Endometriosis
Endometriosis is defined as the presence of functioning endometrial glands and stroma outside the uterine cavity. This diagnosis is most common between the ages of 25-29 years of age with the incidence peaking at approximately 40 years of age. The prevalence in asymptomatic women is 2-22%, women with dysmenorrheal 40-60%, and subfertile women 20-30%. Genetically there is a multifactorial inheritance pattern with 6.9% occurrence rate in first-degree female relatives.
Physical Findings & Clinical Presentation
- Classic triad is dysmenorrhea, dyspareunia, and infertility
- Presence of pelvic pain not correlated with the total area of endometriosis, type of lesion, or volume of disease, but is correlated with the depth of infiltration
- Other symptoms include abnormal bleeding (premenstrual spotting, menorrhagia), cyclic abdominal pain, intermittent constipation/diarrhea, dyschezia, dysuria, hematuria, and urinary frequency
- Rare manifestations: catamenial hemothorax, bloody pleural effusion, massive ascites occurring during menses
- Most severe discomfort is associated with lesions >1 cm in depth
- Bimanual examination may reveal tender uterosacral ligaments, cul-de-sac nodularity, induration of the rectovaginal septum, fixed retroversion of the uterus, adnexal mass, and generalized or localized tenderness