At a glance - Endometriosis

Definition
- Endometrial tissue located outside the uterine cavity.

Epidemiology
- Affects up to 10 per cent of menstruating women.
- More common in women with a family history.
- More common in Caucasians.
- An early first pregnancy is protective.

Pathophysiology
- Poorly understood.
- Retrograde menstruation is thought to be a possible mechanism.

Clinical features
- May be asymptomatic.
- Typically cyclical pelvic and abdominal pain.
- Dysmenorrhoea and menorrhagia.
- Deep dyspareunia.
- Subfertility or infertility.
- Fixed retrograde uterus.

Investigations
- Laparoscopy is the investigation of choice.

Management
- Asymptomatic women do not need treatment.
- Medical treatment options comprise drugs that suppress ovarian
function, including oral contraceptives, danazol,
gonadotrophin-releasing hormones and progestogens.

Surgical treatment
- Surgical treatments aim to remove the maximum ectopic endometrial
tissue.

Special features
- Endometriosis is a chronic relapsing disorder.
- It is a surgical diagnosis.
- Differential diagnoses are irritable bowel syndrome (IBS) and pelvic
inflammatory disease.
- Symptoms do not necessarily correlate with the amount of ectopic
endometrial tissue.
- Treatment may not improve fertility.

Contributed by Dr Aziz Sheikh, professor of primary care research and development, Division of Community Health Sciences, GP Section, University of Edinburgh.

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