The endometrium and endometriosis

Endometriosis represents one of the most intriguing and difficult conditions facing reproductive medicine. The condition is characterized by the finding of tissue with histological similarities to endometrium, outside of the uterine cavity. The controversy surrounding the aetiology of this condition must centre on the endocrine, paracrine and autocrine factors that regulate endometrial differentiation and proliferation. The first description of endometriosis as a discrete entity was made in the 1920s1 by Sampson, and as most of the disease was found in the pelvis this led to the initial hypothesis of simple implantation2, which would be dependent on the retrograde passage of endometrium at menstruation. This hypothesis has gained credence more recently, as Halme el al. 3 showed blood in the peritoneal cavity of 90% of 52 women with patent fallopian tubes having sterilization in the premenstrual period. The presence of blood in peritoneal fluid was significantly reduced in women with occluded tubes. The presence of endometrial glands in peritoneal fluid was confirmed by several other authors4–6 though the endometrial cells constitute less than 20% of the cells, the rest being macrophages and lymphocytes7,8. Thus it is likely that most women experience retrograde menstruation. If the implantation hypothesis is correct, then women with endometriosis must differ from normal women either because their endometriosis has a greater capacity to implant and grow or because the environment of their peritoneal cavity favours the nature of the endometrium. Preview Unable to display preview. Download preview PDF. Similar content being viewed by others

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