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  • Definition: Presence of functional endometrium at places other than uterus (ectopic endometrial tissue)
  • MC sites in order of frequency:
    1. Ovaries (ovarian endometriosis = endometrioma = chocolate cyst of the ovaries)
    2. POD
    3. Uterosacral ligaments
  • Theories for development of endometriosis:
    1. Samson's theory of retrograde menstruation: the most accepted theory
    2. Ivanoff and Meyer: celomic metaplasia
    3. Hematogenous spread
    4. Lymphatic spread (Halban's theory)
    5. Direct implantation
  • Smoking is thought to be protective for endometriosis
  • Classical PV findings are: fixed RV uterus with nodularity in POD

Clinical Features

  • Pain
  • Dysmenorrhea
  • Infertility
  • Dyspareunia (deep)

Reasons for Infertility in Endometriosis

  1. Tubal adhesions/blocks or anatomy between the tube and ovary is distorted (main reason)
  2. Anovulation
  3. The uterus is not suitable for implantation
  4. T Sperm phagocytosis
  5. Dyspareunia decreases coital frequency

Laparoscopy is the Investigation of Choice


Laparoscopy findings are:

  • Chocolate cysts
  • Powder burn spots
  • Matchstick burnt spots
  • Blueberry lesion
  • Red/purple raspberry lesion
  • White lesion
  • Red/flame lesion
  • Subovarian adhesions
    Subtle peritoneal defects associated with endometriosis is called" Allen Master" syndrome.


  • Medical
  • Surgical

Medical Management

  • Pseudopregnancy regimen: OC pills, DMPA POP, and Mirena
  • Pseudomenopause regimen: Danazol (Hardly ever used today because of androgenic side effects)
  • Medical castration: GnRH analogues (most common drug used for medical management)

Surgical Management

  1. Patients with infertility: laparoscopic ovarian cystectomy, adhesiolysis, and electrocoagulation of endometriotic implants with bipolar current.
  2. If the family is complete and the patient has severe pain or menstrual complaints: hysterectomy with bilateral salpingo-oophorectomy
    Generally combined approach is adopted where laparoscopic surgery is followed by GnRHa.

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