nursing faculty

1. BY: SAGAR MASNE (MSC NSG)

2. Introduction
 Endometriosis (en-doe-me-tree-O-sis) is an
often painful disorder in which tissue that
normally lines the inside of your uterus — the
endometrium — grows outside your uterus.
 Endometriosis most commonly involves your
ovaries, fallopian tubes and the tissue lining
your pelvis.
 Rarely, endometrial tissue may spread beyond
pelvic organs.

3. Intro….
 The main symptoms are pelvic pain and infertility.
 Nearly half of those affected have chronic pelvic
pain, while in 70% pain occurs during menstruation.
 Pain during sexual intercourse is also common.
 Infertility occurs in up to half of women affected.
 Less common symptoms include urinary or bowel
symptoms.
 About 25% of women have no symptoms.
 Endometriosis can have both social and
psychological effects.

4. Epidemology
 One estimate is that 10.8 million people are
affected globally as of 2015.
 Other sources estimate about 6–10% of
women are affected.
 Endometriosis is most common in those in
their thirties and forties; however, it can begin
in girls as early as 8 years old.

5. Causes
 The cause is not entirely clear.
 Risk factors include having a family history of the
condition.
 The areas of endometriosis bleed each month,
resulting in inflammation and scarring.
 The growths due to endometriosis are not cancer.
 Diagnosis is usually based on symptoms in
combination with medical imaging, however, biopsy is
the most sure method of diagnosis.
 Other causes of similar symptoms include pelvic
inflammatory disease, irritable bowel
syndrome, interstitial cystitis, and fibromyalgia.

6. Causes
Although the exact cause of endometriosis is not
certain, possible explanations include:
 Retrograde menstruation. In retrograde
menstruation, menstrual blood containing
endometrial cells flows back through the fallopian
tubes and into the pelvic cavity instead of out of
the body. These displaced endometrial cells stick
to the pelvic walls and surfaces of pelvic organs,
where they grow and continue to thicken and
bleed over the course of each menstrual cycle.

7. Cont…
 Transformation of peritoneal cells. In what's
known as the "induction theory," experts
propose that hormones or immune factors
promote transformation of peritoneal cells —
cells that line the inner side of your abdomen
— into endometrial cells.
 Embryonic cell transformation. Hormones
such as estrogen may transform embryonic
cells — cells in the earliest stages of
development — into endometrial cell implants
during puberty.

8. Cont….
 Surgical scar implantation. After a surgery,
such as a hysterectomy or C-section,
endometrial cells may attach to a surgical
incision.
 Endometrial cells transport. The blood
vessels or tissue fluid (lymphatic) system may
transport endometrial cells to other parts of the
body.
 Immune system disorder. It's possible that a
problem with the immune system may make
the body unable to recognize and destroy
endometrial tissue that's growing outside the

9. Cont..
 Localization
 Possible locations of endometriosis
 Most often, endometriosis is found on the:
 ovaries
 fallopian tubes
 tissues that hold the uterus in place
(ligaments)
 outer surface of the uterus

10. Cont…
 Less common sites are:
 vagina
 cervix
 vulva
 bowel
 bladder
 rectum[2]
 Rarely, endometriosis appears in other parts of
the body, such as the lungs, brain, and skin.

11. Cont..
 Rectovaginal or bowel endometriosis affects
approximately 5-12% of women with
endometriosis, and can cause severe pain
with bowel movements.
 Endometriosis may spread to
the cervix and vagina or to sites of a surgical
abdominal incision, known as "scar
endometriosis.

12. Cont…
 Risk factors for scar endometriosis include
previous abdominal surgeries, such as a
hysterotomy or cesarean section, or ectopic
pregnancies, salpingostomy puerperal
sterilization, laparoscopy, amniocentesis,
appendectomy, episiotomy, vaginal
hysterectomies, and hernia repair.
 Endometriosis may also present with skin
lesions in cutaneous endometriosis.

13. Risk factors
 Never giving birth
 Starting period at an early age
 Going through menopause at an older age
 Short menstrual cycles — for instance, less than 27
days
 Having higher levels of estrogen
 Low body mass index
 Alcohol consumption
 One or more relatives (mother, aunt or sister) with
endometriosis
 Any medical condition that prevents the normal passage
of menstrual flow out of the body

14. S/S
 Dysmenorrhea – painful, sometimes disabling
cramps during the menstrual period; pain may
get worse over time (progressive pain), also
lower back pains linked to the pelvis
 Chronic pelvic pain – typically accompanied by
lower back pain or abdominal pain
 Dyspareunia – painful sex
 Dysuria – urinary urgency, frequency, and
sometimes painful voiding

15. S/S
 Infertility. Endometriosis is first diagnosed in
some women who are seeking treatment for
infertility.
 About a third of women with infertility have
endometriosis.
 Among women with endometriosis about 40%
are infertile
 Other symptoms. You may also experience
fatigue, diarrhea, constipation, bloating or
nausea, especially during menstrual periods.

16. D/E
 Histroy collection
 Physical examination
 Pelvic ultrasound
 MRI
 Laproscopy

17. Treatment
 Pain medication
 Your doctor may recommend that you take an
over-the-counter pain reliever, such as the
nonsteroidal anti-inflammatory drugs (NSAIDs)
ibuprofen (Advil, Motrin IB, others) or naproxen
sodium (Aleve, others), to help ease painful
menstrual cramps.

18. Treatment
 Hormone therapy
 Hormonal contraceptives. Birth control pills,
patches and vaginal rings help control the
hormones responsible for the buildup of
endometrial tissue each month. Most women
have lighter and shorter menstrual flow when
they're using a hormonal contraceptive

19. Treatment
 Gonadotropin-releasing hormone (Gn-RH)
agonists and antagonists. These drugs block
the production of ovarian-stimulating
hormones, lowering estrogen levels and
preventing menstruation. This causes
endometrial tissue to shrink. Because these
drugs create an artificial menopause,

20. Treatment
 Progestin therapy. A variety of progestin
therapies, including an intrauterine device
(Mirena), contraceptive implant, contraceptive
injection (Depo-Provera) or progestin pills, can
halt menstrual periods and the growth of
endometrial implants, which may relieve
endometriosis signs and symptoms.

21. Treatment
 Aromatase inhibitors. Aromatase inhibitors
are a class of medicines that reduce the
amount of estrogen in your body. Your doctor
may recommend an aromatase inhibitor along
with a progestin or combination hormonal
contraceptive to treat endometriosis.
 Infertility treatment
 Hystrectomy
 Oophrectomy