Obstetrics and Gynecology · MU Sofia

50. Endometriosis

Explains endometriosis as endometrium-like tissue growing outside the uterus, starting with its prevalence and the main theories of origin, such as retrograde menstruation. It then covers common sites, including ovarian endometriomas and adenomyosis, and sets out the clinical picture in a symptom table with examination findings. The note also reviews diagnosis by imaging and laparoscopy, staging systems, and medical, surgical and fertility-related treatment options.

Inside: 6 sections · 1 table · 16 flashcards · 2 min

Topic 50 of 61 in the MU Sofia syllabus for Obstetrics and Gynecology (Medicine, Year 5). The free AceMed note covers it in 6 sections, about 263 words (2 min of reading), with 16 flashcards.

In this note

  1. Introduction
  2. Theories of origin
  3. Sites
  4. Clinical picture
  5. Diagnosis
  6. Treatment

Introduction

Endometriosis is the presence of endometrium-like tissue outside the uterus, causing a chronic oestrogen-dependent inflammatory disease. It affects about 10% of women of reproductive age and up to half of women with infertility or chronic pelvic pain.

Theories of origin

  • Retrograde menstruation (Sampson): endometrial cells flow back through the tubes and implant.
  • Coelomic metaplasia; lymphatic and vascular spread (distant sites); immune and genetic factors.

Sites

  • Ovaries (endometrioma, "chocolate cyst"), pouch of Douglas, uterosacral ligaments, pelvic peritoneum, rectovaginal septum, bowel and bladder (deep endometriosis); rarely lungs and scars.
  • Adenomyosis: endometrial tissue within the myometrium; enlarged, tender, globular uterus, heavy painful periods.

Clinical picture

Examination: fixed retroverted uterus, tender nodules in the uterosacral ligaments or pouch of Douglas, adnexal mass. Severity of pain does not match the extent of disease.

Diagnosis

  • Transvaginal ultrasound (endometriomas with a "ground-glass" appearance, deep nodules) and MRI.
  • Laparoscopy with biopsy: the traditional gold standard (powder-burn, red, white lesions, adhesions); now not always needed before treatment.
  • CA-125 may be raised but is not diagnostic. Staging: revised ASRM I–IV, or #Enzian.

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