Chapter 128 Endometriosis
INTRODUCTION
Description: Endometriosis is a benign but progressive condition characterized by endometrial glands and stroma found in locations other than the endometrium.
Prevalence: Five percent to 15% of women, 20% of gynecologic laparotomies, 30% of patients with chronic pain, 30% to 50% of patients experiencing infertility.
ETIOLOGY AND PATHOGENESIS
Causes: Endometriosis may arise by one of several proposed mechanisms—lymphatic spread, metaplasia of celomic epithelium or Müllerian rests, seeding by retrograde menstruation, or direct hematogenous spread. Instances of presumed iatrogenic spread (surgical) have been reported. A role for an immunologic defect is debated but remains to be conclusively established.
CLINICAL CHARACTERISTICS
Signs and Symptoms
• Cyclic pelvic pain or dyspareunia (both worst 36 to 48 hours before menses), premenstrual and menstrual pain, dyschezia, midcycle (ovulatory) pain—often the pain reported by patients seems inversely proportional to the amount of disease; small implants seem to be exquisitely painful, and large endometriomata may be asymptomatic
