ENDOMETRIOSIS

INTRODUCTION

  • Presence of endometrial glands and stroma outside the of the normal location.
  • Cells from the lining of the uterus (endometrium) appear and flourish outside the uterine cavity
  • Most commonly found on the pelvic peritoneum but may also be found on the ovaries, rectovaginal septum, ureter, and rarely in the bladder, pericardium, gluteal muscles, abdominal scar and pleura

 

PREVALENCE

  • Most women who are diagnosed with endometriosis are aged between 25 to 35 years (reproductive-aged).
  • More common in Caucasian women than in African American or Asian women.
  • Tends to occur most commonly in taller, thin women with a low body mass index (BMI).

 

 

CAUSES

  • The endometrium is the inner layer of uterine tissue that is shed during menstruation.
  • The endometrium is at its thinnest immediately following menstruation and thickens during the first two weeks of the menstrual cycle.
  • Once the release of the egg (ovulation) has occurred, the endometrial tissue becomes rich in glands.
  • The whole process prepares the uterus for the attachment of a fertilized egg.
  • If implantation does not occur, the endometrial layer is shed, and bleeding, known as menstruation
  • Endometriosis occurs when growth of this endometrial tissue develops outside the uterus. This growth usually occurs within the pelvic region on the ovaries and other pelvic structures

 

 

STAGES

  • Stage I (Minimal)

–     Findings restricted to only superficial lesions and possibly a few filmy adhesions

  • Stage II (Mild)

–     In addition, some deep lesions are present in the cul-de-sac

  • Stage III (Moderate)

–     As above, plus presence of endometriomas on the ovary and more adhesions.

  • Stage IV (Severe)

–     As above, plus large endometriomas, extensive adhesions.

 

 

SYMPTOMS

  • Symptoms of endometriosis-related pain may include:

–     dysmenorrhea – painful, sometimes disabling cramps during menses; pain may get worse over time (progressive pain), also lower back pains linked to the pelvis

–     chronic pelvic pain – typically accompanied by lower back pain or abdominal pain

–     dyspareunia – painful sex

–     dysuria – urinary urgency, frequency, and sometimes painful urination

 

 

TREATMENTS

i) Medical treatments

–     Progesterone or Progestins:

  • Progesterone counteracts estrogen and inhibits the growth of the endometrium.

–     Oral contraceptives

  • Reduce the menstrual pain associated with endometriosis. They may function by reducing or eliminating menstrual flow and providing estrogen support.

–     Danazol (Danocrine) and gestrinone

  • Both agents inhibit the growth of endometriosis but their use remains limited as they may cause hirsutism(excessive hairiness on women) and voice changes.

ii) Surgical Treatments

  • Procedures are classified as

–     Conservative  when reproductive organs are retained

  • Consists of the excision (called cystectomy) of the endometrium adhesions, resection of endometriomas, and restoration of normal pelvic anatomy as much as is possible.

–     Semi-conservative when ovarian function is allowed to continue

  • preserves a healthy appearing ovary, and yet, it also increases the risk of recurrence.

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