Endometriosis

Endometriosis is a benign lesion with cells similar to those lining the uterus, growing
aberrantly in the pelvic cavity outside the uterus. During menstruation, this ectopic
tissue bleeds, mostly into areas having no outlet, which causes pain and adhesions.
Endometrial tissue can also be spread by lymphatic or venous channels. There is a
high incidence among patients who bear children later and have fewer children. It is
usually found in nulliparous women between 25 and 35 years of age and in
adolescents, particularly those with dysmenorrhea that does not respond to
nonsteroidal anti-inammatory drugs (NSAIDs) or oral contraceptives. There appears
to be a familial predisposition to endometriosis. It is a major cause of chronic pelvic
pain and infertility.
Clinical Manifestations
1. Symptoms vary but include dysmenorrhea, dyspareunia, and pelvic discomfort or
pain (some patients have no pain).
2. Dyschezia (pain with bowel movements) and radiation of pain to the back or leg
may occur.
3. Depression, inability to work due to pain, and difculties in personal relationship
may result.
4. Infertility may occur.
Assessment and Diagnostic
Methods A health history, including an account of the menstrual pattern, is necessary
to elicit specic symptoms. On bimanual pelvic examination, xed tender nodules are
sometimes palpated, and uterine mobility may be limited, indicating adhesions.
Laparoscopic examination conrms the diagnosis and enables clinicians to determine
the diseases stage.
Medical Management
Treatment depends on symptoms, desire for pregnancy, and extent of the disease. In
asymptomatic cases, routine examination may be all that is required. Other therapy for
varying degrees of symptoms may be NSAIDs, oral contraceptives, gonadotropinreleasing hormone (GnRH) agonists, or surgery. Pregnancy often alleviates symptoms
because neither ovulation nor menstruation occurs.