Endometrosis

A medical problem women should be aware of.

- Dr B.L. Nagpal

The uterine cavity is lined by a specialised mucous membrane called, endometrium, which undergoes cyclic change of the menstrual cycle regulated by ovarian hormones. The purpose of this is to prepare a “soft bed” for the incoming fertilised ovum to implant and grow.

Menstruation represents the rolling back, breaking down and casting off of this ‘bed’ (secretary endometrium) prepared for a pregnancy which does not materialize and so is sometimes described as, “the weeping of a disappointed uterus with bloody tears”.

Definitions

Endometriosis is defined as the presence of ectopic endometrium in any situation outside its normal location, namely, the lining of the cavity of the uterine body. It is of two types:

a. Endometriosis interna, also called adenomyosis, is characterised by a deep invasion of a muscular layer (myometrium) by islets of endometrium from the basal layer.

b. Endometriosis externa, in which there is a formation of endometrium like masses, also called as endometriomas, in a variety of places in the female pelvis and abdominal cavity.

It is rare to find both the types to be present together in the same patient provided strict diagnostic criteria are observed. They arise in different ways and finding of one type is almost certain in the absence of the other.

The ectopic endometrium responds to the stimulus of oestrogen and to a lesser degree of progesterone and bleeds periodically.

The evidence sites where endometriosis externa (endometriomas) are found as follow: One or both ovaries, tubes, outer surface of uterus, pelvic peritoneum, pouch of Douglas, uterovesical pouch, uterosacral ligaments, rectovaginal septum, rectum, intestines, bladder, cervix, umbilicus, hernia sac and even far away like thigh, arm, pleura etc.

Evidence