Endometriosis - Current issues in diagnosis and medical management

OBJECTIVE: To explore the hypothesis that endometriosis is a disease not just because it exists but because it is functionally active. STUDY DESIGN. Qualitative research analyzing the morphologic appearances of endometriosis and the clinical effect of medical therapies. RESULTS: Analysis of the appearances of symptomatic endometriosis demonstrates that the ectopic endometrimlike tissue mimics eutopic endometrium but with loss of polarization. Ectopic implants resembling superficial endometrium are hemorrhagic and associated with adhesion adn pseudocyst or endometrioma formation. Ectopic implants resembling basal or junction zone endometrium are associated with nodular adenomyotic lessions in the posterior fornix and pelvic supportive structures. They are characterized by smooth muscle hyperplasia and T-lymphocyte aggregates. CONCLUSION: Medical therapy has been shown to be very efficient in reducing pelvic pain as soon as amenorrhea is created and maintained. Regression, but not elimination, of the implant is obtained by medical therapy. Clinical data support the hypothesis that the efficacy of medical therapy is largely achieved by preventing cyclic bleeding in the implants.