Endometriosis is characterized by the presence of endometrial tissue outside the uterine cavity, leading to chronic inflammation. Its etiology includes factors like retrograde menstruation, genetic predispositions, and environmental influences, with common symptoms being pelvic pain and infertility. Diagnosis is typically confirmed through laparoscopy, and treatment options range from medical management to surgical interventions.

1. Endometriosis
Dr.Chaduvula Suresh Babu
Professor
Department of Obstetrics &
Gynaecology
GIMSR, Visakhapatnam, AP

2. Definition
• Ectopic presence of endometrial tissue
outside the uterine cavity.
• Endometrial tissue includes glands and
stroma.
• First described in 1860 - Rokitansky.
• The ectopic tissue will induce chronic
inflammatory reaction.

3. Types by Sampson
• Endometrial tissues outside the uterine
cavity – endometriosis externa
• Endometrial tissue in the myometrium –
endometriosis interna or Adenomyosis

4. Prevalence
• 6-10 %
• Mean age - 25-40 years

5. Etiology / Histogenesis / Pathogenesis
• 1. Retrograde Menstruation and direct
implantation by SAMPSON
• 2. Coelomic metaplasia theory - Meyer &
Ivanoff
• 3. Vascular dissemination
• 4. Lymphatic spread - Halbans
• 5. Immunological defect
• 6. Direct transplantation

6. Etiology
• 7. Genetic factors
• 8. Environmental factors – cosmetics, nail
polishes, plastics, toxic chemicals
• 9. Induction theory
• 10. Circulating stem cells

7. Pathology
• 1. Superficial Peritoneal endometriosis

8. Pathology
• 2. Deep infiltrating Endometriosis [ DIE ]

9. Pathology
• 3. Ovarian Endometrioma or Chocolate
cyst

10. Sites
• 1. Ovary
• 2. Pelvic peritoneum – Anterior and
Posterior culdesac
• 3. Uterosacral ligaments
• 4. Posterior surface of uterus
• 5. Posterior leaf of broad ligament
• 6. Others – appendix, caecum, sigmoid,
scars, bladder, lungs, nose etc.,

11. Risk Factors
• 1. Age – 25-35 years
• 2. Delayed child bearing
• 3. Shorter lactation
• 4. Early menache
• 5. Frequent cycles
• 6. Late menopause
• 7.Low BMI

12. Risk Factors
• 8. Mullerian duct anomalies
• 9. Genetic factor
• 10. Past history of Asthma, allergies

13. Protecting factors
• 1. Smoking
• 2. Exrecise
• 3. Oral contraceptives

14. Clinical features
• A progressive disease with variable
symptoms
• 1. Pelvic pain
• 2. Infertility
• 3. Pelvic mass

15. Symptoms
• 1. Triple dysmenorrhoea – spasmodic,
congestive and progressive types
• 2. chronic pelvic pain
• 3. Deep dyspareunia
• 4. Infertility
• 5. Menstrual disturbances – heavy and or
irregular bleeding

16. Symptoms
• 6. Low backache
• 7. Perimenstrual discomfort
• 8. Others – Cyclical hematuria,
hematemsis, epistaxis, scar bleeding or
swelling
• 10. Dyschezia

17. Signs
• Fixed retroverted uterus
• Lack of mobility
• Adnexal mass
• Local tenderness
• Nodules in POD or over uterosacral
ligaments
• Rarely normal findings

18. Differential diagnosis
• Chronic PID
• Adenomyosis
• Ovarian tumor
• Irritable bowel syndrome
• Pelvic congestion syndrome

19. Investigations

20. 1. Laparoscopy- Gold standard test

21. Ultrasound examination

22. Trans vaginal ultrasound

23. 3. CA 125
• Not a real diagnostic test
• Does not correlate with symptoms
• Non specific
• It is also raised in Pregnancy, PID, Fibroid,
Cancer ovary etc.,

24. Other investigations
• 4. MRI
• 5. CT Scan
• 6. Histology of tissue

25. Laparoscopic appearence
• Powder Burn or Gun Shot lesions
• Black dark brown or bluish puckered
lesion
• Nodules or cysts
• Fibrosis
• Red lesions
• White lesions

26. Black and Blue lesions

27. White defective lesions

28. Yellow, nodule and cyst lesions with
adhesions

29. Chocolate cyst

30. Staging by ASRM
• Depending on
• 1. Site
• 2. Superficial or deep
• 3. Presence or absence of Adhesions

31. ASRM Staging of Endometriosis
• Stage 1. Minimal - 1--5%
• Stage II – Mild - 6 – 15 %
• Stage III – Moderate - 16 to 40 %
• Stage IV – Severe - more than 40 %

32. Treatment
• Expectant
• Medical
• Surgical – Conservative or Radical

33. Medical treatment
• 1. Analgesics – NSAIDs
• 2. Progesterones –
• 3. Combination of Estrogens and
Progesterones
• 4. GnRH analogues
• 5. Aromatase inhibitors
• 6. Danazole
• 7. Gestrinone
• 8. Mirena

34. Surgical Treatment
• Laparoscopy or Laparotomy
• Conservative or Radical
• Conservative – retain uterus and Ovary
• Radical – Removal of Uterus and +/-
Ovaries
• Ovarian cystectomy or Oopherectomy
• Laparoscopic fulguration
• Hysterectomy

35. Infertility
• Ovulation Induction drugs
• Adhesiolysis
• Tuboplasty
• IUI
• IVF
• Adoption

36. Lap Cystectomy

38. Thank You All