B. Distribution of symptomatology.
B. Pelvic and extrapelvic endometriosis.
B. Caucasians, African-Americans, Japanese.
C. Transplantation of endometrial cells.
1. Transplantation theory.
2. Risks for menstrual regurgitation.
VI. Natural history of endometriosis.
VIII. Laparoscopy, ultrasound, and lasers.
A major clinical problem, endometriosis ranks as the second most common gynecological disorder requiring medical and surgical treatment. Despite its widespread occurrence though, the pathophysiology of this disease remains controversial. Many believe that it results from the extrauterine transplantation of endometrial cells. The subsequent proliferation of such cells is then thought to produce symptoms. Various different treatment options are currently available for endometriosis. These include both medical and surgical approaches--each of which may be enhanced by laparoscopic techniques.
The first detailed description of endometriosis was published over 100 years ago by Recklinghausen (1893) (1:741). Endometriosis affects women during their reproductive phase. The disease can develop at any age after menarche. In general, patients present with one or more of the "classic quartet of symptoms (11:601)." These include congestive dysmenorrhoea, deep dyspareunia, pelvic pain, and infertility. Of these four, infertility is the most common. In addition, patients may also suffer repeat hospitalizations and surgery, as well as prolonged medical treatment.
Researchers have found that the frequency and severity of endometriotic symptoms do not generally correlate with either the extent or the site of a patient's lesions. For example, most women do not experience pain. In addition, up to 77% have no dysmenorrhea and up to 70% have no dyspareunia (12:682). In fact, many endometriosis patients are completely asymptomatic: App...