Endometriosis

A condition in which fragments of the endometrium are located in other parts of the body, usually in the pelvic cavity. Endometriosis is most common in women aged 25–40 and may cause infertility. The cause of endometriosis is unclear. In some cases, it is thought to occur because fragments of the endometrium shed during menstruation do not leave the body but instead travel up the fallopian tubes and into the pelvic cavity, where they adhere to and grow on any pelvic organ. These displaced patches of endometrium continue to respond to hormones produced in the menstrual cycle and bleed each month. This blood cannot, however, escape and causes the formation of cysts, which may be painful and can grow to a size as large as a grapefruit. The symptoms of endometriosis vary greatly, with abnormal or heavy menstrual bleeding being most common. There may be severe abdominal pain and/or lower back pain during menstruation. Other possible symptoms include dyspareunia (see intercourse, painful), diarrhoea, constipation, and pain during defaecation; in rare cases, there is bleeding from the rectum. Sometimes, endometriosis causes no symptoms. Laparoscopy confirms the diagnosis. Drugs (including danazol, progestogen drugs, gonadorelin analogues, or the combined oral contraceptive pill) may be given to prevent menstruation. In some cases, local ablation of the endometrial deposit, using either laser or electrocautery during laparoscopy, may be needed. If the woman is not infertile, pregnancy often results in significant improvement of the condition. A hysterectomy may be suggested if the woman does not want children.