Pathogenesis (development of disease) Endometriosis is now also evaluated as a systemic disease. The cause and mechanism of development of endometriosis are largely unclear. Several theories have been developed: Transplantation theory – This assumes that during menstruation endometrial tissue enters the abdominal cavity retrogradely (“retrograde”) via the tubes (fallopian tubes), or is carried away via … Endometriosis: Causes
Reproductive medical procedures (“assisted reproduction technologies” ART) Intrauterine insemination (IUI; transfer of male semen into the uterine cavity) and controlled stimulation.An increased live birth rate (LGR) has been demonstrated in mild endometriosis after controlled ovarian stimulation and IUI. In vitro fertilization (IVF; “fertilization in a test tube”)/intracytoplasmic sperm injection (ICSI; method of artificial insemination in … Endometriosis: Therapy
Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99). Malformations, unspecified Blood, hematopoietic organs – immune system (D50-D90). Disseminated intravascular coagulation – acquired blood clotting disorders due to excessive consumption of clotting factors and platelets (thrombocytes). Hemophilia (bleeding disorder) Endocrine, nutritional and metabolic diseases (E00-E90). Hormonal disorders – especially disorders of estrogen balance (female sex hormone). Cardiovascular … Endometriosis: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be caused by endometriosis: Cardiovascular system (I00-I99). Atherosclerosis (arteriosclerosis; hardening of the arteries). Myocardial infarction (heart attack): -risk (RR 1.63; 95% CI 1.27-2.11), risk for bypass/angioplasty/stent (RR 1.49; 95% CI 1.19-1.86), risk for combined CHD endpoints (RR 1.62; 95% CI 1.39-1.89) about 50% higher … Endometriosis: Secondary Diseases
Despite many attempts to make the disease comparable in expression, complaints, and sequelae, this has not been sufficiently successful. In particular, there is no correlation between the severity of findings and symptoms. In some countries, classification by localization is preferred: Endometriosis genitalis interna (adenomyosis uteri) – endometriosis lesions within the myometrium of the uterus (uterine … Endometriosis: Classification
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin and mucous membranes Abdominal wall and the inguinal region (groin area) [in rare cases: e.g., endometriosis foci on the belly button]. Gynecological examination Inspection Vulva (external, primary female … Endometriosis: Examination
There are no 1st-order laboratory parameters for endometriosis (even Ca-125 is not suitable for diagnosis or progression because of its low specificity (probability that actually healthy persons who do not suffer from the disease in question will also be identified as healthy in the test). 2nd order laboratory parameters – depending on the results of … Endometriosis: Lab Test
Therapy goals Improvement of the symptomatology, esp. pain reduction. Fertility preservation (preservation of fertility). Progression prophylaxis (measures to avert the progression of a disease). Relapse prophylaxis (measures to avert a recurrence of a disease). Therapy indications Pain Involuntary childlessness/infertility Impending organ loss Bleeding (e.g., rectal bleeding/bleeding from the rectum due to endometrial rectal infiltration) or … Endometriosis: Drug Therapy
Obligatory medical device diagnostics. Vaginal ultrasonography (ultrasound using an ultrasound probe inserted into the vagina) – to rule out ovarian endometriosis or adenomyosis (hyperplasia (“excessive cell formation”) of the myometrium (uterine muscles) stimulated by endometriosis) Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device … Endometriosis: Diagnostic Tests
Women of childbearing potential who have asymptomatic endometriosis do not require surgical repair. After ruling out a tubal (“fallopian tube-related”) infertility factor or a male cause of infertility, hormonal stimulation therapy followed by insemination (sperm transfer) can be performed. Surgical therapy of endometriosis is indicated only in cases of acute or chronic recurrent (“recurring”) endometriosis-induced … Endometriosis: Surgical Therapy
The following symptoms and complaints may occur together with endometriosis: Leading symptom Lower abdominal discomfort, cycle-dependent or (later) cycle-independent. Associated symptoms Blood in the stool (melena, hematochezia) – occurs cyclically in the case of endometriosis). Bleeding disorders – hypermenorrhea (increased menstrual bleeding; usually the affected person consumes more than five pads / tampons per day), … Endometriosis: Symptoms, Complaints, Signs
