obstetrics & gynecology,

1. Endometriosis
Samman Khurshid
M.B.B.S.(Final Year)

2. Definition
 Endometriosis is the presence of tissue
similar to normal endometrium, in
structure and function, at sights other than
the lining of the uterine cavity.

3. Incidence
 10 – 20% of the Laparotomies.

4. Etiology and Pathogenesis
 Implantation Theory
 Coelomic Metaplasia Theory
 Lymphatic or Haematogenous
Dissemination

5. Predisposing factors
 Age
 Race
 Socioeconomic status
 Infertility
 Parity
 Genetic
 Auto immune

6. Site of Endometriosis
 Ovaries - Commonest
 Pelvic peritoneum
 Uterovesical pouch
 Retroviginal septum
 Fallopian tubes
 Others

7. Pathology
Gross features
 Spots
 Cysts(chocolate)
 Peritonitis
 Fibrosis – Adhesion
 Strictures – Obstruction
Microscopic features
 Endometrial glands
 Endometrial stroma

8. Symptoms
 Asymptomatic
 Dysmenorrhea
 Dyspareunia
 Abdominal & Pelvic pain
 Menorrhagia
 Infertility
 Others

9. Signs
 No clinical signs
 Cyst or nodular masses
 Retroverted Uterus
 Tenderness
 Bluish nodule

10. Diagnosis
 Examination under anesthesia
 Laparoscopy
 Laparotomy
 Non invasive methods
 Ultrasonography.
 CT-scan/MRI.
 CA-125.

11. Differential Diagnosis
 Chronic pelvic inflammatory disease
 Hemorrhage in corpus luteum
 Myomas
 Malignant disease of ovary
 Ca Cervix and Vagina
 Adenomyosis
 Carcinoma of colon or rectum
 Acute abdomen

12. Treatment
 Expectant treatment
 Medical(Hormones)
 Surgery
 Combination of medical and surgical
treatment
 Assisted reproductive technique

13. Cont.….
 Expectant Treatment
 Medical Treatment
1. Pseudo pregnancy treatment
 Combination of Estrogen and Progestogen
 Progestogens only
2. Pseudo menopause treatment
 Danazol
 Gestrinone
 GnRH analogues or antagonists

14. Complications
 Recurrence of Endometriosis
 Malignant Change in Endometriosis

15. Thanks….