Endometriosis
Endometriosis is defined as the presence of functional endometrial tissue (glands and stroma) outside the uterine cavity, most commonly on the ovaries, pelvic peritoneum, and rectovaginal septum. It is a chronic, estrogen-dependent inflammatory disease.
Classical Presentation
- Dysmenorrhea: Severe, progressive pelvic pain associated with menstruation.
- Chronic Pelvic Pain: Pain that is often non-cyclic.
- Dyspareunia: Especially deep dyspareunia.
- Infertility: Due to pelvic adhesions, distorted anatomy, or chronic inflammation.
Diagnosis & Management
| Method | Details |
|---|---|
| Diagnosis | Laparoscopy remains the gold standard for definitive diagnosis and staging. |
| Medical | The goal is to induce a hypoestrogenic or pseudo-pregnant state (OCPs, Progestins, GnRH agonists). |
High-Yield Exam Pearl:
- Endometrioma: Also known as a “chocolate cyst,” these are ovarian cysts containing thick, dark, old blood.
- Empiric Treatment: In patients with clinical suspicion of endometriosis (pain, dysmenorrhea), clinicians often initiate empiric treatment (OCPs or progestins) without surgical confirmation to reduce symptoms and avoid surgery.