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Endometriosis

GG Hospital

Define Endometriosis

Endometriosis is a prolonged disease which lasts from adolescents to menopause.

It is due to the endometrial cells implanting outside the uterine cavity by chance through retrograde spill through the fallopian tube during menstruation in to the pelvic cavity or the cells spreading through blood stream or lymphatic channel.

It is estimated to affect 176 million women across the world. In India over 32 millions are affected.

This affects women during prime year of their lives, a time when they should be finishing their education, starting and maintaining a career, building relationships and perhaps starting a family.

Endometriosis in the pelvis causes chronic pelvic inflammatory reaction leading to chronic pelvic pain.

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What are the classifications of endometriosis?

According to the  classification of American Fertility Sterility Society, endometriosis can be classified as : 

  • Minimal – Stage 1
  • Mild – Stage 2
  • Moderate — Stage 3
  • Severe – Stage 4

What is its incidence?

  • Reproductive age group 10-15%
  • Infertile patients 4.5- 50%
  • Pelvic Pain / Dyspareunia 40 -50%

What are the signs and symptoms of endometriosis?

Signs

  • Ovarian cyst / Endometrioma – The ovary is enlarged with chocolate like material
  • Mass in the abdomen
  • Adenomyoma – The uterus muscles swells with infiltration of endometriosis and so the uterus becomes big

Symptoms

  • Pelvic pain – lower abdominal discomfort
  • Dysmenorrhoea – Menstrual pain
  • Dyspareunia – Pain during sex
  • Abnormal bleeding – over bleeding, inter-menstrual bleeding
  • Infertility

How is infertility caused by endometriosis?

  • Distorted pelvic organs – relationship of tube & ovaries altered
  • Altered peritoneal function – the healthy fluid in the space around the uterus is altered
  • Altered folliculogenesis / Ovulatory dysfunctions – Ovulation is defective or impaired
  • Altered steroidogenesis – disturbance in the ratio of estrogen and progesterone
  • Granulosa cell dysfunction – cells supporting oocytes does not function properly
  • Oocyte abnormality / Decreased fertilizing capacity – oocytes not healthy and fertilization impaired
  • Sperm phagocytosis – sperms are engulfed by macrophages
  • Accelerated ovum transport – defective transport of ovum into the uterus
  • Disturbed early luteal function – hormones supporting embryos is defective
  • Hyperprolactinemia – Increased prolactin levels which upsets pregnancy
  • Defective implantation – site where the baby grows is hostile
  • Embryo toxicity – Embryo is surrounded by hostile fluid
  • Last but not the least Immunological !

How does one make a diagnosis of endometriosis through USG?

  • Endometriomas 5 to 8 cm in size and have a echogenic to a loculated cyst depending on the amount of coagulated blood material inside.
  • The commonest finding is that of low level homogenous echoes uniformly distributed.
  • The cyst wall is thick due to fibrosis. Other features are, bilateral in nature, multiple cysts, and peri ovarian adhesions.