Endometriosis

Endometriosis is a chronic, estrogen-dependent inflammatory condition in which endometrial-like tissue grows outside the uterine cavity. Common locations include the pelvic peritoneum and ovaries; disease may also involve the bowel, bladder, ureters, or, less often, the thorax. The cause is not established. Retrograde menstruation with implantation, transformation of local cells, lymphatic or vascular spread, and immune dysregulation are proposed mechanisms. These lesions respond to ovarian hormones and provoke inflammation around each menstrual cycle. Repeated inflammation promotes fibrosis and adhesions, which can tether pelvic organs and produce pain even when visible disease is limited. Endometriosis has no definitive cure; treatment is directed toward pain, function, disease complications, and reproductive goals. The clinical pattern is often cyclical and progressive. A patient may report severe dysmenorrhea, pain between periods, deep dyspareunia, pain with bowel movements, cyclical urinary pain, heavy menstrual bleeding, bloating, nausea, fatigue, or difficulty conceiving. Bowel or bladder symptoms that intensify around menstruation are particularly useful clues because they suggest that pelvic organs are being affected by hormonally responsive disease. Pain severity does not reliably match the anatomic stage of endometriosis....