by Dr Elizabeth Menon

Created on: April 28, 2008   Last Updated: July 27, 2008

Endometriosis is defined as the presence of tissue that resembles endometrium that normally lines the inside of the uterus, is seen outside the uterine cavity, such as ovaries, utero-sacral ligaments, pelvic peritoneum, lower genital tract, bladder, bowel or laparotomy scars. Endometriosis is a chronic, debilitating condition that is seen among 7-10% women in the general population.

Causes:

There are many probable causes and theories attributed to this enigmatic condition that does not fit a definite mould. It is estrogen dependent as it is rare before the onset of menstruation and regresses after the menopause.

1. Retrograde Menstruation: Metastatic theory: tubal regurgitation of menstrual blood allows implantation of endometrial cells in the peritoneum, structures in the pelvic and abdominal cavity, especially the ovaries. Endometriosis regresses during pregnancy, which is likely to be due to the suppression of menstruation.

2. The Coelomic Metaplastic Theory: the metaplastic changes of the coelomic epithelium into endometrial glands could explain endometriosis in unusual sites

3. Direct Implantation Theory: direct extension into the myometrium focuses on the most likely cause for Adenomyosis.

4. Lymphatic and Vascular Theory: this probably explains the presence of endometriosis in the lymph nodes and lungs

5. Changes in the immune system and genetics, increasing the susceptibility to endometriosis showing a familial tendency

Symptoms:

There is no real correlation between the extent of endometriosis and the symptoms; the severity of symptoms depends on the site and the complications. Dysmenorrohea is the most common symptom, though cyclical pain and bleeding bleeding from the rectum, the umbilicus or the bladder are also seen. Dyspareunia can be most distressing to the woman and her partner. Hip joint pain due to adhesions and the involvement of the sciatic nerve can be excruciating.

Endometriosis of the ovary can result in ovarian cysts, called chocolate cysts due to the presence of altered blood, the rupture of which can cause inflammation of the peritoneum and severe pain. Adhesions in the pelvis can lead to sub-fertility and infertility. Symptoms and physical findings such as nodular and tender utero-sacral ligament and fixed retroversion of the uterus are suggestive of endometriosis. Identifying the typical blue-black spots or the powder-burn appearance at laparoscopy is the 'gold standard' for diagnosing endometriosis.

Treatment:

symptomatic treatment for pain

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