Endometriosis natural history, complications and prognosis

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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]

Natural History, Complications and Prognosis

Natural History

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. The progression of the disease is variable, it can progress to a severe disease or regress or remain the same. Severe disease is called as deep endometriosis and presents with chronic pelvic pain and infertility other complications due to the extensive fibrosis of the pelvic structures.

Complications

The main complication of endometriosis is infertility and accounts for 17% of cases with infertility. Other common complications include:

• Internal scarring
• Adhesions
• Pelvic cysts
• Chocolate cysts
• Ruptured cyst
• Less common complications include bowel and ureteral obstruction resulting from pelvic adhesions.

Prognosis

Proper counseling of patients with endometriosis requires attention to several aspects of the disorder. Of primary importance is the initial operative staging of the disease to obtain adequate information on which to base future decisions about therapy. The patient's symptoms and desire for childbearing dictate appropriate therapy. Most patients can be told that they will be able to obtain significant relief from pelvic pain and that treatment will assist them in achieving pregnancy.