From the Guidelines
Endometriosis is a complex condition characterized by systemic features including chronic inflammation, immune system dysregulation, and increased oxidative stress, which can lead to significant morbidity and impact quality of life. The condition is associated with various symptoms, including pelvic pain, fatigue, widespread pain, and gastrointestinal symptoms like bloating, diarrhea, or constipation, even without direct bowel involvement 1. Patients with endometriosis often experience hormonal imbalances, with altered estrogen metabolism and progesterone resistance, and may report neurological symptoms such as headaches, migraines, and mood disorders like depression and anxiety 1.
The condition is also linked to comorbidities, including autoimmune disorders like rheumatoid arthritis, systemic lupus erythematosus, and Sjögren's syndrome, suggesting shared immunological pathways 1. Furthermore, endometriosis may have cardiovascular implications, including slightly increased risks of hypertension and cardiovascular disease, as well as metabolic abnormalities like insulin resistance and altered lipid profiles 1.
It is essential to understand these systemic manifestations to provide comprehensive patient care, as they significantly impact quality of life and may require multidisciplinary management approaches 1. The diagnosis of endometriosis can be challenging due to variable presenting symptoms and nonspecific physical examination findings, but imaging studies like expanded protocol transvaginal ultrasound (TVUS) and MRI can help inform patient decision-making and surgical planning 1.
Key features of endometriosis include:
- Chronic inflammation and immune system dysregulation
- Increased oxidative stress
- Hormonal imbalances with altered estrogen metabolism and progesterone resistance
- Neurological symptoms like headaches, migraines, and mood disorders
- Cardiovascular implications, including increased risks of hypertension and cardiovascular disease
- Metabolic abnormalities, such as insulin resistance and altered lipid profiles
- Association with comorbidities, including autoimmune disorders and other chronic conditions 1.
The management of endometriosis should prioritize a multidisciplinary approach, addressing the systemic features and comorbidities associated with the condition, to improve quality of life and reduce morbidity.
From the Research
Systemic Features of Endometriosis
The systemic features of endometriosis include:
- Chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility, occurring in 6-10% of reproductive-aged women 2
- Estrogen-dependent, inflammatory disease that leads to symptoms of pelvic pain, dysmenorrhea, dyspareunia, and infertility 2
- Presence of extrauterine endometrial tissue associated with pain and infertility 3
- Typical symptoms include dysmenorrhoea, dyspareunia, heavy menstrual periods, pelvic pain, dysuria, and chronic fatigue 3
- Clinical manifestations include dyspareunia, cyclic menstrual pain, chronic pelvic pain, and dyschezia, all of which can affect the patient's quality of life and health severely 4
- Rectovaginal endometriosis presents with symptoms including chronic pelvic pain, dysmenorrhea, deep dyspareunia, dyschezia, and rectal bleeding 5
- Endometriosis has physical and psychological effects, causing depression, anxiety, and compromising social relationships 6
Impact on Quality of Life
The impact of endometriosis on quality of life includes:
- Negative impact on sexual life and social relationships 6
- Compromising social relationships and causing depression and anxiety 6
- Economic burden, both individually and for the community, as this pathology leads to a loss of productivity at work and large use of health resources 6
- Symptoms control women's lives, compromising the quality of life in all aspects 6
Disease Characteristics
The disease characteristics of endometriosis include:
- Chronic, recurrent disease, frequently requiring long-term management until menopause and beyond 2
- Benign gynecologic disorder that is defined as functional endometrial tissue outside of the uterine cavity 2
- Chronic inflammatory condition in which foci of endometrial tissue grow outside of the uterine cavity 3
- Severity of the disease ranges from asymptomatic to debilitating symptoms that have a major impact on women's lives 2