Overview
Endometriosis occurs when tissue similar to the uterine lining (endometrium) grows outside the uterus. It commonly involves organs like the ovaries, fallopian tubes, and the tissue lining the pelvis.Definition
Endometriosis is a condition where endometrial glands and stroma are found outside the uterus, where they abnormally attach and grow. This displaced tissue continues to act as it normally would inside the uterus, causing pain and other symptoms.Causes
1. Retrograde Menstruation
The most widely accepted theory is that menstrual blood flows backward through the fallopian tubes into the pelvic cavity, where endometrial cells implant and grow.2. Coelomic Metaplasia
This theory suggests that certain cells in the pelvic lining transform into endometrial-like cells in response to specific stimuli.3. Induction Theory
A combination of the previous theories, this posits that unidentified substances from the endometrium induce mesenchymal tissue to develop into endometrial-like tissue.4. Immune System Dysfunction
Since retrograde menstruation happens in most women, immune system defects may explain why only some develop endometriosis.5. Genetic Factors
Women with a close relative who has endometriosis are about seven times more likely to develop the condition. However, the exact genetic mechanisms are unclear, pointing to a multi-factorial cause involving both genes and environment.Symptoms
1. Pelvic Pain
Chronic pelvic pain, especially during menstruation, is the most common symptom. Pain often starts before menstruation and continues throughout. Adolescents may experience severe pain from their first period.2. Dyspareunia (Pain During Intercourse)
Painful intercourse is another frequent symptom, caused by pelvic tissue adhesion or pressure on the ovaries and other areas affected by endometriosis.3. Infertility
While debated, endometriosis is known to lower fertility rates, especially in moderate to severe cases where the fallopian tubes are affected.4. Other Symptoms
Symptoms such as urinary issues, gastrointestinal problems, and fatigue may arise, particularly if the endometriosis affects organs outside the pelvis, such as the bladder or intestines.Diagnosis
1. Symptom Review
Diagnosing endometriosis begins with evaluating the symptoms, particularly pelvic pain and other related discomforts.2. Physical Examination
A pelvic exam may reveal abnormalities like a retroverted uterus, enlarged ovaries, or tenderness in specific areas like the uterosacral ligament.3. CA-125 Blood Test
Elevated levels of the cancer marker CA-125 can indicate endometriosis, though this test lacks specificity as CA-125 can also be elevated in other conditions.4. Imaging
Ultrasound, MRI, and sometimes CT scans can assist in diagnosing endometriosis, though they may be limited in distinguishing endometriosis from other conditions.5. Laparoscopy
The gold standard for diagnosing endometriosis is laparoscopy, where surgeons visually inspect and, if necessary, biopsy suspicious tissue.Treatment Options
1. Surgical Treatment
The primary goal of surgery is to remove or destroy endometriotic lesions while preserving reproductive organs. Laparoscopy is the most common surgical method, though more invasive surgery might be needed in severe cases.2. Hormonal Therapy
Hormonal treatments aim to reduce or stop menstruation, thereby limiting the growth of endometrial tissue. Options include:- Oral contraceptives
- Progestins
- Gonadotropin-releasing hormone (GnRH) agonists
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