Endometriosis is a benign condition where endometrial tissue grows outside the uterine cavity, most commonly on the ovaries, pouch of Douglas, uterosacral ligaments, and rectovaginal septum. It causes pain and infertility and is diagnosed through laparoscopy or imaging like ultrasound and MRI. Treatment options include expectant management for mild cases, medical therapy using hormones to induce endometrial atrophy, and surgery to destroy endometrial lesions laparoscopically or through hysterectomy. Combined medical and surgical treatment may also be used.

1. Endometriosis
Jiwan Pandey
Intern (SBH)

2. Defined as presence of tissue i.e morphologically
and biologically similar to normal endometrium
and contains functional end glands and stroma in
ectopic locations outside the uterine cavity.
Endometriosis interna : Myometrium
Endometriosis Externa : other then
uterus (Endometriosis)

3. It is a benign condition but it is locally invasive, disseminates widely.
Cyclic hormones stimulate growth but continuous hormone suppress it

4. Abdominal
Ovary
Pouch of Douglas
Uterosacral ligament
Rectovaginal septum
Rectum and pelvic
lymph nodes
Gut ,Appendix
Ureter and urinary
bladder
Extra abdominal
Abdominal scar of
hysterectomy caesarean
section, tubectomy,
myomectomy
Scar over Umbilicus,
vagina , cervix
Episiotomy scar.
Remote
Pleura ,lungs
Deep tissues of
arms and thighs

5. Clinical features of Pelvic Endometriosis
Patients Profile
Age between 30-45 years.
Mostly Nulliparous
Small number of children
Infertility
Postponement of first conception
Higher social status

6. Usually asymptomatic(25%)
Symptoms are not related to extent of lesion but to depth of invasion.
Dysmenorrhea (70%)
Abnormal mensturation
i.e menorrhagia/polymenorrhoea/epimenorrhoea
Infertility
Dyspareunia
Abdominal pain
Symptoms

7. Other symptoms
 Bladder- Frequency,dysuria,haematuria
Sigmoid colon and rectum-Painful defecation
Lungs/Thorax-Cyclical hemoptysis and
hemothorax Pneumothorax
Surgical scars : Cyclical pain and bleeding
from scar

8. On Examination
Abdominal examination-Mass in lower abdomen which is
tender with restricted mobility
Pelvic examination-Pelvic tenderness, nodules in pouch of
Douglas, nodular feel of uterosacral ligament, fixed retroverted
uterus or unilateral or bilateral adnexal mass of varying sizes
Per speciculum:Speculum : Bluish spots in posterior fornix

9. Diagnosis
Serum marker CA 125 :
Moderately raised
Also useful to assess therapeutic response
Detect any recurrence after therapy
Diagnosis of Endometriosis

10. Imaging
Ultrasonography
TVS and Endorectal USG are more better.
MRI shows hyperintensity on T1 weighted images ‘and hypointensity in T2
weighted images
CT and colonoscopy are also used.

11. Laparoscopy is the gold standard
classic lesion is described as powder burns or matchstick
spots on peritoneum of pouch of Douglas

12. Biopsy Confirmation

13. Expectant Management
Medical Therapy
Surgery
Combined Therapy
Treatment Option for pelvic Endometriosis

14. Expectant Management
Case Selection
Minimal endometrosis with no other abnormal pelvic findings
Unmarried
Young married who are ready to start family
Approaching Menopause
Observation with administration of NSAIDS
Married women are encouraged to have conception.

15. Hormonal Treatment
Aim is to induce endometrial atrophy
Pseudo pregnancy Medical oophorectomyPseudo menopause
Combined Oral Pills
Progestogens
IUCD
Danazol
GnRH agonist
Goserelin

16. Surgical Management
Conservative Definitive
Aim is to destroy the endometriotic
lesion in an attempt to improve
symptoms and preserve fertility
Excission and ablation of endometriotic
lesion (laproscopy/electrodiatherapy/
laser vaporisation)
Indicated in women with advanced
stage endometriosis- No prospect
for fertility improvement /
treatment failure/ women who
completed family
Hysterectomy with bilateral
salpingo-oophorectomy

17. Combined medical and surgical
Preoperative hormonal therapy (3-6months ):
Reduction of size and vascularity
Surgery
Postoperative therapy (3-6months) to prevent
recurrence.