Management of Endometriosis Sudha Prasad
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Introduction of EndometriosisChapter 1

2Endometriosis is a common, poorly understood benign disorder. Endometriosis is the growth of endometrial tissue, i.e. glands and stroma, outside of the uterine cavity. It induces a chronic, inflammatory reaction on the peritoneal lining of pelvic organs such as the ovaries and uterus. Other parts of the body like lungs also can be occasionally involved. Due to inflammation and extensive fibrosis adhesion formation occurs leading to tubo-ovarian adhesion and finally distortion of pelvic organs in severe cases. This disease varies from small subtle lesions to large endometriotic cyst. These cysts subsequently thinned out and burst focally to adjacent areas leading to further adhesion formation. These adhesions may be flimsy to very dense one. The condition is predominantly found in women of reproductive age. Therefore, it leads to subfertility, severe dysmenorrhea, deep dyspareunia and chronic pelvic pain.
In early 18th century, there was the custom of early marriage and early pregnancies. As retrograde menstruation is the well-accepted etiological factor and lactational amenorrhea used to prevent endometriosis in young women. Hence, endometriotic nodules were felt more often in older women. After the advent of laparoscope early detection of endometriosis has become easier.3
The overall true prevalence of endometriosis is unknown because the surgery is the only reliable method for its early diagnosis. The estimated prevalence is approximately 8-10 percent in the reproductive age group. The prevalence of endometriosis is found to be higher in infertiles as the laparoscopy is the gold standard tool for the infertility investigations. It was observed as high as 20-40 percent among infertile groups.1,2 In our study at Maulana Azad Medical College, we found 2 percent prevalence in fertile women and 12 percent in infertile women (unpublished data).
To get the precise prevalence in general population it is required to have laparoscopic inspection of pelvis, skill of surgeon to do laparoscopy meticulously, and to identify small colorless subtle endometriotic lesions and finally confirmation of lesions histologically. Possibility of familial tendency of endometriosis has been reported by many investigators.3
  1. Cornillie FJ, Oosterlynck D, Lauweryns JM, Koninckx PR. Deeply infiltrating pelvic endometriosis: Histology and clinical significance. Fertil Steril 1990; 53: 978–83.
  1. Chopin N, Ballester M, Borghese B, Fauconnier A, Foulot H, Malartic C, et al. Relation between severity of dysmenorrhea and endometrioma. Acta Obstet Gynecol Scand 2006; 85(11): 1375–80.
  1. Sung Hoon Kim, Young Min Choi, Seon Ha Choung, Jong Kwan Jun, Jung Gu Kim, Shin Yong Moon. Vascular endothelial growth factor gene + 405 C/G polymorphism is associated with susceptibility to advanced stage endometriosis. Human Reproduction 2005; 20(10): 2904–8.