From the Guidelines
Endometriosis of the uterus is a condition where tissue similar to the lining of the uterus grows outside the uterus, causing inflammation, scarring, and pain, and is characterized by lesions of endometrial-like tissue outside of the uterus 1.
Definition and Symptoms
Uterine endometriosis is a condition where tissue similar to the lining of the uterus (endometrium) grows outside the uterus, typically on the ovaries, fallopian tubes, and pelvic tissues. This misplaced tissue acts like normal endometrial tissue—thickening, breaking down, and bleeding with each menstrual cycle—but has no way to exit the body, causing inflammation, scarring, and pain. Common symptoms include:
- Painful periods
- Pain during intercourse
- Excessive bleeding
- Infertility
Diagnosis and Treatment
Diagnosis of endometriosis can be done through histologic examination or visual inspection by an experienced surgeon, and treatment options vary based on severity, including:
- Pain medications like NSAIDs (ibuprofen 400-800mg every 6-8 hours)
- Hormonal therapies such as birth control pills, GnRH agonists (like Lupron), or progestins (like Depo-Provera or Mirena IUD)
- Surgery to remove endometrial growths in severe cases According to the ACOG committee, current evidence suggests that pain caused by endometriosis can be managed medically, with progestins, danazol, oral contraceptives, nonsteroidal anti-inflammatory drugs, and gonadotropin-releasing hormone (GnRH) agonists all shown to reduce the size of lesions 1.
Classification and Prevalence
The classification of endometriosis has remained controversial, with various systems including the revised American Society for Reproductive Medicine (r-ASRM) classification, the Enzian classification, and the endometriosis fertility index (EFI) 1. The prevalence of endometriosis has been estimated as 176 million women worldwide, affecting approximately 10% of women of reproductive age 1.
From the Research
Definition of Endometriosis of the Uterus
- Endometriosis of the uterus is not directly defined in the provided studies, but it can be inferred that it refers to a condition where endometrial tissue grows outside of the uterus, potentially affecting the uterus.
- Adenomyosis, a related condition, is defined as a benign uterine disorder in which endometrial glands and stroma are pathologically demonstrated in the uterine myometrium 2.
- Endometriosis is mentioned as a condition that often coexists with adenomyosis, and is characterized by the presence of endometrial glands outside of the uterus 3, 2, 4.
Relationship with Adenomyosis
- Adenomyosis is a condition where endometrium-like tissue spreads within the myometrium, and it often coexists with other gynaecological conditions, such as endometriosis or fibroids 3, 5, 2.
- The clinical manifestations of adenomyosis include pelvic pain, dysmenorrhea, heavy menstrual bleeding, and subfertility, which may be similar to the symptoms experienced by women with endometriosis of the uterus 3, 5, 4.
Diagnosis and Treatment
- The diagnosis of adenomyosis, which may be related to endometriosis of the uterus, begins with clinical suspicion and is confirmed with transvaginal ultrasonography and pelvic magnetic resonance imaging 4.
- Treatment of adenomyosis typically starts with hormonal menstrual suppression, and levonorgestrel-releasing intrauterine systems have shown some effectiveness 4.
- Patients with adenomyosis may ultimately have a hysterectomy if symptoms are not controlled with medical therapy 4.