NDOMETRIOSIS is the growth of endometrium
outside the uterine cavity or myometrium
(endometriotic implants), usually in the
peritoneal cavity (Fig. 1). The question of how the
tissue attains this abnormal placement is controversial,
although the predominant theory is that retrograde
menstruation is the cause.
1
Additional factors
that may be important in pathogenesis include immunologic
abnormalities, endometrial disorders, and
peritoneal dysfunction.
1
The principal manifestations of endometriosis are
pelvic pain and infertility.
2
The extent of the pain is
influenced primarily by the location and depth of the
endometriotic implant, with deep implants in highly
innervated areas most consistently associated with
pain. Infertility can result from the distortion of anatomical
relations in the pelvis caused by fibrosis and
the formation of adhesions. In addition, early-stage
disease (characterized by implants alone) may impair
fertility by means of a variety of substances produced
by the implants or the surrounding tissue; such substances
might include prostaglandins, cytokines and