3CAUSES cont’d Fibromyalgia Musculoskeletal systemMental health issuesFibromyalgiaCoccydynia, piriformis/levator ani syndrome, pelvic floor tension myalgiaPostureChronic abdominal wall painOsteitis pubisSomatization disorderOpiate dependencyPhysical and sexual abuseDepressionSleep disorders
4ENDOMETRIOSIS A common health problem among women of reproductive age. Endometrial-like glands and stroma grow in an extrauterine site.
5ETIOLOGY Various theories regarding its etiology. Menstrual flow that produces a greater volume of retrograde menstruation may increase the risk of developing the disease.Early menarche,Regular cycles (especially with an absence of amenorrhea caused by pregnancy),longer and heavier flow are also associated factors.
6ETIOLOGY cont’d Endometriosis is an estrogen-dependent disease Factors that reduce estrogen levels (e.g., menstrual disorders, decreased body-fat content and smoking) are associated with a reduced risk for developing the condition.
7SIGNS AND SYMPTOMSClinical manifestations of endometriosis vary and may be unpredictable in presentation and course.Dysmenorrhea,chronic pelvic pain,Dyspareunia,Uterosacral ligament nodularityAdnexal mass.Asymptomatic in many women
8Pelvic PainPelvic pain caused by endometriosis falls into three categories:Secondary dysmenorrhea, with pain commencing before the onset of the menstrual cycle;Deep dyspareunia that is exaggerated during menses; orSacral backache with menses.
9Pain con’dThe pain associated with endometriosis has little relationship to the type of lesions seen by laparoscopy.It has been shown that the depth of endometriosis lesions correlate with severity of pain.It is thought that painful lesions are those that involve peritoneal surfaces innervated by peripheral spinal nerves, not those innervated by the autonomic nervous system.
10DIAGNOSISA histologic examination should be done to confirm the presence of endometrial lesions.
11TREATMENTCurrent evidence suggests that pain caused by endometriosis can be managed medically. Progestins, danazol, oral contraceptives, nonsteroidal anti-inflammatory drugs and gonadotropin-releasing hormone (GnRH) agonists.
12No medical therapy has been proved to eradicate the lesions.
13SURGERYSurgery for women with endometrial pain is associated with significant reduction in pain during the first six months following surgery.up to 44 percent of women experience a recurrence of symptoms within one year.Data about whether surgical therapy influences long-term therapy are lacking, and there are no data to indicate whether medical or surgical therapy results in better fertility outcomes.