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INTRODUCTION

ESSENTIALS OF DIAGNOSIS

  • Endometriosis is a disorder in which abnormal growths of endometrium-like tissue (epithelium and stroma) are present in locations other than the uterine lining.

  • Although endometriosis can occur very rarely in prepubertal and postmenopausal women, it is found almost exclusively in women of reproductive age.

  • All other manifestations of endometriosis exhibit a wide spectrum of expression.

  • The lesions are usually found on the peritoneal surfaces of the reproductive organs and adjacent structures of the pelvis, but they can occur anywhere in the body (Fig. 58–1).

  • The classification introduces size and location of the lesions, but there is no good correlation between the classification and the symptoms.

  • Similarly, women with endometriosis can be completely asymptomatic or may be crippled by pelvic pain and infertility.

Figure 58–1.

Common sites of endometrial implants (endometriosis). (Reproduced with permission from Way LW. Current Surgical Diagnosis & Treatment. 7th ed. Los Altos, CA: Lange; 1985.)

EPIDEMIOLOGY

Endometriosis is a common and important health problem of women. Its exact prevalence is unknown because surgery is required for its diagnosis, but it is estimated to be present in 6–10% of women in the reproductive age group and up to 50% of infertile women. It is seen in 1–2% of women undergoing sterilization or sterilization reversal, in 10% of hysterectomy surgeries, in 16–31% of laparoscopies, and in 53% of adolescents with pelvic pain severe enough to warrant surgical evaluation. Endometriosis is the commonest single gynecologic diagnosis responsible for hospitalization of women aged 15–44, being found in > 6% of patients.

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Cramer  DW. Epidemiology of endometriosis. In: Wilson  EA (ed): Endometriosis. New York, NY: Alan R. Liss; 1987, p. 5.
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Gruppos Italiano per lo Studio Dell’Endometriosi. Prevalence and anatomical distribution of endometriosis in women with selected gynaecological conditions: Results from a multicentric Italian study. Hum Reprod 1994;9:1158–1162.
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Eskenazi  B, Warner  ML. Epidemiology of endometriosis. Obstet Gynecol Clin North Am 1997;24(2):235–258.
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Meuleman  C, Vandenabeele  B, Fieuws  S, Spiessens  C, Timmerman  D, D’Hooghe  T. High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners. Fertil Steril 2009;92(1):68–74.
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Zhao  SZ, Wong  JM, Davis  MB,  et al. The cost of inpatient endometriosis treatment: An analysis based on the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Am J Manag Care 1998;4:1127–1134.
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PATHOGENESIS

The cause of endometriosis is complex, and the leading theories include retrograde menstruation with transport of endometrial cells, metaplasia of coelomic epithelium, hematogenous or lymphatic spread, and altered immunity. A combination of these theories is likely to be responsible.

A theory of retrograde menstruation was proposed during the 1920s by Sampson. It was postulated that endometriosis occurred ...

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