![]() ![]() Endometriosis-related infertility is thought to be caused by the aforementioned development of lesions accompanied by pelvic distortion or by the presence of an ovarian cyst known as an endometrioma, or “chocolate cyst.” Endometriomas adhere to surrounding structures, such as the fallopian tubes, and are suggested to increase the risk of ovarian cancer. 11Ī patient with endometriosis experiences consistent premenstrual pelvic and lower back pain that may be alleviated following menstruation. 10 A genetic component should not be excluded because endometriosis has an estimated heritability of about 50%. 7-9 The development of endometriosis is characterized by an increase in cyclooxygenase-2 (COX-2), which results in prostaglandin excess and inflammation and in enhanced aromatase activity that raises estrogen levels. 6 Patients with endometriosis have higher concentrations of activated macrophages, interleukins, and tumor necrosis factor, as well as repressed natural killer cell formation, further promoting lesion growth in the area and preventing the elimination of endometrial debris. Estrogen plays a role in this process by promoting cellular proliferation. 5 The tissue implants onto the peritoneum, resulting in the growth of lesions. It was first hypothesized by Sampson that women with prolonged menses have an increased risk because of the retrograde flow of sloughed endometrial cells into the pelvic cavity from the fallopian tubes. ![]() Several theories have been proposed for the pathogenesis of endometriosis. 3 Endometriosis occurs rarely in postmenopausal women. In addition to causing debilitating pain, endometriosis results in worse clinical outcomes in women undergoing assisted reproductive technology, adding to the negative social and psychological impact of this chronic gynecologic condition. ![]() 2 Although it is considered a benign disorder, endometriosis can affect the patient’s quality of life. 1 As of 2010, an estimated 176 million women of childbearing age worldwide were affected. Surgery is considered if a pelvic mass is detected or if the patient is planning a pregnancy.Įndometriosis, which is the estrogen-dependent growth of endometrial tissue outside the uterus, causes inflammation, pelvic pain, dysmenorrhea, painful intercourse, and infertility in approximately 10% of females of reproductive age. Following an evaluation of patient-specific toxicities, oral contraceptives, progestins, danazol, or gonadotropin-releasing hormone agonists are used to suppress estrogen levels. Management of endometriosis involves the use of nonsteroidal anti-inflammatory drugs and hormonal therapies, which have been observed to reduce endometrial proliferation. Endometriosis affects about 10% of women of childbearing age. Patients with this gynecologic condition, for which there is no cure, experience debilitating pelvic pain during menstruation and have a greater chance of infertility. ABSTRACT: Endometriosis is an estrogen-mediated growth of endometrial tissue outside the uterus. ![]()
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