endometriosis
ENDOMETRIOSIS

Endometriosis is having extrauterine endometrial tissue that causes chronic inflammatory response.

The patient experiences chronic pelvic pain, pain during intercourse and/or menstruation and infertility.

Diagnosis is attained by pathologic examination of the tissue obtained from laparoscopy or laparotomy.

Goals of treatment are decreasing pain, enhancing fertility, and preventing progression or recurrence. 

 

Definition

  • An estrogen-dependent disease wherein endometrial-like tissue is found outside the uterus inducing a chronic inflammatory response
    • Pelvic organs (especially ovaries) and peritoneum are frequently affected
  • 5-10% of reproductive-aged women are affected
  • Prevalence is higher in Asian women while a lower incidence is found among African women as compared to Caucasians 

Etiology

  • Pathogenesis of endometriosis remains unclear but theories for its cause include:
    • Genetics, particularly among the patient’s 1st-degree relatives  
    • Retrograde menstruation  
    • Immune system problems  
    • Metaplastic changes of the peritoneal coelomic mesothelial cells
    • Spread of ectopic menstrual tissue via the bloodstream or lymphatic system
    • Increase in estrogen sensitivity with increase in progesterone resistance

Signs and Symptoms

  • Main clinical features include:
    • Chronic pelvic pain (found in 70-82% of patients)
    • Dyspareunia (suggests deep posterior infiltration)
    • Infertility (21% prevalence rate)
  • Other symptoms may include severe dysmenorrhea, pain on ovulation, noncyclical pelvic pain, cyclical bowel or bladder symptoms with or without abnormal bleeding or pain, dyschezia, dysuria, chronic fatigue, or abdominal or lower back discomfort
    • In adolescents, endometriosis is the most common cause of secondary dysmenorrhea
  • Although it is vital to consider the patient’s complaints affecting physical, mental and social well-being, it should be noted that patients with endometriosis may be completely asymptomatic (with 2-22% prevalence rate)

Types of Endometriosis

  • Types of endometriosis include: 
    • Adenomyosis (asymmetrical uterine enlargement)
    • Ovarian endometriomas or chocolate cysts
    • Peritoneal endometriosis
    • Deep infiltrating endometriosis (lesions that penetrate >5 mm)
    • Disseminated endometriosis
  • Complications of endometriosis include pain, fertility problems, and risk of developing ovarian cancer 
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