Pathophysiology and treatment of endometriosis

The pathophysiology of endometriosis and its treatment are discussed. Endometriosis is a gynecological disorder characterized by the growth of the ectopic endometrium. The usual plaque looks like a small blood-filled cyst that is surrounded by a puckering scar. This tissue responds to fluctuating levels of hormones just as the normal endometrium does, and monthly bleeding of the cysts occurs followed by inflammation and scarring. Endometriosis may cause infertility, dyspareunia, dysmenorrhea, pelvic pain, and other menstrual problems. Therapy is chosen based on extent of disease, tolerance of side effects, and desire for pregnancy. Surgery is usually reserved for more extensive cases of the disease or if fertility is no longer desired. Induction of "pseudopregnancy" with estrogen-progesterone combinations has been used frequently; however, weight gain, initial exacerbation of pain, and the possibility of thromboembolism are limiting factors. Pseudomenopause, induced by danazol therapy, is an alternate method of treatment that causes a static endometrium. It offers rapid relief of symptoms to the majority of patients, and its most common side effects of weight gain and edema are reversible. Fertility rates after treatment are difficult to compare, but they appear to be similar for both hormonal therapies. Danazol has emerged as an effective alternative to the estrogen-progesterone combination treatment of endometriosis. Danazol may be prescribed before surgery to reduce lesions, following surgery to ablate any remaining lesions, or as the sole therapy for endometriosis.