Endometriosis can be defined as the monitoring of the endometrium gland structures and stroma (supporting tissue) lining the uterus (womb) in another region outside the uterus.
It is observed in approximately 10% of women in their reproductive years and in approximately half of those with a history of infertility.
It is often multifocal and most commonly involves pelvic structures (ovaries, tubes, Douglas space behind the uterus, rectovaginal septum and uterine ligaments). Less frequently, distant areas of the peritoneal cavity or periumbilical tissues are involved. Very rarely, lymph nodes, lungs, heart, striated muscles and bones may be affected.
Four hypotheses have been proposed to explain the development of endometriosis.
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Regurgitation (backflow) The theory of benign metastasis argues that the endometrial tissue is far from the uterus through the blood vessels and lymphatic system. argues that it spreads to other regions,
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The metaplastic theory is based on the embryonic pelvis and abdominal mesothelial remnants from which the endometrium originates, transforming into the endometrium to form endometriosis,
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The extrauterine stem cell theory proposes that circulating stem cells from the bone marrow differentiate into endometrial tissue.
Studies suggest that endometrial tissue is not only in the wrong place, but is also abnormal. In particular, aromatase activity in stromal cells has a key role in the pathogenesis of endometriosis by causing local estrogen production and facilitating the maintenance and continuity of endometriosis tissue located in the foreign region. Inflammatory environmental response accompanying endometriosis is also an important finding. When endometriosis foci are in the ovaries, they are seen as blood-filled cysts. The reason why they are called chocolate cysts is that as the lesion becomes chronic, the blood turns brown and takes on a chocolate-like appearance.
Located outside the uterus. As a result of the periodic bleeding of the endometrium layer, conditions such as widespread fibrosis, adhesions in the pelvic structures, and obstruction in the tubules may develop.
The clinical findings that can be seen in the presence of endometriosis-endometrioma generally depend on the location and extent of the lesions. Almost all cases have dysmenorrhea (painful menstruation) and pelvic pain due to intra-pelvic bleeding and periuterine adhesions. If there is rectal wall involvement, pain may be experienced during defecation. Involvement of the uterus or bladder serosa causes painful sexual intercourse, and intense adhesions around the tubes and ovaries cause infertility.
The first step in diagnosis is learning the patient's complaints and a physical examination. If endometriosis is considered as a preliminary diagnosis based on clinical findings, ultrasound is the first imaging method to be chosen in addition to laboratory examination for diagnosis. Ultrasound can be performed by transvaginal and/or suprapubic method according to patient suitability and compliance. On ultrasound, the lesions are observed in the ovaries as cysts with smooth walls, dense content, and no blood supply in Color Doppler examination. Diagnosis of extraovarian endometriosis on ultrasound is difficult, and secondary findings such as fluid in the pelvis, membranes-septas due to adhesions or enlargement of the tubes may be seen. In cases where ultrasound is insufficient for diagnosis, MRI or even laparoscopic direct examination may be necessary.
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