Endometriosis is a chronic condition characterised by the growth of endometrial tissue in sites other than the uterine cavity, most commonly the pelvic cavity (including the ovaries)

Adenomyosis is the invasion of the middle layer of uterus by endometrial tissue. This leads to painful as well as heavy periods.

Extrauterine endometrial tissue causes inflammation, pain and the formation of adhesions.

Endometriosis is estimated to affect 5-10% of women of reproductive age

Risk for first-degree relatives of women with severe endometriosis is six times higher than that for relatives of unaffected women.

Aetiology

We are still unclear regarding cause for endometriosis. Suggested theories have included:

Retrograde menstruation.

Lymphatic or haematogenous spread.

Metaplasia.

Presentation

Common symptoms include:

Painful periods

Painful intercourse

Cyclical or chronic pelvic pain.

Subfertility

The clinical presentation is variable, with some women experiencing several severe symptoms and others having no symptoms at all.

Investigations

For a definitive diagnosis of endometriosis, laparoscopy is the gold standard investigation but it is invasive with a small risk of major complications – eg, bowel perforation.

Pelvic Ultrasound is advised to assess for Endometriomas- (ovarian cyst).

 Management

The treatment of endometriosis is usually individually based, depending on the nature and severity of symptoms and the need for future fertility.

Medical treatment may reduce symptoms in some of patients, but none of the treatment options has been shown to reduce recurrence of symptoms once treatment has stopped.

Surgical options include removing severe and deeply infiltrating lesions (which may reduce pain related to endometriosis), ovarian cystectomy (for endometriomas), adhesiolysis, and bilateral oophorectomy (often with a hysterectomy).

Management may also include pain management specialists and clinical psychologists.

Prognosis

The natural course of the disease is variable and may or may not be progressive.

In the five years after surgery or medical treatment, 20-50% of women will have a recurrence.