Endometriosis.- General Gynaecology module part2

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A nulliparous woman had dysmenorrhea and history of subfertility. On laproscopy she was
found to have grade 3 endometriosis. Which of the following would be the treatment of
choice in her case?


A 34-year-old woman presents with chronic pelvic pain. The pain is worse during the
premenstrual period, associated with fatigue, and is exacerbated by standing, walking and
gardening. The pain worsens after intercourse, resulting in a throbbing ache afterwards. This
has resulted in significant relationship difficulties.
What is the definitive investigation to establish the diagnosis in this case?


. A 35-year-old woman presents to the gynaecology clinic with pelvic pain and
dysmenorrhoea. A pelvic examination demonstrates tenderness and fullness in
the right iliac fossa. Which test should be used to diagnose or exclude an ovarian


Ms XY is 38 years old and suffers from primary infertility and endometriosis. Her
recent TV scan suggests the presence of a 2.5 cm endometrioma. Her pain is well
controlled using simple analgesics.
She is due to undergo IVF. Which treatment is best suited to deal with her


A 25-year-old presents with lower abdominal pain of 12 months
duration. The pain is worse around her menses, which are also heavy.
Sexual intercourse is painful. She has altered bowel habits especially
around menstruation. You suspect that she may have either irritable
bowel syndrome or endometriosis or both. What approach will you take
to differentiate between the two conditions?


8. A 30-year-old nulliparous woman is referred to you complaining of cyclical pelvic pain
and abdominal swelling. A pelvic ultrasound suggests a diagnosis of adenomyosis. What
is your first-line management?


A 44-year-old woman had a total abdominal hysterectomy with bilateral
salpingo-ophorectomy for long-standing pelvic pain due to severe endometriosis. On her
return home she is struggling to climb the stairs. There is also some abnormal sensation
over the thigh as well as her right calf. On examination, the GP has established a loss of the
knee jerk reflex.
Which nerve/s is most likely to have been injured during the operation?


Young patient with history of lower abdominal pain more intense near periods, intense
dyschezia and relieved after that she wants to know whether it is IBS or endometriosis. What
is your investigation?


A 24-year-old woman, virgo intacta, presents to the gynaecology clinic with
abdominal and pelvic pain, dysmenorrhoea and dyschezia. What is the most
appropriate initial assessment for the diagnosis of endometriosis?


A 38-year-old woman presents to the gynaecology clinic with a two year history of worsening
non-cyclical pelvic pain and dysmenorrhoea. An USS pelvis was normal. She has no other
medical history of note and smokes 10 cigarettes per day.
What is the most appropriate initial treatment?



You are consenting a patient prior to laparoscopic resection of extensive endometriosis.
What is the most common major complication of gynaecological laparoscopic surgery?

13) Which carcinoma associated with endometriosis?


A 23 year old woman with a 3 year history of pelvic pain and deep dyspareunia has been
consented for a diagnostic laparoscopy because her symptoms have not responded to
medical treatment. At laparoscopy, she is found to have deposits of endometriosis in the
ovarian fissae, utero-sacral ligaments and bilateral 3-4cm ovarian endometriomas with

H MRI pelvis
I Dilatation and curettage J Endocervical and urethral swabs
K Commence combined oral contraceptive pill L Levonorgestrel IUS
M Refer to pain clinic N Refer to gastroenterologist


A 30-year-old presents to the clinic with lower abdominal pain,
altered bowel habits, dyspareunia and dysmenorrhoea. Clinical
examination fails to identify any signs of pathology. You suspect irritable
bowel syndrome.
What first treatment will you recommend?


Lady C/O chronic pelvic pain that worsens during menstruation . what are the chances that
she has endometriosis


22. A 32-year-old woman with pain is diagnosed to have endometriosis. She has been trying
to conceive for over 18 months. Which of the following is true?

18) TAH+BSO done for endometriosis now depression and hot flushes


A 30 yr old nulliprous womn married since 10 yrs came wth complain of lower abdominal
pain dysmenorhea n dyspareunia ultrasoind shows complex adnexal mass of 10 cm ×10 xm
the msot proble dignosis is


A 53-year-old woman is referred to gynaecology clinic with a 12 month history of bloating,
change in stool frequency and intermittent pelvic pain. She is still having regular periods and
has no other medical or surgical history of note.
What is the most important first investigation to perform?


A 25-year-old woman has been trying to conceive for 2 years. She has painful periods and
occasional dyspareunia. On examination, the GP felt that the uterus was retroverted with
reduced mobility and there were palpable nodules in the rectovaginal septum. The GP has
done the following investigations:
full blood count – normal
thyroid function – normal
day 21 progesterone – normal
FSH and LH level - normal
rubella serology – immune
Chlamydia swab – negative
pelvic ultrasound – normal
partner's semen analysis – normal.
She is now referred to the gynaecology outpatient clinic.
Which is the most appropriate management now?


A woman with a previous diagnosis of pelvic endometriosis presents to the clinic
with cylical rectal bleeding. Vaginal and rectal examinations are inconclusive.
What is the most appropriate initial assessment to identify or exclude rectal

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