Endometriosis
They are contraindicated in parous women with endometriosis
ENDOMETRIOSIS
- Definition: presence of endometrial glands and stroma outside the uterine cavity
- theories of pathogenesis:
- Retrograde menstruation — menstrual tissue flows backward through fallopian tubes into pelvis
- Coelomic metaplasia — peritoneal mesothelium transforms into endometrial-type tissue
- Vascular/lymphatic spread — endometrial cells spread via blood or lymphatics to distant sites
Read this in General Pathology Revision: Cell Injury, Inflammation & Adaptation (MBPA 3500 Pa
What our notes say
- They are contraindicated in parous women with endometriosis (Junior Clerkship in Reproductive Health (MBOG 4200): end of year examination, 4 )
- Endometriosis is an indication, and young nulliparous women can use them. (Junior Clerkship in Reproductive Health (MBOG 4200): end of year examination, 4 )
- Tubal damage (infection, surgery, endometriosis), an IUD, and assisted conception are. (Obstetrics II CAT: miscarriage, pregnancy physiology and antenatal care, 26 MCQs)
- The foci of endometriosis are most often found on serosal surfaces in the pelvis, but can be found in other locations such as the surface of the bowel. (Female system — Past Paper Questions & Answers)
- ONE of the following is the most common site of endometriosis: (Medical MCQs: Chemical Pathology & Haematology Exam Review)
- Assisted reproduction, smoking, endometriosis, or tubal anomalies (Reproductive Health 1 End of Trimester CAT: ectopic pregnancy, ANC and abortion )
Study material on Endometriosis
- Female & Male Genital Pathology: Ulcers, HPV, Endometriosis, Pre-eclampsia
- Female system
- Female Reproductive Pathology: HPV, Cancer, PCOS & Pregnancy
- Medical MCQs: Chemical Pathology & Haematology Exam Review
- Year 4 Gynaecology CAT 2 (MBOG 4212): 8 October 2021
- Junior Clerkship in Reproductive Health (MBOG 4200): end of year examination, 4 July 2019
- General Pathology Revision: Cell Injury, Inflammation & Adaptation (MBPA 3500 Paper 1)
- Medical Pathology Final Revision: Chemical, Hema, Systemic
- Female Reproductive Pathology — MCQ Quiz
- Pathology by Dr. Irungu
Practice questions on Endometriosis
Adenomyosis differs from endometriosis in that adenomyosis
- Involves functioning endometrium that bleeds cyclically
- Commonly affects distant sites like the lungs and bone
- Derives from the basalis layer and does not bleed cyclically
- Forms chocolate cysts within the ovarian parenchyma
Answer: C. Adenomyosis derives from the stratum basalis which does not respond to hormonal cycling. Endometriosis contains functioning endometrium that undergoes cyclic bleeding. ---
Which theory of endometriosis best explains its occurrence in the lungs and skeletal muscle?
- Metaplastic transformation of coelomic epithelium
- Retrograde menstruation through fallopian tubes
- Direct implantation during surgical procedures
- Vascular or lymphatic dissemination of endometrial cells
Answer: D. Vascular and lymphatic dissemination explains how endometrial tissue reaches distant sites like the lungs, heart, and skeletal muscle where retrograde flow cannot reach. ---
Why are COX-2 inhibitors and aromatase inhibitors useful in treating endometriosis?
- They directly destroy ectopic endometrial implants surgically
- They block HPV-related proliferation of endometrial cells
- They reduce prostaglandin E2 and local oestrogen production
- They stimulate progesterone receptors in the myometrium
Answer: C. Endometriotic tissue has high aromatase activity and elevated PGE2, promoting local oestrogen and survival of ectopic tissue. Both drug classes target these mechanisms. ---
Histologic diagnosis of endometriosis requires at least two of which three features?
- Koilocytosis, stromal fibrosis, and haemosiderin pigment
- Endometrial glands, endometrial stroma, and haemosiderin pigment
- Chocolate cysts, psammoma bodies, and stromal fibrosis
- Columnar epithelium, myxoid stroma, and lymphoid follicles
Answer: B. The three diagnostic features are endometrial glands, endometrial stroma, and haemosiderin pigment. At least two must be present to confirm the diagnosis histologically. ---
ONE of the following is the most common site of endometriosis
- Pelvic peritoneum
- Ovary
- Retrovaginal septum
- Uterine ligament
- Uterosacral ligaments
Answer: B. The ovaries are the most common site for endometrial implants.
Aetiological theories for endometriosis EXCEPT
- Metaplastic theory
- Vascular dissemination theory
- Neoplastic theory
- Regurgitation theory
Answer: C. The neoplastic theory is not a recognized etiological theory for endometriosis. Theories include regurgitation, metaplasia, and dissemination. ---