Endometriosis

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It is the presence of endometrial glands and stroma in locations other than the uterine endometrium  and  musculature.  The  common  locations  of  endometriosis  include  the  pelvis,  small  intestines,  bowels, appendix, anterior abdominal wall and incision scars 

Clinical presentation 

 

      Chronic  pelvic  pain,  lower  back 

pain and rectal pain 
      Dysmenorrhea 

      Dyspareunia 

Management at Dispensary and Heath center 

 

      Dysfunctional uterine bleeding      Infertility 

 

A: ibuprofen (PO) 200–600mg 8hourly (maximum 2.4 g/day) 

         OR 

A: acetylsalicylic (PO) acid 300–600mg 4hourly 

                                     OR              

A: diclofenac (PO) 50–100mg 8–12hourly 

OR 

B: mefenamic acid (PO) 500mg 8hourly 

OR 

A: hyoscine butyl bromide (PO) 20mg 8hourly for 5days 

Referral: Refer the patient with endometriosis to hospital for further investigations and management. 

Management of endometriosis at Hospital  Investigations 

• Abdominal pelvic/transvaginal ultrasound 
• CT scan 
• MRI 
• Laparoscopy 

Pharmacological treatment of endometriosis 

A: combined oral contraceptive pills (PO) 1 tab 24hourly for 3months 

OR 

A: medroxyprogesterone acetate (IM) 300mg monthly for 6months. 

OR 

S: danazol (PO) 200-400mg 12hourly depending on the severity. Continue RX to maintain  amenorrhea. 

OR 

S: Goserelin (IM) 3.6mg monthly for 4-6months