Endometriosis – ectopic endometrial tissue #1
Contents:
Definition
Risk factors
Sites of lesion
Classification
Clinical presentation
Physical examination
Investigations
Differential diagnosis
Management
Complications
Follow up
Prognosis
Definition:
Endometriosis is defined by the presence of ectopic endometrial tissues outside of the uterus. The endometrial tissues contain both glandular and stromal elements. The exact prevalence is unknown. However, it is estimated to be 6-10% in the general female population.
Risk factors:
• Women with uterine or genital tract outflow abnormalities
• Nulliparity
• Delayed child bearing
• Early menarche (first menses)
• Regular and short cycle interval of menstruation where the duration is longer and heavy menstrual flow present
• Exposure to environment toxins
• There is presentation of familial predisposition (multifactorial)
Sites of lesion:
• Ovaries and pelvic peritoneum are the commonest sites
• Utero-sacral ligaments, fallopian tubes and rectovaginal septum
• Vagina will be affected as the extension from uterosacral or rectovaginal disease or on vaginal vault during hysterectomy
• Other sites consist of urinary tract (includes ureter and bladder), bowel, intra abdominal organs, pulmonary and abdominal and episiotomy scar.
Classification:
Most common use classification is the revised American Society Reproductive Medicine Classification of Endometriosis (1996). This system scoring is based on visual inspection and is divided into 4 categories:
Stage Score Severity of disease
Stage I 1 – 5 Minimal
Stage II 6 – 15 Mild
Stage III 16 – 40 Moderate
Stage IV >40 Severe
This scoring system reflects the anatomical severity of endometriosis. The pitfall of this system is it has poor correlation between the score, the degree of symptoms and the prognosis regarding fertility of the patients.
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Tags: contraceptive oral pill, dysmenorrhea, dyspareunia, endometrioma, endpmetriosis, infertility, intussusceptions, mirena, pelvic pain
Technorati Tags: contraceptive oral pill, dysmenorrhea, dyspareunia, endometrioma, endpmetriosis, infertility, intussusceptions, mirena, pelvic pain
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