Endometriosis
Endometrial tissue outside the uterus

Epidemiology


5-10% women of reproductive years are estimated to be affected.
Risk factors
Genetic component (increases the risk by 7 fold)
Late childbearing age
Early menarche
Protective factors

Aetiology



  • Retrograde menstruation Picture1.jpg
Retrograde passage of endometrial tissue along the Fallopian tubes driving menstruation. Locations include ovaries, uterosacral ligament, Pouch of Douglas
  • CMI fault
Fault in CMI permitting endometrial growth in ectopic location. The endometrial growth is digested by macrophages into fibrotic tissue.

  • Cyclical hormonal stimulation
This is stimulated by Oestrogen, and to some extent also Progesterone.


Signs and Symptoms


Dysmenorrhea
Non-cyclical pelvic pain
Infertility

Diagnosis


Laparoscopy
Biopsy to confirm

Management


Primary Management
  • NSAIDs
  • OCP

Hormonal Management
  • GnRH agonists e.g. Zoladex
  • Medroxyprogesterone acetate e.g. Provera
  • Danazol
  • Gestrinone
[+] Leronorgestrel intrauterine devices e.g. Mirena
Surgical Management
  • Laser/CO2 ablation of lesions
  • Ovarian cystectomy
  • Hysterectomy with bilateral oophorectomy
N.B. 20-40% recurrence rate


Adenomyosis
infiltration of basal endometrial cells in the uterine muscle myometrium




Chronic Pelvic Pain

Differental Diagnosis




Ovarian cyst
Pelvic Inflammaory Disease/Pelvic Adhesions
Endometriosis
Adenomyosis