Endometriosis Follow-Up Consultation Letter

Patient Information

• Name: Sarah Jenkins
• Date of Birth: 14/05/1992
• Medical Record Number: NHS-482-910-3847

Date of Consultation: 24/10/2023

Referring Physician: Dr Alistair Vance, GP

Clinical History

• Follow-up for stage III endometriosis. Pt reports persistent cyclic pelvic pain, severe dysmenorrhoea, and deep dyspareunia despite conservative management. Also notes worsening cyclical R-sided sciatica and LBP, prompting joint orthopaedic/gynaecological review.
• Diagnostic laparoscopy and ablation of superficial peritoneal endometriosis (2019). Mild asthma.
• Dienogest (Visanne®) 2 mg PO OD, naproxen 500 mg PO BD PRN, paracetamol 1,000 mg PO QDS PRN, evening primrose oil 1,000 mg PO OD.
• Non-smoker, 4 units EtOH/week. Works as a graphic designer; lives with partner. Nulliparous, planning pregnancy in 2–3 years.
• NKDA.

Examination

• Soft, non-distended. Mild deep tenderness in LIF and suprapubic region. No guarding or rebound.
• Retroverted uterus with reduced mobility. Palpable, tender nodularity along the R uterosacral ligament and cul-de-sac. No adnexal masses appreciated.
• Anteverted uterus of normal size. 3.2 cm × 2.8 cm left ovarian endometrioma with ground-glass echogenicity. Negative sliding sign posteriorly, suggestive of POD obliteration.

Assessment Discussion

• Recurrent deep infiltrating endometriosis (DIE) with L ovarian endometrioma and probable R uterosacral/sciatic nerve root involvement.
• Adenomyosis, pelvic inflammatory disease, mechanical radiculopathy (discogenic).

Plan

• Continue dienogest 2 mg PO OD. Request urgent pelvic and lumbosacral plexus MRI to map deep infiltrating lesions and assess for neural impingement. List for laparoscopic excision of DIE and L ovarian cystectomy once imaging is reviewed. Referral to pelvic floor physiotherapy.
• Review in clinic in 6 weeks with MRI results to finalise surgical approach (joint gynaecology/orthopaedics).
• Discussed surgical risks including bowel, bladder, and ureteric injury, as well as potential impact of ovarian cystectomy on ovarian reserve (AMH levels to be checked). Advised to attend A&E if experiencing acute severe abdominal pain, fever, or sudden neurological deficits in the lower limbs.

Sincerely,

Mr David Thorne, FRCS, MRCOG Consultant Gynaecologist & Pelvic Surgeon St Thomas' Hospital, Westminster Bridge Rd, London SE1 7EH Tel: 020 7188 7188 | Email: d.thorne@nhs.net