Endometriosis is defined as the presence of the normal endometrial (lining of the uterus) tissue in an abnormal location. (As in other than the uterine cavity). It is found in about 8-10% of women , although in the infertile population the rates may be as high as 20-70%.
This tissue responds to the same hormonal stimuli as the normal lining in the uterine cavity, and hence bleeds every month with menstruation. This sets up an inflammatory response in the pelvis, leading to scar tissue formation.
Mechanism of endometriosis:
Several theories have been put forth. The most frequent is that of retrograde menstruation. (The flow of menstrual debris into the peritoneal cavity.) Abnormal hormone regulation, genetic factors, immune dysfunction and changes in the peritoneal cells (metaplasia) have all been implicated in the causation of endometriosis.
Location of endometriosis.
It is usually found in the pelvis. The ovaries, tubes, vagina, cervix, or the ligaments behind the uterus are commonly affected. More unusual locations include previous operative scars, ling, kidney, spleen ureter, bladder, nasal mucosa, and the breast.
Symptoms of endometriosis.
According to the American Society of Reproduction (ASRM), “Endometriosis should be viewed as a chronic disease that requires lifelong pain management plan with the goal of maximizing the use of medical treatment and avoiding repeated surgical procedures.”
The symptoms are usually cyclic menstrual pelvic pain, painful intercourse and infertility. Occasionally there may be bladder and bowel symptoms. Sometimes the disease is silent, and may be diagnosed incidentally at the time of surgery for other reasons.
Diagnosis of Endometriosis:
Although the patient’s history and physical examination are suggestive of the disease, the gold standard is a laparoscopy. The surgery allows the staging of the disease as well as a chance to treat the patient.
Staging of endometriosis:
Stage I. Minimal. Few or superficial implants.
Stage II Mild. More implants, deeper endometriosis.
Stage III Moderate. More implants, ovaries affected, adhesions(scar tissue) present.
Stage IV Severe. Similar to Stage III, but multiple and more dense adhesions.