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-inflammatory 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 difficulties 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 specific symptoms. On bimanual pelvic examination, fixed tender nodules are

sometimes palpated, and uterine mobility may be limited, indicating adhesions.

Laparoscopic examination confirms the diagnosis and enables clinicians to determine

the disease’s 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, gonadotropin-

releasing hormone (GnRH) agonists, or surgery. Pregnancy often alleviates symptoms

because neither ovulation nor menstruation occurs.