Endometriosis is the
presence of endometrial tissue outside of the uterus. These implants
look like red spots on the peritoneum (the intraabdominal surface of
the uterus, ovaries, intestine, and all organs). These implants bleed
during menstruation creating an inflammatory environment in the
pelvis. After some time this inflammation causes adherence between
organs (adhesions). Sometimes could appear chocolate cyst (endometriomas)
in the ovaries which are cysts filled with bloody material that are
caused by endometrial implants on the ovaries (see fig). Clinically
some manifestations are dysmenorrhea (pain with menstruation),
dyspareunia (pain with coitus) and infertility. Many times it also
produces premenstrual spotting.
Endometriosis
Diagnosis should be done through laparoscopy observing the implants
directly. There are some signs that can be seen with a vaginal
examination and through the use of sonogram that suggest the presence
of endometriosis, however the final diagnosis should be done by
laparoscopy. Endometriosis is classified according to the degree of
severity: minimum, mild, moderate and severe. In minimum and mild
endometriosis it is convenient to ablate the endometrial implants
during laparoscopy. In moderate and severe cases it is also important
to eliminate as much of the endometriosis as possible, through
implants and endometriomas excision, pelvis washing, etc. Some
moderate or severe endometriosis cases require administration of GnRh
analogues (drugs that cause an absence of menses over a period of
time) in order to produce a "cooling" of the implants (reducing their
activity).
Endometriosis Lesions
The best results of the surgery are seen in the first twelve
months. So it is important to take advantage of this stage (monthly
follow up). In severe cases the only way to get pregnant is in vitro
fertlization (IVF)
