Endometriosis

DEFINITION

Endometriosis is the condition in which endometrial tissue is found outside of the uterus, often causing pain and/or infertility.

PREVALANCE

Five to 10% of women in reproductive age

PATHOPHYSIOLOGY

The ectopic endometrial tissue is functional. It responds to hormones and goes through cyclic changes, such as menstrual bleeding.

The result of this ectopic tissue is "ectopic menses," which causes peritoneal inflammation, pain, fibrosis, and, eventually, adhesions.

Tissue in endometriosis is viable and behaves normally.

SITES OF ENDOMETRIOSIS

Common

■ Fallopian tubes

■ Uterosacral ligaments

Less Common

Rare

■ Nasopharynx

Exam scenario: 37-year-old female complains of hemoptysis with each period. Diagnosis: Endometriosis of nasopharynx or lung

Complications of endometriosis: Prolonged bleeding causes scarring ^ adhesions. Adhesions cause infertility and small bowel obstructions.

ADHESIONS

Adhesions from prolonged endometriosis can cause:

■ Infertility from fallopian tube or outer uterine adhesions

■ Small bowel obstruction from intestinal adhesions

THEORIES OF ETIOLOGY

Though the etiology is unknown, there are three theories:

1. Retrograde menstruation: Endometrial tissue fragments are transported through the fallopian tubes and implant there or intra-abdomi-nally.

2. Mesothelial (peritoneal) metaplasia: Peritoneal tissue becomes en-dometrial-like and responds to hormones.

3. Vascular/lymphatic transport: Endometrial tissue is transported via blood vessels and lymphatics.

Dyspareunia (painful intercourse) presents most commonly as pain with deep penetration.

CLINICAL PRESENTATION

Most commonly in women in their late 20s and early 30s:

■ Dysmenorrhea

■ Dyspareunia—implants on pouch of Douglas

Dyschezia (pain with defecation)—implants on rectosigmoid

■ Infertility

■ Vaginal staining (from vaginal implants)

SIGNS

Retroflexed, tender uterus Nodular uterosacral ligaments Ovarian mass (endometrioma) Blue/brown vaginal implants (rare):

■ "Chocolate cyst"—an implant that occurs within the ovarian capsule and bleeds, creating a small blood-filled cavity in the ovary

DIAGNOSIS

1. Laparoscopy or laparotomy: Ectopic tissue must be seen for diagnosis:

■ White implants—oldest

2. Biopsy: Positive findings contain glands, stroma, hemosiderin.

CLINICAL COURSE

30% asymptomatic

If left untreated, most lead to increasing pain and possible bowel complications.

Often, there is improvement with pregnancy secondary to temporary cessation of menses.

TREATMENT

51 Tips for Dealing with Endometriosis

51 Tips for Dealing with Endometriosis

Do you have Endometriosis? Do you think you do, but aren’t sure? Are you having a hard time learning to cope? 51 Tips for Dealing with Endometriosis can help.

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