Endometriosis

Lucky Saraswat
In: Reproductive Medicine for the MRCOG · 2021 · pp. 22–30 · doi:10.1017/9781108861724.003 · W4246382425
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Endometriosis, a chronic estrogen-dependent condition affecting 10% of women, involves endometrial-like cells growing outside the uterus, causing pelvic pain and infertility, and requires individualized management due to frequent recurrence.

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This chapter from a reproductive medicine textbook defines endometriosis as a chronic, estrogen-dependent condition characterized by ectopic endometrial-like tissue proliferation, primarily affecting the pelvis. It outlines the clinical presentation of pelvic pain and infertility, noting that symptom severity does not correlate with disease extent and that diagnosis typically requires laparoscopy. The text reviews pathogenesis involving genetic and immunological factors, while management strategies include hormonal therapy, surgical excision, and assisted reproduction, emphasizing the need for individualized care due to high recurrence rates. This paper is centrally about endometriosis — specifically its epidemiology, pathophysiology, and clinical management in the context of infertility and pelvic pain.

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Abstract

Endometriosis is a chronic oestrogen-dependent condition that affects 10% of women from puberty to menopause. It is characterised by the presence and proliferation of endometrial-like cells outside the uterine cavity, generally within the pelvis. Endometriosis can present as superficial or deep peritoneal lesions, ovarian endometrioma or deep rectovaginal disease. The two hallmark symptoms of endometriosis are pelvic pain and infertility resulting in poor quality of life. There is no correlation between the extent of the disease and severity of symptoms. The true prevalence of the condition is not known, as it requires a laparoscopy to confirm the diagnosis. It is found in up to 30% of women with infertility and in 45% of those with pelvic pain. While there are several theories of pathogenesis, an interplay of genetic, hormonal, environmental and immunological factors is implicated in the development of endometriosis in susceptible women. Symptoms are managed with a combination of hormonal treatment and laparoscopic ablation or excision of lesions for pain and usually assisted reproduction for infertility. Endometriosis is prone to recurrence after treatment, requiring multiple contacts with healthcare and repeat surgery. Management of endometriosis requires an individualised approach based on the woman’s age, predominant symptoms and priorities, which are subject to change over time.
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- Reproductive Medicine for the MRCOG - Reproductive Medicine for the MRCOG - Copyright page - Contents - Contributors - Chapter 1 Epidemiology and Initial Assessment of the Infertile Patient - Chapter 2 Disorders of Ovulation and Reproductive Endocrine Disorders Associated with Infertility - Chapter 3 Endometriosis - Chapter 4 Uterine and Tubal Causes of Infertility - Chapter 5 Andrology and Infertility - Chapter 6 Unexplained Infertility - Chapter 7 Assisted Reproduction - Chapter 8 Adjuvants in Assisted Reproduction - Chapter 9 Laboratory Procedures for Assisted Reproduction - Chapter 10 Fertility Preservation - Chapter 11 Third-Party Reproduction - Chapter 12 Managing Ethical Dilemmas in Reproductive Medicine - Chapter 13 Evidence-Based Reproductive Medicine - Chapter 14 The Organisation of Services and Quality Assurance in Fertility Practice - Index - References Published online by Cambridge University Press: 25 February 2021 Book contents - Reproductive Medicine for the MRCOG - Reproductive Medicine for the MRCOG - Copyright page - Contents - Contributors - Chapter 1 Epidemiology and Initial Assessment of the Infertile Patient - Chapter 2 Disorders of Ovulation and Reproductive Endocrine Disorders Associated with Infertility - Chapter 3 Endometriosis - Chapter 4 Uterine and Tubal Causes of Infertility - Chapter 5 Andrology and Infertility - Chapter 6 Unexplained Infertility - Chapter 7 Assisted Reproduction - Chapter 8 Adjuvants in Assisted Reproduction - Chapter 9 Laboratory Procedures for Assisted Reproduction - Chapter 10 Fertility Preservation - Chapter 11 Third-Party Reproduction - Chapter 12 Managing Ethical Dilemmas in Reproductive Medicine - Chapter 13 Evidence-Based Reproductive Medicine - Chapter 14 The Organisation of Services and Quality Assurance in Fertility Practice - Index - References Endometriosis is a chronic oestrogen-dependent condition that affects 10% of women from puberty to menopause. It is characterised by the presence and proliferation of endometrial-like cells outside the uterine cavity, generally within the pelvis. Endometriosis can present as superficial or deep peritoneal lesions, ovarian endometrioma or deep rectovaginal disease. The two hallmark symptoms of endometriosis are pelvic pain and infertility resulting in poor quality of life. There is no correlation between the extent of the disease and severity of symptoms. The true prevalence of the condition is not known, as it requires a laparoscopy to confirm the diagnosis. It is found in up to 30% of women with infertility and in 45% of those with pelvic pain. While there are several theories of pathogenesis, an interplay of genetic, hormonal, environmental and immunological factors is implicated in the development of endometriosis in susceptible women. Symptoms are managed with a combination of hormonal treatment and laparoscopic ablation or excision of lesions for pain and usually assisted reproduction for infertility. Endometriosis is prone to recurrence after treatment, requiring multiple contacts with healthcare and repeat surgery. Management of endometriosis requires an individualised approach based on the woman’s age, predominant symptoms and priorities, which are subject to change over time. - Type - Chapter - Information - Reproductive Medicine for the MRCOG , pp. 22 - 30Publisher: Cambridge University PressPrint publication year: 2021 Burney, RO, Giudice, LC., Pathogenesis and pathophysiology of endometriosis. Fertil Steril 2012;98(3):511–19.CrossRefGoogle ScholarPubMed Dunselman, GA, Vermeulen, N, Becker, C, et al. and European Society of Human Reproduction and Embryology. ESHRE guideline: Management of women with endometriosis. Hum Reprod (Oxf), 2014;29(3): 400–12.CrossRefGoogle ScholarPubMed Gruppo italiano per lo studio dell’endometriosi. Prevalence and anatomical distribution of endometriosis in women with selected gynaecological conditions: results from a multicentric Italian study. Gruppo italiano per lo studio dell’endometriosi. Hum Reprod (Oxf) 1994;9(6):1158–62.Google Scholar American Society for Reproductive Medicine. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril. 1997;67(5):817–21.CrossRefGoogle Scholar Bricou, A, Batt, RE, Chapron, C. Peritoneal fluid flow influences anatomical distribution of endometriotic lesions: Why Sampson seems to be right. Eur J Obstet Gynecol Reprod Biol 2008; 138(2):127–34.CrossRefGoogle ScholarPubMed Cramer, DW, Missmer, SA. The epidemiology of endometriosis. Ann NY Acad Sci 2002;955:11–22; discussion 34–6, 396–406.CrossRefGoogle ScholarPubMed Bravi, F, Parazzini, F, Cipriani, S, Chiaffarino, F, Ricci, E, Chiantera, V, Vigano, P, La Vecchia, C., Tobacco smoking and risk of endometriosis: a systematic review and meta-analysis. BMJ Open 2014;4(12):e006325-2014–006325.CrossRefGoogle ScholarPubMed Parazzini, F, Cipriani, S, Bravi, F, Pelucchi, C, Chiaffarino, F, Ricci, E, Vigano, P. A metaanalysis on alcohol consumption and risk of endometriosis. Am J Obstet Gynecol 2013;209(2):106.e1–106.10.CrossRefGoogle ScholarPubMed NICE (National Institute of Care and Excellence). Endometriosis: Diagnosis and management. NICE guideline NG73, September 2017.Google Scholar Duffy, JM, Arambage, K, Correa, FJ., et al. Laparoscopic surgery for endometriosis. Cochrane Database Syst Rev 2014;(4):CD011031.Google Scholar Nnoaham, KE, Hummelshoj, L, Webster, P, et al. and World Endometriosis Research Foundation Global Study of Women’s Health, Consortium. Impact of endometriosis on quality of life and work productivity: A multicenter study across ten countries. Fertil Steril 2011;96(2):366–73.e8.CrossRefGoogle ScholarPubMed Simoens, S, Dunselman, G, Dirksen, C, et al. The burden of endometriosis: Costs and quality of life of women with endometriosis and treated in referral centres. Hum Reprod (Oxf) 2012;27(5):1292–9.CrossRefGoogle ScholarPubMed Guo, SW., Recurrence of endometriosis and its control. Hum Reprod Update 2009;15(4):441–61.CrossRefGoogle ScholarPubMed Accessibility compliance for the HTML of this chapter is currently unknown and may be updated in the future. To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle. 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endometriosisendometriomainfertility

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