Endometriosis Disease

BASICS

DESCRIPTION

Heterotopic islands of uterine mucosa (endometrium) found in many locations.

Pelvic sites - peritoneal surfaces (bladder, cul-de-sac, pelvic side walls, broad ligaments, uterosacral ligaments, fallopian tubes, and uterus), lymph nodes, ovaries, bowel
Distant sites - vagina, cervix, abdominal wall, arm, leg, pleura, lung, diaphragm, kidneys, spleen, gallbladder, nasal mucous membranes, spinal canal, stomach, breast
System(s) affected: Reproductive
Genetics: N/A
Incidence/Prevalence in USA: 8-30/100,000; may be as high as 8-15% in women of reproductive age
Predominant age: Women of reproductive age and possibly in menopausal women with signs and symptoms aggravated by hormone replacement therapy
Predominant sex: Female only

SIGNS AND SYMPTOMS

Infertility (30-40% of patients with endometriosis)
Dyspareunia
Dysmenorrhea
Dyschezia
Chronic pelvic pain
Premenstrual spotting
Spontaneous abortion
Luteinized unruptured follicle syndrome

CAUSES

Retrograde menstruation (Sampson's theory)
Lymphatic/vascular metastases (Halban's theory)
Direct implantation
Coelomic metaplasia (coelomic epithelium undergoes metaplasia forming functioning endometrium)

RISK FACTORS

Hereditary/genetic predisposition
Delayed childbearing
Luteinized unruptured follicle syndrome (granulosa/theca cells undergo luteinization but actual follicular rupture fails to occur, thereby predisposing to limited progesterone secretion into peritoneal cavity thus allowing refluxed endometrial cells to implant and proliferate)

DIAGNOSIS

LABORATORY

No special value, but CA-125 levels may be elevated

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Biopsy of endometriotic lesions usually demonstrate both endometrial glands and stroma

SPECIAL TESTS

CA-125

IMAGING

Vaginal/abdominal ultrasound (identify only endometriomas of ovaries)
MRI for pelvic masses (endometriomas)
Hysterosalpingography for tubal occlusion proximally or distally and periadnexal adhesions

DIAGNOSTIC PROCEDURES

Laparoscopy

TREATMENT

APPROPRIATE HEALTH CARE

Diagnose and treat "early" to prevent sequelae such as infertility and pelvic pain

GENERAL MEASURES

At the time of laparoscopy, attempt laser vaporization or fulguration of implants, drainage/resection of ovarian endometriomas, and lysis of pelvic adhesions
Consider uterosacral ligament laser vaporization/fulguration for presacral neurectomy for severe pelvic pain or dysmenorrhea. Microsurgery or in-vitro fertilization (IVF) or gamete intrafallopian tube transfer (GIFT) may be necessary when laparoscopic surgery followed by superovulation induction with human menopausal gonadotropins (Pergonal, Humegon), pure follicle-stimulating hormone (Follistim, Fertinex, Gonal-F) and artificial intrauterine insemination have failed to achieve pregnancy.

SURGICAL MEASURES

Cardiac surgery to replace infected valve may be performed before antibiotic treatment course is completed when:
- There is evidence of congestive heart failure due to valve incompetence, or
- Multiple major systemic emboli have occurred, or
- The infection is caused by resistant organisms, e.g., fungus, Pseudomonas aeruginosa, or
- There is dehiscence of infected prosthetic valve, or
- There is relapse of prosthetic valve endocarditis, or
- There is persistent bacteremia despite antibiotic treatment

ACTIVITY

Activity may be limited depending upon severity of pelvic pain

DIET

No special diet

PATIENT EDUCATION

Prevention of disease difficult but may be maintained in quiescent state with oral contraceptive agents
Printed materials available from The American Fertility Society, 2140 11th Ave South, Suite 200, Birmingham, AL 35205-2800, (205)933-8494

FOLLOW UP

PREVENTION/AVOIDANCE

Pregnancy seems to have a temporary ameliorating effect upon the course of the disease
Endometriosis is generally a recurring disorder that may persist even into early menopause

POSSIBLE COMPLICATIONS

Infertility/subfertility
Sterility
Chronic pelvic pain
Total abdominal hysterectomy and bilateral salpingo-oophorectomy
Intussusception

EXPECTED COURSE AND PROGNOSIS

Pregnancy should occur, but depends upon the severity of the disease
Signs and symptoms generally regress with the onset of the menopause, but can usually be controlled during the reproductive years

MISCELLANEOUS

ASSOCIATED CONDITIONS

Pelvic endometriosis is rarely associated with endometrioid carcinoma of the ovary
Hematuria with bladder involvement
Rectal bleeding with bowel involvement
Hemoptysis with lung involvement

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: Endometriosis may persist even during early menopause and may be exacerbated with estrogen replacement therapy
Others:

Endometriosis of the intramural portion of the fallopian tube may cause isthmic proximal tubal obstruction and infertility
Infertility may not only be related to anatomical disruption of pelvic structures but to liberation of peritoneal macrophages which can predispose to gamete phagocytosis
Immune disorders such as production of anti-endometrial antibodies can also be associated with reproductive dysfunction

PREGNANCY

Refer to board certified reproductive endocrinologist or gynecologist with expertise in infertility

OTHER NOTES

Educate female patients of reproductive age as to the signs and symptoms of pelvic endometriosis

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.