Benign General Gynecology
Benign General Gynecology 2008
Endometriosis is a common benign gynecologic disorder defined as the presence of endometrial glands and stroma outside of the normal location. First identified in the mid-nineteenth century (Von Rokitansky, 1860), endometriosis is most commonly found on the pelvic peritoneum but may also be found on the ovaries, rectovaginal septum, ureter, and rarely in the bladder, pericar-dium, and pleura (Comiter, 2002; Giudice, 2004). Endometriosis is a hormonally dependent disease and as a result is chiefly found in reproductive-aged women. Endometrial tissue located within the myometrium is termed adenomyosis and is discussed in greater detail in Chapter 9 (p. 208).
The incidence of endometriosis is difficult to quantify, as women with the disease are often asymptomatic, and imaging modalities have low sensitivities for diagnosis. Women with endometriosis may be asymptomatic, subfertile, or suffer vary-ing degrees of pelvic pain. The primary method of diagnosis is laparoscopy, with or without biopsy for histologic diagnosis (Kennedy, 2005; Marchino, 2005). Using this standard, investi-gators have reported the annual incidence of surgically diag-nosed endometriosis to be 1.6 cases per 1,000 women aged between 15 and 49 years (Houston, 1987). In asymptomatic women, the prevalence of endometriosis ranges from 2 to 22 percent, depending on the population studied (Eskenazi, 1997; Mahmood, 1991; Moen, 1997). However, because of its link with infertility and pelvic pain, endometriosis is notably more prevalent in subpopulations of women with these complaints. In infertile women, the prevalence has been reported to be between 20 to 50 percent and in those with pelvic pain, 40 to 50 percent (Balasch, 1996; Eskenazi, 2001).
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