A Brief Review of Endometriosis

Endometriosis is a common condition that affects women during their reproductive years.

Key Points

Highlights:

• Endometriosis is more commonly seen in women without a previous pregnancy, with a family history of endometriosis or abnormal menstrual periods.

What’s done here?

• The symptoms, causes, diagnosis, and treatment of endometriosis are discussed here.

Key Points:

• Some of the symptoms of endometriosis include painful menstrual cramps or heavy menstrual periods, pain during or after sexual intercourse, pain during a bowel movement or urination, and abdominal pain. There are some endometriosis patients, however, who do not experience the symptoms. 
• Endometriosis can cause bleeding in between periods, intestinal problems, chronic pelvic inflammatory disease, or infertility.
• The etiology of endometriosis is not still known, however, the most possible cause is accepted to be the backflow of menstrual blood. Genetic factors, immune irregularities, estrogen imbalances, and surgery (such as cesarean deliveries or abdominal surgeries) are considered to be other causes.
• The patient’s medical history and an examination are important in the diagnosis of endometriosis. Imaging, such as transvaginal ultrasound and magnetic resonance imaging may be helpful. To confirm endometriosis, laparoscopy is needed. Endometriosis lesions can be confirmed by histopathological diagnosis.
• Treatment of endometriosis aims to relieve the symptoms. Treatment for pain includes hormonal contraceptives, pain relievers, gonadotropin-releasing hormone agonists, aromatase inhibitors and gonadotropin-releasing hormone antagonists. If laparoscopic endometriosis removal procedures do not work, other fertility techniques such as in vitro fertilization may be the choice of treatment in infertile patients.

Lay Summary

Endometriosis is a common disease among women of reproductive age. It is more frequently seen among women without prior pregnancies, women with a family history of endometriosis, and women with abnormal menstrual periods.

Peiris et al., researchers from the United States and China, reviewed the symptoms, causes, diagnosis, and treatment of endometriosis in their recently published paper in The Journal of the American Medical Association.

Endometriosis patients may experience pain, bleeding in between periods, intestinal problems, chronic pelvic inflammatory disease, or infertility. Some of the patients are asymptomatic.

The most likely cause of endometriosis is considered to be the backflow of menstrual blood, which is called "retrograde menstruation". Genetic factors, immune irregularities, estrogen imbalances, and surgery (such as cesarean deliveries or abdominal surgeries) are among the other causes.

What is important in the diagnosis of endometriosis is the patient’s medical history and a detailed examination. Imaging, such as transvaginal ultrasound and magnetic resonance imaging may also be helpful. To confirm endometriosis, laparoscopy is needed. Endometriosis lesions can be confirmed by histopathological diagnosis.

Treatment of endometriosis focuses on relieving the symptoms. Treatment for pain includes hormonal contraceptives, pain relievers, gonadotropin-releasing hormone agonists, aromatase inhibitors, and gonadotropin-releasing hormone antagonists. If laparoscopic endometriosis removal procedures do not work, other fertility techniques, such as in-vitro fertilization, maybe the choice of treatment in infertile patients.

Research Source: https://jamanetwork.com/journals/jama/fullarticle/2719310