Foreword

Endometriosis is a condition in which endometrial tissue grows outside the uterine cavity.

Etiology

If endometrial tissue grows in the ovary, it is called an endometrioma, also known as a chocolate cyst. If it grows in the muscle layer of the uterus, it is called adenomyosis.

The cause of endometriosis is still not fully understood. Possible factors include:

1. Retrograde menstruation: menstrual blood containing endometrial cells flows backward through the fallopian tubes into the abdominal cavity.
2. Transport via blood or lymph: endometrial tissue may travel through blood vessels or lymphatic vessels to other parts of the body, such as the lungs, umbilicus, and lymph nodes.
3. Autoimmune deficiency: normally, endometrial fragments are cleared by white blood cells and lymphocytes. However, in some women, excess endometrial tissue is not fully absorbed and may attach to the ovaries, fallopian tubes, bladder, colon, or the pouch of Douglas.

Examinations

1. Palpation: examination through the rectum, vaginal examination, or abdominal palpation.
2. Ultrasonography: to detect the location of any pelvic cysts.
3. Blood test: to check the level of the CA-125 tumor marker in the blood.
4. Laparoscopy: the only method that can confirm the diagnosis.

Symptoms

1. Dysmenorrhea: 1–2 weeks before the menstrual period, women often feel lower abdominal pressure, backache, diarrhea, dizziness, and sometimes severe abdominal pain. In rare cases, it can be severe enough to cause shock.
2. Infertility: about 30%–50% of infertile women are found to have endometriosis.
3. Dyspareunia (painful sexual intercourse): occurs in about 25%–40% of women and may cause spotting after sex.
4. Vaginal spotting or heavy menstrual bleeding before the period: about 10%–20% of women experience abnormal bleeding due to hormonal imbalance.
5. Surgical scar pain: if endometriosis occurs in a surgical scar, pain may follow the menstrual cycle.
6. Periodic hemoptysis or nosebleeds: occurs if endometrial tissue invades the lungs or nasal mucosa.
7. Other symptoms: non-specific signs such as blood in urine, pain during urination, or pain during bowel movements.

Treatments

1. Medication (hormone therapy): includes progesterone, oral contraceptives, androgens, or gonadotropin-releasing hormone (GnRH) agonists.
2. Surgery: laparoscopic surgery or open abdominal surgery (laparotomy).
3. Combined treatment: a combination of medication and surgery.