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| ==Overview== | | ==Overview== |
| | No definitive cause of [[endometriosis]] has been established; it is thought to be multifactorial in origin. |
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| ==Causes== | | ==Causes== |
| While the exact cause of endometriosis remains unknown, many theories have been presented to better understand and explain its development. These concepts do not necessarily exclude each other.
| | No definitive cause of [[endometriosis]] has been established; it is thought to be multifactorial in origin.<ref name="pmid22127593">{{cite journal |vauthors=Oliveira FR, Dela Cruz C, Del Puerto HL, Vilamil QT, Reis FM, Camargos AF |title=Stem cells: are they the answer to the puzzling etiology of endometriosis? |journal=Histol. Histopathol. |volume=27 |issue=1 |pages=23–9 |year=2012 |pmid=22127593 |doi=10.14670/HH-27.23 |url=}}</ref> |
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| # Endometriosis is a condition caused by excess [[estrogen]] created each month in the female body, and is seen primarily during the reproductive years. In experimental models, excess estrogen is necessary to induce or maintain endometriosis. Medical therapy is often aimed at lowering estrogen levels to control the disease. It is hypothesized that excess estrogen levels may be measured by a female taking her morning temperature (with a thermometer showing a tenth decimal) at the same time each day for a month or two. To learn more about taking your waking temperature, please see the book: "Taking Charge of Your Fertility" by Toni Weschler, MPH. A normal woman's body temperature varies from 98.5 to 97.5 degrees Fahrenheit (36.9 to 36.3 degrees Celsius), however it is hypothesized that someone with endometriosis may see temperatures of 98.5 to 97.0 °F (36.9 to 36.1 °C). The lower temperatures signify the estrogen phase of a normal female's cycle, therefore it is logical that women with excessively lower body temperatures, may have an excess of estrogen, thus endometriosis. Research is needed to determine the reliability of using waking temperatures to diagnose endometriosis and its severity. Additionally, the current research into Aromatase, an estrogen-synthesizing enzyme produced by the implants themselves, has provided evidence as to why and how the disease persists after menopause and hysterectomy.
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| # "Retrograde menstruation", in which some of the menstrual debris of menstruation flows into the pelvis, may play an important role (John A. Sampson). While most women may have some retrograde menstrual flow, typically their immune system is able to clear the debris and prevent implantation and growth of cells from this occurrence. However, in some patients, endometrial tissue transplanted by retrograde menstruation is able to implant and establish itself as endometriosis. Factors that might cause the tissue to grow in some women, but not in others, need to be studied, and some of the possible causes below may provide some explanation, e.g. hereditary factors, toxins, or a compromised immune system. It can be argued that the uninterrupted occurrence of regular menstruation month after month for decades, is a modern phenomenon, as in the past women had more frequent menstrual rest due to pregnancy and lactation.
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| # A competing theory suggests that endometriosis does not represent transplanted endometrium but starts ''de novo'' from local [[stem cells]]. This process has been referred to as coelomic [[metaplasia]]. Triggers of various kind (including [[menses]], toxins, or immune factors) may be necessary to start this process.
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| # Hereditary factors play a role. It is well recognized that daughters or sisters of patients with endometriosis are at higher risk of developing endometriosis themselves. A recent study (2005) published in the ''American Journal of Human Genetics'' found a link between endometriosis and chromosome 10q26.<ref>Treloar SA, Wicks J, Nyholt DR, Montgomery GW, Bahlo M, Smith V, Dawson G, Mackay IJ, Weeks DE, Bennett ST, Carey A, Ewen-White KR, Duffy DL, O'connor DT, Barlow DH, Martin NG, Kennedy SH. Genomewide linkage study in 1,176 affected sister pair families identifies a significant susceptibility locus for endometriosis on chromosome 10q26. Am J Hum Genet. 2005 Sep;77(3):365-76. Epub 2005 Jul 21. PMID 16080113. [http://www.medicine.ox.ac.uk/ndog/oxegene/Papers/ASHG%20%282005%29.pdf Full Text].</ref> One study found that, in female siblings of patients with endometriosis the [[relative risk]] of endometriosis is 5.7:1 versus a control population.<ref>Kashima K, Ishimaru T, Okamura H, Suginami H, Ikuma K, Murakami T, Iwashita M, Tanaka K. Familial risk among Japanese patients with endometriosis. Int J Gynaecol Obstet. 2004 Jan;84(1):61-4. PMID 14698831</ref>
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| # It is accepted that in specific patients endometriosis can spread directly. Thus endometriosis has been found in abdominal [[incision]]al scars after surgery for endometriosis.
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| # On rare occasions endometriosis may be transplanted by [[blood]] or by the [[lymphatic system]] into peripheral organs (e.g. [[lungs]], [[brain]]).
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| # Recent research is focusing on the possibility that the [[immune system]] may not be able to cope with the cyclic onslaught of retrograde menstrual fluid. In this context there is interest in studying the relationship of endometriosis to [[autoimmune disease]], [[allergy|allergic]] reactions, and the impact of [[toxins]].<ref>Capellino S, Montagna P, Villaggio B, Sulli A, Soldano S, Ferrero S, Remorgida V, Cutolo M. Role of estrogens in inflammatory response: expression of estrogen receptors in peritoneal fluid macrophages from endometriosis. Ann N Y Acad Sci. 2006 Jun;1069:263-7. PMID 16855153</ref>
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| Another area of research is the search for endometriosis markers. These markers are substances made by or in response to endometriosis that health care providers can measure in the blood, urine, or daily waking temperature. If markers are found, health care providers could diagnose endometriosis by testing a woman's blood, urine, or daily waking temperature, which might reduce the need for surgery. [[CA-125]] is known to be elevated in many patients with endometriosis,<ref>{{cite journal |author=do Amaral V, Ferriani R, de Sá M, Nogueira A, e Silva J, e Silva A, de Moura M |title=Positive correlation between serum and peritoneal fluid CA-125 levels in women with pelvic endometriosis |journal=Sao Paulo Med J |volume=124 |issue=4 |pages=223-7 |year=2006 |pmid=17086305}}</ref> but not specifically indicative of endometriosis.
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| ===Drug Side Effect===
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| * [[Clomifene]]
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| * [[Tamoxifen]]
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |