ENDOMETRIOSIS

• Endometrial tissue lying outside the uterine cavity.

• Usually found within the pelvis ,commonly located on the peritoneum lining the pelvic side walls, pouch of
Douglas, uterosacral ligaments and bladder
• Can induce fibrosis and be found infiltrating into deeper tissue such as rectovaginal septum and bladder.
• If implanted the ovary, an endometrioma forms
• It responds to cyclical hormonal changes, and undergoes cyclical bleeding and local inflammatory reactions.
• Adenomyosis-Uterine condition often seen with endometriosis

Aetiology • Sampson’s implantation theory :The transplantation theory, originally proposed by

Sampson in the mid-1920s, is based on the assumption that endometriosis is caused by
the seeding or implantation of endometrial cells by transtubal regurgitation during
menstruation Transplantation Theory
• Meyer’s coelomic metaplasia theory: It proposes that an endogenous (undefined)
biochemical factor can induce undifferentiated peritoneal cells to develop into
endometrial tissue.
• Genetic and immunological factors
• Vascular and lymphatic spread

Clinical • Severe cyclical non colicky pain around the time of menstruation
Features • Heavy menstrual loss
• Severe fatigue
• Iriitable bowel syndrome
• Deep dyspareunia
• Dyschexia
• Cyclical epistaxis with nasal passage deposits
• Cyclical rectal bleeding with bowel deposits

Diagnosis Physical • Thickening of nodularity of the uterosacral ligaments

Examination • Tenderness in the pouch of Douglas
• An adnexal mass
• Fixed retroverted uterus
Imaging • TVUSS
• MRI
• Laparoscopy
• Biomarkers
Endometriosis
and Infertility

Management • Anaalgesics
• Combined oral contraceptives
• Progestogens
• Gonadotrophin releasing hormone agonists
• Fertility sparing surgery
• Hysterectomy and oophorectomy