Endometriosis
Definition
Endometriosis is the presence of functioning endometrial glands and stroma outside the uterine cavity, commonly affecting the ovaries, peritoneum, and pelvic structures.
Etiopathogenesis
- Retrograde Menstruation (Sampson’s Theory) – Endometrial fragments move through the fallopian tubes and implant in the peritoneum.
- Coelomic Metaplasia – Peritoneal cells transform into endometrial-like tissue.
- Lymphatic & Hematogenous Spread – Endometrial tissue spreads via blood and lymphatics.
- Genetic & Immunological Factors – Defective immune surveillance allows implantation of endometrial cells.
Common Sites of Endometriosis
- Ovaries (Chocolate Cysts)
- Pouch of Douglas
- Uterosacral Ligaments
- Broad Ligament
- Rectovaginal Septum
- Bowel & Bladder
Clinical Features of Endometriosis
- Dysmenorrhea (Severe menstrual cramps)
- Chronic Pelvic Pain
- Dyspareunia (Painful intercourse)
- Dyschezia (Painful defecation)
- Dysuria (Painful urination)
- Infertility
Diagnosis of Endometriosis
- Clinical Examination – Tenderness in the pelvis, nodules in the pouch of Douglas.
- Imaging Studies
- Transvaginal Ultrasound (TVUS) – Identifies ovarian endometriomas.
- MRI – Gold standard for deep infiltrating endometriosis.
- Serum CA-125 Marker – Elevated in moderate-severe cases.
- Laparoscopy (Gold Standard) – Confirms diagnosis and allows excision.
Complications of Endometriosis
- Endometriomas (Chocolate Cysts) – Ovarian cysts filled with old blood.
- Adhesions & Distorted Pelvic Anatomy – Can cause chronic pelvic pain and infertility.
- Malignant Transformation (Rare, 1-2%) – In ovarian endometriomas.
Treatment & Management of Endometriosis
1. Medical Management
- NSAIDs (Pain relief)
- Hormonal Therapy
- Combined Oral Contraceptives (COCs)
- Progestins (Medroxyprogesterone, Dienogest)
- Gonadotropin-Releasing Hormone (GnRH) Agonists (Leuprolide)
- Danazol (Androgenic agent, inhibits ovulation)
2. Surgical Management
- Laparoscopic Excision or Ablation of Lesions
- Oophorectomy (For severe cases with ovarian involvement)
- Hysterectomy with Bilateral Salpingo-Oophorectomy (Definitive treatment in non-fertility-seeking patients)
Adenomyosis
Definition
Adenomyosis is a benign condition where endometrial tissue invades the myometrium, leading to uterine enlargement, pain, and heavy menstrual bleeding.
Etiology & Risk Factors
- Unknown (Idiopathic) Causes
- Repeated Childbirth & Uterine Trauma (Curettage, C-sections)
- Estrogen Influence
Pathology of Adenomyosis
- Endometrial Glandular & Stromal Invasion into Myometrium
- Uterine Myometrial Hypertrophy
- Thickened Uterine Walls (Especially Posteriorly)
Clinical Features of Adenomyosis
- Menorrhagia (Heavy Prolonged Menstrual Bleeding)
- Dysmenorrhea (Severe Cramping Pain)
- Pelvic Pain & Pressure Symptoms
- Dyspareunia
Diagnosis of Adenomyosis
- Clinical Examination
- Uterus Enlarged, Globular, Tender on Bimanual Exam
- Imaging Studies
- Transvaginal Ultrasound (TVUS) – Asymmetrically thickened myometrium.
- MRI (Gold Standard) – Characteristic “Swiss cheese” or heterogeneous myometrial appearance.
- Histopathology (Definitive Diagnosis) – Done post-hysterectomy.
Treatment & Management of Adenomyosis
1. Medical Management
- NSAIDs (For Pain Relief)
- Hormonal Therapy
- Oral Contraceptives (OCPs)
- Progestins (Levonorgestrel IUD, Depot Medroxyprogesterone)
- Gonadotropin-Releasing Hormone (GnRH) Agonists (Leuprolide)
2. Surgical Management
- Hysterectomy (Definitive Treatment for Symptomatic Patients)
- Endometrial Ablation (For Conservative Management)
Key Differences Between Endometriosis & Adenomyosis
|
Feature |
Endometriosis |
Adenomyosis |
|
Definition |
Endometrial tissue outside the uterus |
Endometrial tissue inside the myometrium |
|
Common in |
Young women with infertility |
Middle-aged multiparous women |
|
Symptoms |
Dysmenorrhea, dyspareunia, infertility |
Menorrhagia, pelvic pain, dysmenorrhea |
|
Uterus Size |
Normal |
Enlarged, globular uterus |
|
Best Diagnostic Tool |
Laparoscopy |
MRI |
|
Definitive Treatment |
Laparoscopic excision, Oophorectomy |
Hysterectomy |