Endometriosis natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]

Overview

Endometriosis is a condition affecting females in the reproductive age group. It has a wide spectrum of presentations, it can be asymptomatic or present with premenstrual spotting and cyclical abdominal pain or present with infertility or chronic pelvic pain or as deep endometriosis presenting with dyspareunia, dyschezia and cyclical rectal bleeding. Complications of endometriosis include infertility, fibrosis, chocolate cyst, and rarely affecting other organs such as lung.

Natural History, Complications and Prognosis

Natural History

Endometriosis is a condition affecting females in the reproductive age group. It has a wide spectrum of presentations, it can be asymptomatic or present with premenstrual spotting and cyclical abdominal pain or present with infertility or chronic pelvic pain or as deep endometriosis presenting with dyspareunia, dyschezia and cyclical rectal bleeding. The progression of the disease is variable, it can progress to a severe disease or regress or remain the same. Severe disease is called as deep endometriosis and presents with chronic pelvic pain and infertility other complications due to the extensive fibrosis of the pelvic structures.

Complications

The main complication of endometriosis is infertility and accounts for 17% of cases with infertility. Other common complications include:

• Internal scarring
• Adhesions
• Pelvic cysts
• Chocolate cysts
• Ruptured cyst
• Less common complications include bowel and ureteral obstruction resulting from pelvic adhesions.

Prognosis

Prognosis of endometriosis is variable with medical therapy, majority of the patients improve with medical therapy but the symptoms recur in 30 to 40% of patients once the treatment is stopped.