Clinical symptoms and ultrasound as a method of diagnosis of endometriosis

Abstract

Endometriosis is typically seen during the reproductive years; it has been estimated that it occurs in roughly 5% to 10% of women. The objective of the work was to estimate different symptoms of endometriosis and ultrasound in the diagnosis of endometriosis. The retrospective study was conducted on a group of 60 patients, aged 44 ± 0.5, selected from the Gynaecology Department from the Municipal Clinical Hospital Nr.l, Municipal Clinical Hospital Nr.3 and Oncologic Institute, Chisinau with the diagnosis of endometriosis confirmed histological, in the period 2006-2008 and check group of 24 patients, aged 42,2 ± 2,0, selected from the Gynaecology Department of Women Health Center “Virginia”, Cahul, with the diagnosis of uterine myoma, during the period January - November 2008. Patients were analyzed by the following criteria: clinical symptoms of diseases, ultrasound exam. Endometriosis is most common at the group of women at age of 19-39 (45%) and in the higher socio-economic group. The presumptive diagnosis established were: “uterine myoma, metrorrhagia” - 30 cases (50%), “menorrhagia” - 2 cases (3,3%), endometrial cancer - 2 cases (3,3%), hydateform m ole- 1 case (1,7%), adenomyosis - 13 cases (21,7%), cervix endometriosis and fallopian tubes endometriosis each in 2 separate cases (1,7%) and ovarian endometriosis in 10 cases(16,6%). Most frequent symptoms were dysmenorrhea in 43 cases (71,7±5,8%, p<0,001), pelvic pain associated with headaches in 7 cases (11,7±4,1% , p<0,05), chronic fatigue in 9 cases (15±4,6%, p<0,01), depression in 10 cases (16,7±4,8%, p<0,01), nausea in 3 cases (5±2,8%, p>0,05). Symptoms often worsen in time with the menstrual cycle. Dyspareunia were present in 18 cases (30±5,9 %, p<0,001), disturbance of menstrual cycles were manifested by hypermenorrhea in 11 cases (18,4±5,0% (p<0,001), hyper-polymenorrhea in 21 cases (35±6,1%, p<0,001), menorrhagia in 24 cases (40±6,3%, p<0,001) and in the fact posthemorrhagic anemia was estimated in 20 cases (33,4±6,1%, p<0,001). Infertility were present in 19 cases (31,7±6,0%, p<0,001). Brown pre- and postmenstrual bleeding were detected in 22 cases (36,7±6,2%, p<0,001). Often an enlarged uterus from adenomyosis is misdiagnosed as being from fibroids; this common error can lead to wrong diagnosis. The check group diagnosed with uterine myoma had the following symptoms: in 21 cases (80,7%) there were no clinical symptoms, in 3 cases (11,5%) painful periods and in 2 cases (7,8%) abnormal haemorrhage. Adenomyosis causes the walls of the uterus to thicken and the uterus to become enlarged. During the bimanual exam uterine enlargement corresponding to 6-7 weeks gestation in 7 cases (14,5±4,5%), to 8-9 weeks gestation in 15 cases (31,4±5,6%) and more then 10 weeks gestation in 22 cases (45,8±6,4%). Uterine retroversion was present in 23 cases (47,9±6,4%, p<0,001).In 26 cases (54,2±7,0%, p<0,001) adenomiosis was associated with uterine myoma. Pelvic ultrasonography imaging was used to identify individual lesions, but these modalities are not helpful in assessing the extent of endometriosis. Even with direct visualization, diagnosis of endometriosis can be difficult. All patients had performed ultrasound exam and just 28 (48,3±6,5%, p<0,001) ultrasound reports had indicated endometriosis as a possible diagnosis based on ultrasound findings, and that because of the fact that ultrasound exam wasn’t perform pre- and postmenstraul to detected the pathognomonic signs of endometriosis (the size of uterus before and after menstruation vary in 2 weeks gestation). Dysmenorrhea in 71,7±5,8%, hyper-polymenorrhea in 35±6,1%,brown pre- and postmenstrual bleeding in 36,7±6,2%, uterine enlargement are the common symptoms of endometriosis and ultrasound exam had indicated endometriosis as a possible diagnosis in 28 cases (48,3±6,5%).