Endometriosis

Abstract

Endometriosis is a common cause of pelvic, low back, and abdominal pain caused by the implantation of normal uterine endometrial mucosa in abnormal locations. Endometriosis occurs in approximately 8% of women with approximately 30% of these women completely asymptomatic. An estrogen-dependent disease, it usually affects reproductive aged women with an active hypothalamic-pituitary-ovarian axis. It is identified in approximately 35% of infertile women and in 80% of women suffering from chronic pelvic pain. There is a 10-fold increased incidence of endometriosis in those women who have a first-degree relative suffering from the disease with a locus on chromosome 7p15.2 lined to an increased incidence of endometriosis in women of European descent. There is also concordance in monozygotic twins. A suggestion is that there is an increased incidence of endometriosis and specific phenotypic traits including red hair, nevi, freckles, and sensitivity to sun exposure. Other risk factors for endometriosis include early menarche, prolonged heavy menstrual flow, and delayed first birth.

The pain of endometriosis is cyclical in that it accompanies menstruation. The onset of pain usually precedes menstrual flow by 48 hours and begins to resolve after 2 days of menstruation. The ameliorating effects of pregnancy and menopause are the rule, although hormone replacement therapy may cause a recurrence of the symptoms associated with endometriosis. The pain of endometriosis is not related to the load of abnormal implanted endometrial mucosa and stroma, but the location and depth of each endometrial implant

Keywords

endometriosis, pelvic pain, back pain, abdominal pain, ectopic pregnancy, ovarian cancer, endometrial cancer, dysmenorrhea, dyspareunia, dysuria, bowel obstruction

ICD-10 CODE N80.9

Keywords

endometriosis, pelvic pain, back pain, abdominal pain, ectopic pregnancy, ovarian cancer, endometrial cancer, dysmenorrhea, dyspareunia, dysuria, bowel obstruction

ICD-10 CODE N80.9

The Clinical Syndrome

Endometriosis is a common cause of pelvic, low back, and abdominal pain caused by the implantation of normal uterine endometrial mucosa in abnormal locations. Endometriosis occurs in approximately 8% of women with approximately 30% of these women completely asymptomatic. An estrogen-dependent disease, it usually affects reproductive aged women with an active hypothalamic-pituitary-ovarian axis. It is identified in approximately 35% of infertile women and in 80% of women suffering from chronic pelvic pain. There is a 10-fold increased incidence of endometriosis in those women who have a first-degree relative suffering from the disease with a locus on chromosome 7p15.2 lined to an increased incidence of endometriosis in women of European descent. There is also concordance in monozygotic twins. A suggestion is that there is an increased incidence of endometriosis and specific phenotypic traits including red hair, nevi, freckles, and sensitivity to sun exposure. Other risk factors for endometriosis include early menarche, prolonged heavy menstrual flow, and delayed first birth.

The symptomatology associated with endometriosis is summarized in Box 92.1 . The pain of endometriosis is cyclical in that it accompanies menstruation. The onset of pain usually precedes menstrual flow by 48 hours and begins to resolve after 2 days of menstruation. The ameliorating effects of pregnancy and menopause are the rule, although hormone replacement therapy may cause a recurrence of the symptoms associated with endometriosis. The pain of endometriosis is not related to the load of abnormal implanted endometrial mucosa and stroma, but the location and depth of each endometrial implant ( Fig. 92.1 ). There may also be bidirectional crosstalk between abnormal endometrial implants and subserving nerves as pain patterns become established ( Fig. 92.2 ). Psychometric testing suggests that patients suffering from symptomatic endometriosis have increased anxiety and neuroticism when compared with other female control groups. These symptoms may be exacerbated if the endometriosis is associated with infertility.

Box 92.1

Common Symptoms of Endometriosis