Endometriosis

  • presence of endomtrial glands and stroma outside body of uterus
  • may be responsible for inflammation, infertility and pain

Sites

  • pouch of Douglas
  • pelvic peritoneum
  • ovary

Rarer

  • serosal surface of uterus
  • cervix
  • vulva
  • vagina
  • bladder
  • small / large intestine

Aetiology (possible)

  • retrograde menstruation
  • defect in cell-mediated immunity

Pathology

  • implantation of ectopic endometrium
  • miniature cyst
  • haemorrhage into cyst
    • increase in size
    • ?pressure destruction of functional endometrium
  • leakage / rupture
    • irritation
    • adhesions

Clinical features

  • symptom less in 1/4 women
  • associated with other pelvic disorders in 1/4 women
  • pain
    • typically lower abdominal crampy pain
    • starts premenstrually
    • peaks in last few days of menstruation and subsides
    • may be constant pain that varies in intensity
  • menstrual irregularities
    • premenstrual staining, spotting
    • menorrhagia
    • frequent / heavy periods
  • dyspareunia
    • cul-de-sac
    • uterus retroverted and fixed
  • infertility
    • disputable unless lesions severe and anatomy distorted
  • pain on defaecation
  • small masses on pelvic examination (not usually bigger than orange)

Diagnosis

  • Laparoscopy

Complications

  • proportion of endometrial Ovarian Cancer arises from pre-existing endometriosis

Management