Endometriosis is a condition where tissue similar to the endometrium (the lining of the uterus that is shed with the period) is present outside the uterus.
The most common sites are around the ovaries, on the utero-sacral ligaments and between them in the Pouch of Douglas, but it can occur in any part of the pelvis or abdomen, in fact anywhere in the body.
It may be present as superficial implants, deep-seated nodules, or as cysts within the ovaries.
The severity of endometriosis is usually classified as mild, moderate, or severe. .
Symptoms of endometriosis are most commonly different types of pain, including pain with periods (dysmenorrhoea), pain with intercourse (dyspareunia), chronic pelvic pain, or infertility with or without pain symptoms.
The diagnosis is ultimately based on visualisation (laparoscopy), ideally with histological confirmation, but history and examination may be highly suggestive, and ultrasound may show an ovarian endometrioma.
Treatment options include various hormonal therapies and surgery, which is usually performed laparoscopically.
Prognosis is not always predictable, but recurrence rates after surgery between 10% and 20% per annum are not uncommon.
It is important to state that medical (non-surgical) treatment of endometriosis does not improve fertility potential.
The objectives of surgery in treating endometriosis, which is ideally performed by laparoscopy, are to remove all visible and palpable endometriosis in the hope of alleviating pain and improving fertility potential.
Results of laparoscopic treatment are good. Eight out of 10 women report reduction in pain, but one or two in 10 experience a return of pain in the year after surgery.
Improvement in fertility potential has been demonstrated after surgical treatment of minimal and mild endometriosis, and strongly suspected after surgical treatment of moderate and severe disease.
Complications of laparoscopy specifically related to endometriosis surgery include adhesions, which occur in up to 3 out of 10 cases of operation on ovarian endometriomas. These may contribute to ongoing infertility.
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