Endometriosis

Endometriosis is a disease in which endometrial glands and stroma implant and grow in areas outside the uterus. The disease has a multi-factorial etiology including genetic and environmental factors. Exposure to ovarian hormones appears to be essential. Estrogens stimulate ectopic endometrium growth and aberrations in estrogen signaling have been associated with the disease. Caucasians appear to be more likely to suffer from endometriosis than African Americans or Asians. There is also an increased prevalence in taller women and those with a lower BMI. Genetic factors contribute to approximately 51% of endometriosis risk. Patients with an affected first-degree relative have an approximate 7 to 10-fold increased risk of developing endometriosis. The prevalence of endometriosis ranges from 2-50% of reproductive aged women. The morbidity associated from endometriosis is great, as it can cause both chronic pelvic pain and infertility. In women with infertility, the prevalence ranges from 20-50%. Endometriosis is present in 71-87% of women with chronic pelvic pain. A multidisciplinary approach is often required for the diagnosis and management of this disease. In women with pelvic pain and suspected endometriosis, first line treatment would be non-steroidal anti-inflammatory medications with/without oral contraceptives or progestins. In the treatment of infertility associated with endometriosis, the age, history, health status, physical exam, and wishes concerning treatment should be weighed. There are certain situations where surgery may be indicated for the treatment of infertility associated with endometriosis. Controlled ovarian stimulation with IUI or IVF is often indicated.