce temporary medical/chemical menopause → lower oestrogen → symptom relief."

"Why limit GnRH agonists duration (lecture)?"

"Menopause consequences: bone health, cardiovascular health, cognitive effects; typically ~6 months then review."

"When might HRT be needed with GnRH agonists (lecture)?"

"If used longer-term due to hypo-oestrogenic effects."

"GnRH agonists sometimes used in relation to what surgery?"

"Often used before hysterectomy / as part of surgical pathway (lecture emphasis)."

"Does surgery permanently cure endometriosis?"

"Often no; symptoms may return and surgery may need repeating."

"Recurrence rate after surgery (lecture)"

"Roughly 20–50% have symptom recurrence."

"When is hysterectomy considered?"

"Last resort if other measures fail; major decision with surgical menopause + fertility implications."

"Heat-based options"

"Heat packs; warm baths; hot water bottle (variable benefit)."

"TENS machine mechanism (lecture)"

"Blocks pain signals and/or increases endorphins → reduced pain perception."

"Physiotherapy role"

"Pain/stress-related support; may be NHS referral option."

"Research gap mentioned"

"Limited evidence on lifestyle & non-pharmacological options; more research needed."

"Fertility impact (endometriosis)"

"Harder to conceive naturally; especially with severe disease; lesions/scarring can disrupt ovulation/tubes."

"Why can severe endometriosis reduce fertility?"

"Lesions in tubes/ovaries + scar tissue + disrupted ovulation/tubal function."

"Can endometriosis be asymptomatic but still present?"

"Yes; may be found incidentally on investigation."

"What is adenomyosis?"

"Endometrial tissue grows into the muscular wall of the uterus."

"Key difference: endometriosis vs adenomyosis"

"Endometriosis = outside uterus; adenomyosis = into uterine muscle wall."

"Typical bleeding pattern in adenomyosis (lecture)"

"Often heavier bleeding."

"Can adenomyosis be asymptomatic?"

"Yes; sometimes found only on scans/investigations."

"Can adenomyosis and endometriosis occur together?"

"Yes; commonly co-exist (lecture notes increasing recognition)."

"What is PCOS?"

"An endocrine (and metabolic) disorder emerging around puberty; characterised by hyperandrogenism + ovulatory dysfunction ± polycystic ovaries."

"PCOS is best described as"

"A syndrome (cluster of features); not just “”cysts.””"

"Common hyperandrogenism features"

"Acne; excess facial/body hair in patterns not expected."

"Ovulation in PCOS"

"Often irregular (can still occur; but not monthly/regularly)."

"Polycystic ovarian morphology means"

"Multiple underdeveloped follicles on ovaries seen on ultrasound (cyst-like appearance)."

"Difference: polycystic ovaries vs PCOS"

"Polycystic ovaries alone ≠ PCOS; PCOS needs ≥2 diagnostic features."

"What happens to follicles in polycystic ovary morphology (lecture)?"

"Follicles remain underdeveloped and may not reach maturation for ovulation."

"Is PCOS cause fully known?"

"No; multifactorial (genetic + environmental)."

"Major mechanism highlighted"

"Insulin resistance plays a big role; relationship may be bidirectional (PCOS ↔ insulin resistance)."

"Hormonal pattern described (lecture)"

"High insulin → higher androgens; often high LH; FSH “”not quite right”” → poor follicle development."

"Why does ovulation fail despite LH (lecture explanation)?"

"Follicle may not mature enough to release an egg."

"What is synthesised instead of oestrogen in the lecture’s explanation?"

"More androgens (linked to clinical features)."

"PCOS diagnostic requirement (lecture)"

"At least 2 of: ovulatory dysfunction; hyperandrogenism (clinical/biochemical); polycystic ovarian morphology on ultrasound."

"How can ovulatory dysfunction be inferred clinically?"

"Infrequent/absent periods + menstrual diary."

"Biochemical marker commonly checked"

"Total testosterone (often elevated)."

"Other blood markers mentioned"

"SHBG; free androgen index; LH/FSH (may require repeats)."

"Why might repeated hormone checks be needed?"

"Hormones fluctuate across cycle."

"Ultrasound purpose in PCOS"

"Detect polycystic ovarian morphology (“”cyst-like”” follicles)."

"Differentials to rule out (lecture examples)"

"Hypothyroidism; premature ovarian insufficiency; other causes of similar symptoms."

"Major complication: type 2 diabetes risk"

"Increased due to insulin resistance + weight gain risk."

"Insulin resistance prevalence in PCOS (lecture)"

"~80%."

"Factor that worsens insulin resistance risk"

"Being overweight."

"Menopause interaction (lecture)"

"Menopause fat redistribution/weight gain may further increase type 2 diabetes risk in PCOS."

"PCOS and fertility"

"Single most common cause of infertility in young patients (lecture claim) due to ovulatory dysfunction."

"Cardiovascular risk drivers"

"Increased BMI; hypertension risk; altered metabolic profile."

"Other issues noted"

"Sleep impact; psychological disorders; pregnancy complications."

"Cancer risk mentioned"

"Increased risk of endometrial cancer."

"Core principle of PCOS management"

"Patient education + reduce long-term metabolic risks + optimise hormones."