by Patrick Mccormack

Created on: May 10, 2008   Last Updated: May 21, 2008

Endometriosis is the term that is used to describe the presence of endometrial stroma or glands in tissues outside of the uterine body. It occurs within the following sites, descending in the order of most commonly occurring.

1) Ovaries
2) Uterine ligaments
3) Rectovaginal septum (separating the vagina and the rectum)
4) Pelvic peritoneum
5) Laparotomy scars
6) And rarely in the umbilicus vagina, vulva or appendix

Clinically the condition is extremely important as it causes dysmenorrhoea (severe uterine pain during menstruation), infertility and pelvic pain along with other common problems. Endometriosis frequents approximately 10% of women affecting those of an active reproductive life, more often within their third and fourth decades.

The clinical signs and symptoms of endometriosis usually consist of pelvic pain (due to the intra pelvic bleeding and periuterine adhesions), dyspareunia (painful sexual intercourse) and sever dysmenorrhoea. If pain on defecation is experienced then this is normally a sign of rectal wall involvement however if dysuria (painful urination) is experienced then this normally indicates involvement of the bladder serosa. Menstrual disturbances may also occur but within around 30% to 40% of women, infertility is the common presenting complaint. A positive to this disorder is that malignancies rarely develop within the endometriotic lesions.

To treat the disorder the clinical symptoms rather than the causes may be treated first, such as painkillers for the pain or hormone control to aid in the relief of the menstrual symptomatic causes. If the problem persists after initial treatments then usually the uterus and any adhering lesions are removed surgically. The lesions and tissue removed will be sent for histological examination for a conformation of the diagnosis and examination for any further underlying causes.

The exact reasons behind the development of endometriosis in some women are unknown however there are differing hypothesis that exist though none of which have been proven.
1) The regurgitation theory
2) The metaplastic theory
3) The vascular or lymphatic dissemination theory.

Hormonal, genetic and immune factors have also been put forward as to increasing a woman's susceptibility to endometriosis. These theories are based on finding differences between normal endometrial tissue and endometriotic tissue. Such as finding the enzyme aromatase cytochrome p450 (whose function is to aromatize androgens producing estrogens) within endrometriotic tissue but not in the normal endometrium. Other investigations have also noted the difference between biochemicals within these two differing endometrial tissues, which could also be responsible for this condition.

Endometriosis can be traumatic both physically and psychologically for any woman whom may develop it. It can be largely painful, uncomfortable and worrying for the sufferer however treatment is generally successful and the long-term prognosis of recurrence is unlikely.

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