Endometriosis is a chronic condition where tissue similar to the lining of the uterus (endometrium) starts to grow in other places, such as the ovaries, fallopian tubes, and along the pelvis.
Epidemiology:
Commonly affects women of reproductive age.
Etiology:
The exact cause is unknown.
Theories include retrograde menstruation, metaplastic transformation, and genetic factors.
Risk factors: Family history, menstrual factors (such as early menarche, short cycles), and never having been pregnant.
Pathophysiology:
Endometrial-like tissue outside the uterus behaves like it would inside the uterus: thickening, breaking down, and bleeding with each menstrual cycle.
Unlike the endometrial lining, this tissue has no way to exit the body, leading to inflammation, pain, and the formation of scar tissue (adhesions).
Clinical Features:
Dysmenorrhea (painful periods).
Chronic pelvic pain.
Pain during or after sexual intercourse.
Infertility.
Other symptoms may include painful bowel movements or urination, fatigue, diarrhea, constipation, bloating, and nausea, especially during menstrual periods.
Diagnosis:
Based on symptoms, clinical examination, and history.
Ultrasound can be used as an initial imaging modality.
Definitive diagnosis often requires laparoscopy with biopsy of lesions.
Management:
No cure, but treatments focus on symptom relief and management of infertility.
Pain management: NSAIDs, hormonal contraceptives.
Hormone therapy: Gonadotropin-releasing hormone (GnRH) agonists and antagonists, progestin therapy.
Surgical options: Laparoscopic removal of endometriosis implants, adhesiolysis, hysterectomy with or without removal of ovaries.
Prognosis:
Chronic condition with symptoms typically improving after menopause.
Fertility issues can be a significant concern for some women.
