A diagnosis of endometriosis denotes the presence of endometrial tissue outancillary the lining of the uterine cavity. Such ectopic tissue is generally confined to the pelvic breadth, best commalone around the ovaries, uterovesical peritoneum, uterosacral ligaments, and cul-de-sac, but it can appear anywhere in the anatomy.

This ectopic endometrial tissue responds to normal stimulation in the aforementioned way the endometrium does. Duarena menstruation, the ectopic tissue bleeds, which causes the surrounding tissues to beappear inflamed. This inflammation causes fibrosis, advanceing to adhesions that produce pain and cause infertility.

Active endometriosis usually occurs between ages 30 and 40, especially in women who columnpone childbearing; it's uncommon beahead age 20. Severe symptoms of endometriosis may accept an abrupt onset or develop over abounding years. This disorder usually becomes progressively severe duarena the menstrual years; In the column menopause, it tends to subside.

Causes of endometriosis

The mechanisms by which endometriosis causes symptoms, including infertility, are unknown. The capital theories to explain this disorder are:

transtubal regurgitation of endometrial corpuscles and implantation at ectopic armpits.
coelomic metaplasia (repeated inflammation may induce metaplasia of mesothelial corpuscles to the endometrial epithelium).
lymphatic or hematogenous spread to account for extraperitoneal disease.

Signs and symptoms of endometriosis

The classic symptom of endometriosis is acquired dysmenorrhea, which may produce constant pain in the lower abdomen as able as the vagina, columnerior pelvis, and aback. The pain usually begins 5 to 7 canicule beahead menses, reaches its aiguille on canicule of bleeding, and aftermosts for 2 to 3 canicule. It differs from primary dysmenorralleviate pain, which is added cramp like and concentrated in the abdominal midline. The severity of pain doesn't necessarily indicate the extent of the disease.

Other clinical features depend on the location of the ectopic tissue:

ovaries and oviducts: infertility and profuse menses
ovaries or cul-de-sac: deep-thrust dyspareunia
bladder: suprapubic pain, dysuria, hematuria
rectovaginal septum and colon: painful defecation, rectal bleeding with menses, pain in the coccyx or sacrum . small bowel and appendix: nausea and vomiting, which worsen beahead menses, and abdominal cramps
cervix, vagina, and perineum: bleeding from endometrial deposits in these breadths duarena menses.

The primary complication of endometriosis is infertility.

Diagnosis of endometriosis

Palpation duarena a pelvic examination may detect multiple tender nodules on the uterosacral ligaments or in the rectovaginal septum in one-third of patients. These nodules enlarge and beappear added tender duarena menses.

Palpation may additionally uncover ovarian enlargement in the presence of endometrial cysts on the ovaries or thickened, nodular adnexa (as in pelvic inflammatory disease). Laparosarchetype is acclimated to conclose the diagnosis and deterabundance the stage of the disaffluence beahead treatment is initiated.

Endometriosis treatment

The stage of the disaffluence and the patient's age and desire to accept children are treatment considerations for endometriosis. In stages I and II (balmy forms with superficial endometria and blury adhesions), conservative therapy for young women who appetite to accept children includes androgens such as danazol, which produce a temporary remission. Progestins and articulate contraceptives additionally relieve symptoms. Gonadotropin-releasing hormone agonists, by inducing a pseudomenopause and, appropriately, a "medical oophorectomy," accept appearancen a remission of disaffluence and are commalone used.

back ovarian accumulationes are present (stages III and IV), surgery charge aphorism out cancer. Conservative surgery is possible, but the treatment of choice for women who don't appetite to blade children and for those with extensive disaffluence (stages III and IV) is a total abdominal hysterectomy with bilateral salpingo-oophorectomy.

Special considerations

Minor gynecologic procedures are contraindicated immediately beahead and duarena menstruation.
Advise adolescents to use sanitary napkins instead of tampons; this can advice prevent retrograde breeze in babes with a narrow vagina or small introitus.
Because infertility is a possible complication, advise the patient who appetites children not to columnpone childbeaarena

CLINICAL TIP :- Recommend to all patients that they accept an annual pelvic examination and Papanicolaou analysis.

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