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Related Experiment Videos

Is endometriosis a disease?

P G Wardle1, M G Hull

  • 1Department of Obstetrics and Gynaecology, University of Bristol, UK.

Bailliere'S Clinical Obstetrics and Gynaecology
|December 1, 1993
PubMed
Summary

Endometriosis may not always be a disease, as many cases are asymptomatic and self-limiting. Treatment is only recommended for progressive cases with tissue damage, not for asymptomatic endometriosis.

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Area of Science:

  • Gynecology
  • Pathophysiology
  • Reproductive Medicine

Background:

  • Recent studies question whether endometriosis is always a disease, citing increased diagnoses due to advanced detection methods like laparoscopy.
  • High prevalence in women with pelvic pain or infertility (up to 80%) and even in asymptomatic women (up to 22%) suggests it might be a physiological variant.
  • Endometriosis lesions are often found in visually normal peritoneum and can be microscopic or non-pigmented, complicating diagnosis and understanding.

Purpose of the Study:

  • To evaluate the current understanding of endometriosis, particularly regarding its classification as a disease.
  • To analyze the correlation between endometriosis and symptoms, treatment efficacy, and natural disease progression.
  • To establish criteria for when endometriosis should be considered a disease requiring treatment.

Main Methods:

  • Review of recent comparative studies on endometriosis pathogenesis and pathophysiology.
  • Analysis of data on lesion types, prevalence in symptomatic and asymptomatic women, and spontaneous regression rates.
  • Examination of symptom correlation with lesion extent/site and the effectiveness/risks of current treatments.

Main Results:

  • Endometriosis prevalence is high, potentially indicating a physiological variant rather than a disease in all cases.
  • A significant percentage of endometriosis cases (58%) are self-limiting and resolve spontaneously.
  • Symptom severity and frequency do not consistently correlate with the extent or location of endometriosis lesions.
  • Most women with endometriosis are asymptomatic, lacking dysmenorrhea, dyspareunia, or general pelvic pain.
  • Current treatments lack universal efficacy, carry risks, and have significant placebo benefits, with high recurrence rates (45% within 5 years).

Conclusions:

  • Endometriosis should only be treated when it meets disease criteria, exhibiting progression, tissue damage, or physiological disturbance.
  • Asymptomatic endometriosis without observable tissue damage should not be classified or treated as a disease.
  • Treatment for pain or prophylactic measures in minor or asymptomatic endometriosis is empirical and not a definitive requirement for a questionable disease.

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