Endometriosis overview: Difference between revisions
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==Overview== | ==Overview== | ||
== Historical Perspective == | |||
The early descriptions of endometriosis were in the early 19th century, and it was described as adenomyomas. In 1920's endometriosis was differentiated from adenomyosis and a detailed description of the disease was given by Cullen and Sampson. Sampson proposed the theory of retrograde menstruation as the pathogenesis of the disease. | |||
== Classification == | |||
Endometriosis is classified into four stages of severity based on revised American Society for Reproductive Medicine scoring system. The staging is based on the description and distribution of the lesions and the presence of adhesions. | |||
== Pathophysiology == | |||
Exact pathogenesis of endometriosis is not clear and several theories have made an attempt to describe the pathogenesis. Sampson theory of retrograde menstruation, coelomic metaplasia theory, lymphatic and vascular dissemination theory explain the implantation and invasion of the endometrial tissue outside the uterine cavity. Immunologic factors and genetic factors are also thought play a role in the pathogenesis of endometriosis. | |||
== Causes == | |||
Exact cause of endometriosis is unknown, it is thought be multifactorial in origin. | |||
= Differential Diagnosis = | |||
== Epidemiology and Demographics == | |||
Endometriosis affects approximately around 11% of the female population in the reproductive age group. It accounts for majority of cases with chronic pelvic pain and infertility. | |||
== Risk Factors == | |||
The risk factors predisposing women for the development of endometriosis include: early age of menarche, nulliparity, positive family history and presence of congenital cerival stenosis or obstructive lesions in the uterovaginal tract. | |||
== Screening == | |||
Standard screening for endometriosis is not recommended. | |||
== Natural History, Complications and Prognosis == | |||
Endometriosis is a condition affecting females in the reproductive age group. It has a wide spectrum of presentations, it can be asymptomatic or present with premenstrual spotting and cyclical abdominal pain or present with infertility or chronic pelvic pain or as deep endometriosis presenting with dyspareunia, dyschezia and cyclical rectal bleeding. Complications of endometriosis include infertility, fibrosis, chocolate cyst, and rarely affecting other organs such as lung. | |||
== Diagnosis == | |||
=== History and Symptoms === | |||
Endometriosis is a condition affecting women in the reproductive age group. The presenting features include cyclical abdominal pain, dysmenorrhea, pain with passing stools and pain while having intercourse. | |||
=== Physical Examination === | |||
Examination findings on digital vaginal examination and speculum examination include: fixed retroverted uterus, with palpable nodularity of the uterosacral ligaments and cul-de-sac with narrowing of the posterior fornix. | |||
=== Laboratory Findings === | |||
Laboratory findings associated with endometriosis include features of iron deficiency anemia and increased levels of caner antigen-125 and interleukin 1. | |||
=== EKG === | |||
There are no specific EKG findings associated with endometriosis. | |||
=== Chest X-Ray === | |||
There are no specific chest X-Ray findings associated with endometriosis. | |||
=== CT === | |||
There are no specific CT findings associated with endometriosis. | |||
=== MRI === | |||
MRI is useful for the assessment of the anatomical locations and severity of the disease. The typical appearance of endometriosis includes a characteristic hyperintensity on T1-weighted images and a hypointensity on T2-weighted images. | |||
=== Ultrasound === | |||
There are no specific echocardiography findings associated with endometriosis. | |||
=== Other Imaging Findings === | |||
There are no associated other imaging findings with endometriosis. | |||
=== Other Diagnostic Studies === | |||
== Treatment == | |||
=== Medical Therapy === | |||
=== Surgical Therapy === | |||
Patients with failed medical therapy and patients with stage 3 or stage 4 disease are candidates for surgical therapy. Lazer and excision of the lesions is done for isolated lesions, total hysterectomy is reserved for patients with extensive disease. | |||
== Prevention == | |||
=== Primary Prevention === | |||
There are no primary preventive measures for endometriosis, however reduced intake of exogenous estrogen is advised for elderly women. | |||
=== Secondary Prevention === | |||
There are no secondary preventive measures for endometriosis. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 20:31, 15 June 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]
Overview
Historical Perspective
The early descriptions of endometriosis were in the early 19th century, and it was described as adenomyomas. In 1920's endometriosis was differentiated from adenomyosis and a detailed description of the disease was given by Cullen and Sampson. Sampson proposed the theory of retrograde menstruation as the pathogenesis of the disease.
Classification
Endometriosis is classified into four stages of severity based on revised American Society for Reproductive Medicine scoring system. The staging is based on the description and distribution of the lesions and the presence of adhesions.
Pathophysiology
Exact pathogenesis of endometriosis is not clear and several theories have made an attempt to describe the pathogenesis. Sampson theory of retrograde menstruation, coelomic metaplasia theory, lymphatic and vascular dissemination theory explain the implantation and invasion of the endometrial tissue outside the uterine cavity. Immunologic factors and genetic factors are also thought play a role in the pathogenesis of endometriosis.
Causes
Exact cause of endometriosis is unknown, it is thought be multifactorial in origin.
Differential Diagnosis
Epidemiology and Demographics
Endometriosis affects approximately around 11% of the female population in the reproductive age group. It accounts for majority of cases with chronic pelvic pain and infertility.
Risk Factors
The risk factors predisposing women for the development of endometriosis include: early age of menarche, nulliparity, positive family history and presence of congenital cerival stenosis or obstructive lesions in the uterovaginal tract.
Screening
Standard screening for endometriosis is not recommended.
Natural History, Complications and Prognosis
Endometriosis is a condition affecting females in the reproductive age group. It has a wide spectrum of presentations, it can be asymptomatic or present with premenstrual spotting and cyclical abdominal pain or present with infertility or chronic pelvic pain or as deep endometriosis presenting with dyspareunia, dyschezia and cyclical rectal bleeding. Complications of endometriosis include infertility, fibrosis, chocolate cyst, and rarely affecting other organs such as lung.
Diagnosis
History and Symptoms
Endometriosis is a condition affecting women in the reproductive age group. The presenting features include cyclical abdominal pain, dysmenorrhea, pain with passing stools and pain while having intercourse.
Physical Examination
Examination findings on digital vaginal examination and speculum examination include: fixed retroverted uterus, with palpable nodularity of the uterosacral ligaments and cul-de-sac with narrowing of the posterior fornix.
Laboratory Findings
Laboratory findings associated with endometriosis include features of iron deficiency anemia and increased levels of caner antigen-125 and interleukin 1.
EKG
There are no specific EKG findings associated with endometriosis.
Chest X-Ray
There are no specific chest X-Ray findings associated with endometriosis.
CT
There are no specific CT findings associated with endometriosis.
MRI
MRI is useful for the assessment of the anatomical locations and severity of the disease. The typical appearance of endometriosis includes a characteristic hyperintensity on T1-weighted images and a hypointensity on T2-weighted images.
Ultrasound
There are no specific echocardiography findings associated with endometriosis.
Other Imaging Findings
There are no associated other imaging findings with endometriosis.
Other Diagnostic Studies
Treatment
Medical Therapy
Surgical Therapy
Patients with failed medical therapy and patients with stage 3 or stage 4 disease are candidates for surgical therapy. Lazer and excision of the lesions is done for isolated lesions, total hysterectomy is reserved for patients with extensive disease.
Prevention
Primary Prevention
There are no primary preventive measures for endometriosis, however reduced intake of exogenous estrogen is advised for elderly women.
Secondary Prevention
There are no secondary preventive measures for endometriosis.