17 Other symptoms that are less specific but are frequently reported by patients with endometriosis include abdominal pain and bloating, abnormal uterine bleeding, low back pain and fatigue. Deep endometriosis that invades adjacent organs can lead to symptoms at time of menstruation such as painful bowel movements (dyschezia), bloody stools (hematochezia), dysuria or hematuria.ĭiaphragmatic or thoracic implants can cause cyclical dyspnea, chest or shoulder pain, hemoptysis and pneumothorax. Less commonly, any of these 3 symptoms can be the main presenting problem without the presence of dysmenorrhea. Deep dyspareunia (hitting pain, felt in the upper vagina during sexual intercourse), chronic pelvic pain and infertility are also common symptoms and can coexist with dysmenorrhea. 16 This can be distinguished from primary dysmenorrhea, which is usually shorter in duration and responds well to nonsteroidal anti-inflammatory drugs. Regardless of subtype, most (90%) symptomatic patients have secondary dysmenorrhea, which can be incapacitating and is often their presenting problem. Endometriosis is sometimes diagnosed incidentally at surgery performed for other indications, with the patient having reported no symptoms. Symptoms of endometriosis can vary and may change over time. Imaging and laparoscopic appearance of endometriosis subtypes. Extrapelvic disease is a less common clinical presentation of endometriosis and may occur at sites such as the diaphragm, thoracic cavity and surgical scars. 15 Deep endometriosis has the capacity to cause end-organ damage such as kidney failure (from ureteric obstruction) or bowel obstruction, so timely diagnosis and management is important. Endometriomas frequently co-occur with deep endometriosis, and finding an endometrioma on ultrasonography should prompt further investigation, especially if the patient reports severe pain. 14 Subtypes may overlap some patients may have more than 1 manifestation of the disease concurrently. Deep endometriosis (previously called deep infiltrating endometriosis) is identified by lesions that extend beyond the peritoneum these lesions are often nodular and fibrotic, and have the capacity to invade adjacent pelvic organs such as the rectosigmoid, ureter or bladder. Endometriomas are ovarian cysts that contain dark, blood-stained fluid (often called chocolate cysts). Superficial peritoneal endometriosis is the most common subtype and consists of lesions of various colours located on the surface of the peritoneum. Three subtypes of pelvic endometriosis are important to recognize as they may affect symptom presentation and method of diagnosis ( Figure 1). What are the subtypes of endometriosis and their clinical manifestations? Hematogenous or lymphatic spread is postulated to explain extrapelvic endometriosis. Other theories include coelomic metaplasia, whereby the normal peritoneal tissue (i.e., mesothelium) transforms via metaplastic transition to ectopic endometrial-like tissue. 9 The endometrial-like cells are able to implant outside the uterus and respond to estrogen stimulation from the ovaries and the cells themselves, leading to inflammation and subsequent scarring and adhesions. 8 Endometriosis is postulated to develop because of alteration in this process owing to factors such as cellular adhesion and proliferation, somatic mutations, inflammation, localized steroidogenesis, neurogenesis and immune dysregulation. The most accepted theory is that endometrial cells reach the peritoneal cavity through retrograde menstruation (a physiologic process that occurs in 90% of women) these cells are usually broken down and cleared. ![]() Many theories have been suggested to explain the development of endometriosis, but none are definitive. 6 Endometriosis also affects fertility by altering the peritoneal environment or by distorting the pelvic anatomy about 30% of patients with endometriosis have difficulty conceiving. ![]() ![]() 3 Endometriosis can involve multiple organ systems and its symptoms are often chronic, which can affect work productivity, social life, intimate relationships and mental health considerably, 4, 5 and lead to substantial societal costs. Symptom severity is not correlated to extent of disease patients with substantial disease may be asymptomatic, adding to the puzzle of this condition. 2 The condition can cause severe dysmenorrhea, deep dyspareunia and chronic pelvic pain, as well as bowel and bladder symptoms and fatigue. 1 Case series have identified endometriosis in 40%–50% of women and adolescents with persistent pelvic pain and in 30%–40% of women with infertility. 1 It is one of the most prevalent gynecologic conditions, believed to affect roughly 1 million people in Canada. Endometriosis is estimated to affect about 10% of women of reproductive age, and an unknown number of gender-diverse people.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |