Clinical manifestations of endometriosis

Clinical manifestations of endometriosis

Clinical Manifestations

 

ENDOMETRIOSIS ASSOCIATED PAIN

 

  1. Acquired dysmenorrhea: possibly as early as third menstrual cycle in adolescents
  2. Three or more emergency visits for unexplained pelvic pain
  3. Low central backache and lower abdominal pain
  4. Midcycle pain: mittelschmerz
  5. Deep dyspareunia resulting from endometriosis of uterosacral ligaments and rectovaginal pouch of Douglas
  6. Deep dyspareunia, worse before menses
  7. Pain with bowel movements before and during menses

 

 

ENDOMETRIOSIS-ASSOCIATED INFERTILITY

 

  1. Primary infertility: never pregnant

 

  1. Affects roughly 41% of women with endometriosis
  2. Monthly fecundity reduced

 

  1. Secondary infertility: previously pregnant

 

  1. Roughly 35% of women with endometriosis state difficulty conceiv­ing and carrying pregnancy to term.

 

  1. Outcome of first pregnancy before diagnosis of endometriosis

 

  1. Decreased live births
  2. Increased spontaneous abortions
  3. Increased elective abortions
  4. Infrequent ectopic pregnancies

 

ENDOMETRIOSIS-ASSOCIATED HEALTH PROBLEMS

 

  1. Profuse, unremitting menorrhagia
    1. Risk of multiple blood transfusions
    2. Risk of pituitary ischemia
    3. Risk of multiorgan hormonal replacement
  2. Intractable pelvic pain associated with frozen pelvis
  3. Bowel pain or obstruction
  4. Ureteral obstruction
    1. Risk of hydroureter and hydronephrosis
    2. Risk of hypertension
    3. Risk of autonephrectomy
    4. Risk of renal failure if obstruction is bilateral
  5. Osteoporosis
    1. Risk increased by endometriosis
    2. Risk increased by gonadotropin-releasing hormone (GnRH) ovarian suppression
    3. Risk increased by early bilateral oophorectomy
    4. Risk increased by withholding estrogen replacement
  6. Pneumothorax and hemothorax
  7. Malignant transformation endometriosis posterior fornix
    1. Risk increased by unopposed estrogen replacement
    2. Risk removed by excising endometriosis

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