Endometriosis

In endometriosis, cells that normally grow inside the uterus (womb), instead grow outside the uterus. Summary: Endometriosis is very common; the cause — and why some women have endometriosis and many others do not — has not been fully fathomed, although there are several prevalent theories; most women with endometriosis have no symptoms; but pelvic pain during menstruation or ovulation is a frequent symptom of endometriosis; endometriosis may be suspected by during a physical examination; it is confirmed by surgery, usually laparoscopy; the available treatment includes medication for pain, hormone therapy, and surgery. Endometrial cells line the uterus and are normally shed each month during menstruation. When endometrial cells grow outside the uterus, the cells implant. These implants occur most commonly within the fallopian tubes and on the outside of the tubes and ovaries, the outer surface of the uterus and intestines and anywhere on the surface of the pelvic cavity. They can also be found, less often, on the surface of the liver, in old surgery scars or, very rarely, in the lung or brain. Endometrial implants respond to the hormones of the menstrual cycle just as does the normal endometrium. The implants build up during the month and then they break down and during menstruation they bleed internally. Blood from the implants cannot leave the body via the vagina (or by other exit). The internal bleeding, tissue inflammation and, later, scarring cause the symptoms of endometriosis. Endometriosis occurs in the reproductive years. The average age at diagnosis is 25-30. (It has been reported in girls as young as 11.) The central theory of the cause of endometriosis is retrograde menstruation. Blood and endometrium tissue from the uterus back up into the fallopian tubes and drip into the pelvic and abdominal cavity. Retrograde menstruation may, it is thought, be due to a defect in the uterus or it may be related to the way the uterus contracts when it is expelling the menstrual tissue. Genetic factors and the immune system probably are also important in determining which women develop endometriosis and where the endometrial cells implant. The common symptoms and signs are pain (usually pelvic) and infertility. Pelvic pain usually occurs during or just before menstruation and lessens after menstruation. Some women experience pain or cramping with intercourse, bowel movements and/or urination. Even a pelvic examination by a doctor can be painful. The intensity of pain may change from month to month and vary greatly among women. Some women experience progressive worsening of symptoms while others can have resolution without treatment. Endometriosis can cause infertility. When laparoscopy is done for infertility studies, endometrial implants can be found in some patients, many of whom may not have painful symptoms of endometriosis. It believed that endometriosis bleeding, inflammation, and scarring can cause distortion of the female reproductive organs (such as obstruction of the fallopian tubes), resulting in infertility. However, the severity of the disease is not necessarily directly related to the degree of infertility.

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Ectopic occurrence of endometrial tissue, frequently forming cysts containing altered blood. SYN: endometrial implants. [endometrium + -osis, condition]

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en·do·me·tri·osis .en-dō-.mē-trē-'ō-səs n, pl -oses -.sēz the presence and growth of functioning endometrial tissue in places other than the uterus that often results in severe pain and infertility see ADENOMYOSIS

en·do·me·tri·ot·ic -trē-'ät-ik adj

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n.

the presence of tissue similar to the lining of the uterus (see endometrium) at other sites in the pelvis or, rarely, throughout the body (e.g. in the lung, rectum, or umbilicus). It is thought to be caused by retrograde menstruation. When the tissue has infiltrated the wall of the uterus (myometrium) the condition is known as adenomyosis. The tissue may also be found in the ovary, Fallopian tubes, pelvic ligaments, on the pelvic peritoneum, and even in the cervix and the vagina. This tissue undergoes the periodic changes similar to those of the endometrium and causes pelvic pain and severe dysmenorrhoea. The pain is usually worse immediately before, and at the beginning of, menstruation but usually ceases after menstruation. The symptoms resolve in pregnancy and after the menopause. Treatment is normally to down-regulate ovarian function with analogues of gonadotrophin-releasing hormone, such as goserelin (see LHRH analogue). Surgical treatment may also be necessary, usually by laser or ablative therapy via laparoscope. More radical surgical treatment in the form of a total abdominal hysterectomy and bilateral salpingo-oophorectomy is sometimes required.

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en·do·me·tri·o·sis (en″do-me″tre-oґsis) [endometrium + -osis] a condition in which tissue containing typical endometrial granular and stromal elements occurs in locations outside the uterine cavity, chiefly on the ovaries and pelvic peritoneum; called also adenomyosis externa and e. externa. endometriotic adj