Endometriosis, Cervical erosion, Clinical features and treatment

Endometriosis:

Presence of functioning endometrium in sites other than Uterine mucosa.

• Adenomyosis:- When Endometrial tissue lies in the Myometrium, it is locally invasive and disseminates widely.

Common sites:-

• Ovaries
• Pelvic peritoneum
• Pouch of Douglas
• Sigmoid colon
• Appendix
• Uterosacral ligaments
• Rectal vaginal sputum

Clinical features:-

• In 25% cases, there are no symptoms and the disease is diagnosed accidentally.
• Depth of penetration is related to symptoms rather than the spread. Lesions penetrating more than 5 mm are responsible for pain;

1. Dysmenorrhea (70% cases)
2. Abnormal menstrual (20% cases)
3. Infertility (40-60% cases)
4. Chronic Pelvic pain
5. Dyspareunia
6. Abdominal pain

Diagnosis:-

Increasing secondary Dysmenorrhea, dyspareunia and Infertility. Moderate elevation of Serum CA125.

Imaging:-

• USG, MRI, CT, Colonoscopy, Laproscopy and Cystoscopy.
• Laproscopy is considered as gold standard.

Complications:-

• Endocrinopathy
• Rupture of chocolate cyst
• Infection of chocolate cyst
• Intestinal obstruction
• Ureteral obstruction

Treatment:-

1. Preventive– Avoid tubal patency test immediately after Curettage or around the time of menstruation.
2. Forcible pelvic examination should not be performed.
3. Family history of conception need to be checked.
4. Curative– Abolish or minimise symptoms. Improve fertility and prevent recurrence.

Hormones and Drugs:-

• Combined estrogen and progesterone
• Danazol
• Gestinone
• GnRH analogues
• Progesterones- oral- Norethisterone and Medroxy pregesterone acetate
• IM- Medroxy progesterone
• IUCD- Levonorgesterol releasing IUCD.

Cervical Erosion (Ectopy):

Cervical ectopy is a condition in which the squamous epithelium of the ectocervix is replaced by the columnar epithelium; which is itself continuous with the endocervix.

Causes:-

1. Congenital– At birth, in about one-third cases. This condition condition contunues on for a few days till the level of Oestrogen derived from mother falls and thus heals on its own.
2. Acquired– It occurs when the Oestrogen level is high, and happens in pregnancy and among pill users.

Clinical features:-

Symptoms=

• Vaginal discharge may be excessively mucoid, offensive and irritant in presence of infection.
• Associated Cervicitis may produce backache, pelvic pain and sometimes Infertility.

Signs=

Internal examination; done by Per speculum- There is bright red area surrounding and extending beyond the external os in the ectocervix. The edge is clearly demarcated. The lesion is neither tender, nor bleeds to touch.

Diagnosis:-

The Diagnosis is confused with ectropion, early carcinoma, primary lesion or tubercular ulcar. Biopsy confirms the diagnose for tubercular ulcar and carcinoma.

Management:-

• If, the disease is detected during pregnancy and puerparium; its treatment is held for at least 12 weeks.
• Pills must be stopped.
• Surgical treatment by- Cryosurgery, Thermal cauterisation and laser vaporisation.