Endometriosis
When endometrial tissue appears outside the lining of the uterine cavity, endometriosis results. Such ectopic tissue is generally confined to the pelvic area, most commonly around the ovaries, uterovesical peritoneum, uterosacral ligaments, and the cul-de-sac, but it can appear anywhere in the body.
Ectopic endometrial tissue responds to normal stimulation in the same way as the endometrium. During menstruation, the ectopic tissue bleeds, which causes inflammation of the surrounding tissues. This inflammation causes fibrosis, leading to adhesions, which produce pain and infertility.
Active endometriosis usually occurs between ages 30 and 40, especially in females who postpone childbearing; it’s uncommon before age 20. Severe symptoms of endometriosis may have an abrupt onset or may develop over many years. This disorder usually becomes progressively
severe during the menstrual years but tends to subside after menopause.
severe during the menstrual years but tends to subside after menopause.
Causes
The direct cause is unknown, but familial susceptibility or recent hysterotomy may predispose a female to endometriosis. Although neither of these possible predisposing factors explains all the lesions in endometriosis or their location, research focuses on the following possible causes:
Transportation (retrograde menstruation). During menstruation, the fallopian tubes expel endometrial fragments that implant outside the uterus.
Formation in situ. Inflammation or a hormonal change triggers metaplasia.
Induction (a combination of transportation and formation in situ). The endometrium chemically induces undifferentiated mesenchyma to form endometrial epithelium. (This is the most likely cause.)
Immune system defects. Endometriosis may result from a specific defect in cell-mediated immunity. Researchers have documented higher titers of antibodies to endometrial antigens in patients with this disorder.
Complications
The primary complication of endometriosis is infertility. Other complications include spontaneous abortion, anemia due to excessive bleeding, and emotional problems due to infertility.
Assessment
The patient may complain of cyclic pelvic pain, infertility, and acquired dysmenorrhea. The patient typically reports pain in the lower abdomen, vagina, posterior pelvis, and back. This pain usually begins from 5 to 7 days before menses, reaches a peak, and lasts for 2 to 3 days. It differs from primary dysmenorrheal pain, which is more cramplike and concentrated in the abdominal midline. However, the severity of pain doesn’t necessarily indicate the extent of the disease.
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