Endometriosis is a gynecological disorder where endometrial tissue grows outside the uterus, most commonly on the ovaries, fallopian tubes, and pelvic peritoneum. It causes painful periods, infertility, and other symptoms. The cause is unknown but theories include retrograde menstruation through the fallopian tubes or changes in the immune system. Diagnosis is confirmed through laparoscopy and treatment involves oral contraceptives, progestins, minimal invasive surgery such as laparoscopy to destroy or remove the endometrial implants, or in severe cases hysterectomy.

1. DR.SANDHANARAJ.S, DEPT OF MM,
GHMCHT.
Endometriosis
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2.  One of the most mysterious and facinating
gynaecological disorder
 By definition endometriosis is the occurance of
ectopic endometrial tissues outside the cavity
of uterus which contain endometrial stroma
which is capable of responding to the varying
degree to cyclical hormonal stimulation
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3. AETIOLOGY
 Disease of child bearing period
 Changing social paterns
 Late marriage
 Limitation of family size
 Seen in affluent class
 Genetic suceptabilty
 Familial tendency
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4. THEORIES
 Implantaion theory
 Reflux of menstrual endometriam through fallopian
tubules
 Reserch on rhesus monkeys confirmed it
 Coelomic metaplasia theory
 Rests of embryonic mesothelium
 Metasttic theory
 Embolisation of menstrual fragments
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5.  Histogenesis by induction
 Some chemical substances present had been
considerd to be the important cause
 Homonal influence
 Oestrogen is considerd
 Pregnancy tends to decrease due to increased
progestrone level
 Rarely seen before puberty
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6.  Immunological factor
 Alterd immunology
 Impaired t cells and nk activity
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7. SITES OF ENDOMETRIOSIS
 Ovaries
 Cul-de-sac- uterosacral ligament
 Peritoneum overlying the bladder
 Sigmoid colon
 Back of uterus
 Intestinal coils
 Appendix
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8. PATHOLOGY
 Area appears dark red,bluish and blackish
cystic area
 Scarring around the lesion giving a puckering
look
 Non pigmented areas or yellowish whitish thick
plaque
 Powder burnt areas
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9. CHOCLATE CYSTS OF OVARIES
 Most important manifestation of endometriosis
 Obivious thickening of tunica albugenia
 Vascular red adhesions are well marked on
undersurface of the ovary
 Inner surface of cyst wall is vascular and
contain areas of dark brown tissue
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10. HISTOLOGICL APPEARANCE
 Lining epithelium is usually columnar
 Tendency for formation of papillae
 A zone of tissue containing large cells with
brown cytoplasm,polyhedral in shape
resembling leutin –this pseudoxanthoma cells
are probably large macrophages or scavenger
cells
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11. CLASSIFICATION –AMERICAN FERTILITY
SOCIETY
 Based on size and location of endometrial
lesion
 Minimal –small spot seen at laprotomy but no
clinical symptom
 Mild-scatterd fresh superficial lesions No
scarring or retraction.no adenexal adhesions
 Moderate –ovaries ar involved with scarring
and retraction,more than 2cm in size minimal
peritubal and ovarian adhesions
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12.  Severe –ovaries are involved with size of
endometriosis exceeding 2cm
 Dence peritubal and periovarian adhesions
restricting the mobility
 Uterosacral ligaments are thickened
 Evidence of involvement of bowel and urinary
tract
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13. CLINICAL FEATURES
 Dysmenorrhoea
 Most common symptom
 Pain begining before the onset of menstruation
,builds up continously until the flow begining and
gradually declines there after
 Backache is the most common complaint
 Sometime there may be radiating pain along the
sacral nerve
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14.  Abdominal pain
 Lower abdominal pain of varying intensity
1. Dyspareunia
movements of cervix elicit tenderness
 Infertilty
 40%
 Menstrual symptoms
 Menorrhagia is common
 Irregular bleeding may also occur
 Polymenorrhea is noted in ovarian involvement
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15.  Chronic pelvic pain –prostaglandin E2 is the
cause of this pain
 Urological symptoms-frequency dysuria rarely
haematuria
 Hydronephrosis
 Bowel symptoms –painful defecation,diarrhoea
and melena around menstruation,some times
constipation
 Painfull abdominal mass-stimulating peritonits
appendicitis and ectopic pregnancy
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16. PHYSICAL FINDINGS
 Abdominal examination –cystic swolling
 Swolling is fixed and may be slighty tender
 Speculam examination-bluish or blackish
puckerd spots in posterior fornix,spots which is
tender to touch
 Vaginal examination-tender fixed retroverted
uterus
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17. DIFFERENTIAL DIAGNOSIS
 Chronic pelvic inflamatory disease
 Uterine myomas
 Ovarian malignant tumour
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18. INVESTIGATIONS
 Laproscopy
 CA 125 ,glycoprotien and cell surface antigen is
raised to 35u/l in 80% of cases
 Ultrasound and MRI
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19. PROPHYLAXIS
 Low dose of oral contaracepive pills
 Tubal patency test is to be avoided in
immediate intermenstrual phase
 Operation of the genital tract should be
sheduled in premenstrual period
 Hystrectomy and classical caesarean section is
to be avoided
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20. TREATMENT
 Oral contraceptive
 Oral progestrone
 Minimal invasive surgery
 Done using laproscopy
 Aspiration of fluid in the culde sac
 Destruction of endometriotic implants by
diathermy,cauterization or vapourisation
 Large lesions and choclate cyst can be exised
 Laproscopic breaking of the adhesions –relives
dysmenorrhoea
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21.  Laser uterosacral nerve ablation –LUNA
 SURGERY
 Saphingio oophorectomy
 Abdominal hystrectomy
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