November
2008
Endometriosis
Endometriosis: endometrial glands and stroma that is present outside the uterus. Prevalence not known. Can be asymptomatic and found on autopsy and incidentally during surgery. But prevalence when involved with other diseases are such: 1% all women undergoing major gynecologic surgery; 1-7% tubal ligation; 12-32% reproductive age with pelvic pain undergoing laparoscopy; 9-50% laparoscopy for infertility; 50% teenagers laparoscopy for chronic pelvic pain or dysmenorrhea.
Risk factors: delayed pregnancy (so professional women might have it more). 25-35yo. Taller, thinner women. Ovarian steroids needed so rare in those menopausal or pre-menarche. Endometriosis might be a risk factor for developing ovarian cancer. The ovarian cancer risk is reduced with OCP but higher with HRT or tamoxifen.
Endometrial tissue goes on in descending order: ovaries, anterior and posterior cul-de-sac, posterior broad ligaments, uterosacral ligaments, uterus, oviducts, sigmoid colon and appendix, round ligament. Appendix in 2-4% cases. Has even been reported in breasts, spine, lungs, and extremities. Can cause adhesions.
Pain usually with menstrual period, but it can be continuous. Pelvic pain, dysmenorrheal, subfertility, deep dyspareunia, cyclical bowel or bladder symptoms, chronic fatigue. If under skin, bruising from the bleeding can be seen! On exam can mimic PID. The endometriosis tissue unlike that in the uterus contains fibrous tissue, cysts, and blood.
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