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Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity and is considered a benign gynaecologic condition; however, in some cases, its progress may be aggressive. It may be present to a very mild degree and cause considerable symptoms or there may be substantial endometriosis with little or no symptoms.

The disease occurs in approximately 10% of women of reproductive age and regresses after the menopause. A much higher prevalence of up to 82 percent occurs in women with pelvic pain, and in women undergoing investigation for infertility the prevalence is 25 percent. With careful evaluation it is found to be present in a significant percentage of those with so called Unexplained Infertility. Sex steroids, oestrogen and progesterone, are mainly produced in the ovaries and they regulate the growth of endometrial tissue. The effects of endometriosis include reduced fertility, dysmenorrhoea (painful periods), dyspareunia (painful intercourse) and chronic non-menstrual pain, all of which affect quality of life. In a study of women with pelvic pain, many patients who eventually were diagnosed with endometriosis had been diagnosed previously with irritable bowel syndrome.

The usual method for the diagnosis of endometriosis is by laparoscopy. Diagnosis based solely on visual inspection requires a surgeon with experience in identifying the many possible appearances of endometrial lesions. Endometriosis may occur anywhere within the abdominal or pelvic cavities, careful and detailed inspection is necessary and lesions may still be missed. There is also relatively poor correlation between visual diagnosis and confirmed histology, and microscopic endometrial lesions may be found in normal-appearing peritoneal samples. So if seen at laparoscopy endometriosis may be confirmed and graded, not seen, does not mean, not present.

Endometriosis can cause local inflammation, leading to adhesions. Adhesions in endometriosis form as a result of endometrial tissue bleeding into the surrounding area causing inflammation, and as this “heals” scar tissue forms. Some patients have patches of endometriosis and adhesions without having had the classical pain symptoms of endometriosis.

Endometriosis appears to affect fertility in a number of ways - the fallopian tubes may not function normally or be bound by adhesions; ovarian function may be disrupted and endometriosis may release substances which interfere with fertility. This is supported by research data which shows that IVF is less successful in women with endometriosis.
There appears to be a link between endometriosis and Candida. Endometriosis is often very difficult to treat, but in those patients with a history of Candida (thrush), treatment of the Candida often results in simultaneous success in treating their endometriosis.
Dr. Michael  Collins http://www.obsgyn.co.uk
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