Endometriosis is a benign disease defined by the presence
of ectopic ( outside the uterus ) endometrial tissue and stroma that can
be associated with pelvic pain and infertility. Endometriosis exhibits
a broad spectrum of clinical manifestations, is prone to progression and
recurrence, and often presents difficult clinical management problems
for women and their clinicians. Endometriosis is a major cause of
infertility and may be present with no symptoms. Some studies indicate
that endometriosis decreases pregnancy rates even though there may be
little visible organ damage.
Most estimates of the prevalence of endometriosis range
from 5% - 20% among women with pelvic pain and 20% - 40% among infertile
women; a general prevalence of 3% - 10% in reproductive - aged women is
likely.
The causes of endometriosis are not clearly understood,
although the most accepted one is the theory of retrograde ( back flow
) menstruation and implantation. Endometriosis tends to cluster within
families. It is six to seven times more prevalent among the first degree
relatives of affected women than in the general population.
Endometriosis is strongly associated with infertility.
In women with advanced stages of endometriosis, grossly distorted pelvic
anatomy or tubal occlusion offers a logical
explanation, but in women with milder disease, any mechanisms that may
be responsible are less obvious. Indeed, whether minimal and mild degrees
of disease can be regarded as a cause of infertility remains highly controversial.
The infertility associated with endometriosis has been attributed to three
primary mechanisms: distorted adnexal anatomy that inhibits or prevents
ovum capture after ovulation, interference with oocyte development or
early embryogenesis, and reduced endometrial receptivity.
Traditional medical therapies for endometriosis have
reduced or eliminated cyclic menstruation. These include multiple medications
with different side - effects: danazol, progestins, oral contraceptives,
and GnRH agonists ( Lupron ).
Overall, the effects of medical treatments on the volume of endometriosis
are similar, but medical treatments are not effective for all but the
smallest of ovarian endometriomas ( less than 1 cm ). Treatment with danazol
or a GnRH agonist may decrease the size of endometriomas but does not
eliminate them.
The objectives of surgical treatment of endometriosis
is to restore normal anatomy, to excise or destroy all visible disease,
and to prevent or delay recurrence of disease. Surgery
for the treatment of endometriosis can be performed via laparotomy or
laparoscopy. Laparoscopy offers the advantages of better visualization,
less tissue trauma and desiccation, smaller incisions, and a shorter postoperative
recovery. Deeply infiltrating endometriosis involving the rectovaginal
septum requires extensive surgery.
In women with advanced symptomatic disease who
have completed childbearing and those in whom medical and conservative
surgical treatment fails, radical surgical treatment ( hysterectomy and
bilateral removal of the tubes and ovaries ) merits serious consideration
and discussion. The Endometriosis Association is an international organization
that provides education and support for women with endometriosis.
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