- 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
- 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).
- 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
- 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 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
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.