Endometriosis is the presence of endometrial tissue outside the uterine cavity, usually on the ovaries, ligaments and peritoneum. There are two main types: internal adenomyosis where tissue is in the myometrium, and external endometriosis. Common symptoms are heavy periods, pelvic pain and fertility issues. The leading theory for pathogenesis is retrograde menstruation, where menstrual tissue flows back through the fallopian tubes. Diagnosis is via laparoscopy and histology. Treatment options include hormonal therapy to suppress menstruation, or surgical excision via laparoscopy or laparotomy. Adenomyosis involves endometrial tissue deep in the uterine wall.

1. Endometriosis
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2.  Definition
 Types
 Sites
 Clinically
 Management
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3.  Presence of endometrial tissue in sites
other than the uterine cavity
 Types
 In internal endometriosis(adenomyosis)
the ectopic endometrium is confined
to the myometrium
 External endometriosis,
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4. External endometriosis
 Features
 asymptomatic
 nulliparous women or those of low
parity at between 30 and 45 years of
age
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5.  Characteristic symptoms are :
 Heavy ,often irregular menses
 Secondary dysmenorrhoea
 Dyspareunia
 Pelvic pain between menses
Fertility issues
 Symptoms do not correlate well
with size of lesion
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6. pathogenesis
 Several theories for development of
external endometriosis
 Metaplasia-both epithelial and stromal
cells of the endometrium have a
common precursor in the coelomic
epithelium and adjacent mesenchyme.
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7. Pathogenesis
the most widely
embraced theory
involves retrograde
menstruation5
Retrograde menstruation

8.  Retrograde menstruation and implantation of
viable cells on ,for example ,the ovaries and
peritoneum of the pouch of Douglas
 Mechanical implantation into scars at the time
of surgery ,eg hysterectomy or hysterotomy. It
very rarely follows caesarean section
 Venous or lymphatic metastasis. This (or
metaplasia) could account for rare pulmonary
endometriosis
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9. Common site of endometriosis

10.  The commonest sites:
 Both ovaries
 broad ligament
 Pouch of Douglas
 uterosacral ligaments
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11.  The rectum ,urinary tract or lungs
may occasionally be involved
 Fertility can be compromised by
tubal and ovarian damage and
pelvic adhesions.
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12.  Diagnosis
 Full history
 laparoscopy is essential for proper
diagnosis,
 Histology
endometriosis 12

13.  Medical treatment
 Aimed at suppressing enogenous
cyclical changes in oestrogen and
progesterone to prevent menses
 Use of progestogen or the oral
contraceptive pill for 6-9 months
 Gonadotropin-releasing hormone
(GnRH) agonist
endometriosis 13

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15.  Surgical treatment
 Conservative surgery by laparoscopy or
laparotomy:
 small deposits can be diathermised,
exercised or vaporised using a CO2
laser .
 Large chocolate cysts require excision
endometriosis 15

16. adenomyosis
 Islets of endometrial tissue,glands
and stroma are found deep in the
uterine wall ,which responds by
hyperplasia of muscle and fibrous
tissue

endometriosis 16

17. Features
 Older women,
 multiparous women (in constrast to
external endometriosis)
 Increasingly severe dysmenorrhoea
 Secondary dysmenorrhoea
 Gradually enlarging tender uterus
endometriosis 17

18.  Adenomyosis difficult diagnose definitely other
than by histology after hysterectomy
 Treatment –TAH with conservation of ovaries
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