Accordingly, due to the link between endometriosis and infertility, quality of life is even further reduced if women suffering from the clinical symptoms are surplus childless.
Non-invasive diagnostic tools are not yet available.īecause the clinical symptoms of endometriosis range from severe dysmenorrhea, dyspareunia, dysuria to severe chronic pelvic pain, it is apparent that the disease rigorously interferes with the patients’ quality of life and affects social life, sexuality, and psychological well-being. The unambiguous diagnosis of endometriosis is generally accepted by clinicians only after laparoscopic macroscopic evaluation and subsequent histomorphometric analyses of biopsies. According to Redwine, the most common sites of pelvic endometriosis are the Douglas pouch and the uterosacral ligaments.Ī widely used classification of endometriosis has been introduced by the American Society for Reproductive Medicine (rASRM) and incorporates number, size, and location of endometrial implants, endometriomas, and/or adhesions as well as their morphology (red, white, and black) yielding to a classification from stage 1 (minimal endometriosis) to stage 4 (severe endometriosis). Deep infiltrating endometriosis, e.g., in the Douglas pouch, the sacrouterine ligaments, or the septum retrovaginale, is a very painful form of endometriosis characterized by fibrosis, smooth muscle proliferation, and fibromuscular nodules this clinical entity is also called adenomysis externa. Additionally, endometriosis extragenitalis mostly occurs within the pelvic cavity, septum rectovaginale, intestine, and ureter. Further, endometriosis genitalis externa is being referred to if lesions can be located adjoining ovaries (endometriomas, endometriotic cysts), Douglas pouch, uterine ligaments, vagina, vulva, or perineum. Various forms of endometriosis have been described, such as endometriosis genitalis interna with endometrium adjacent to the eutopic endometrium, e.g., within the myometrium (adenomyosis) or the fallopian tubes. To date, insights into the pathophysiology of endometriosis, and thus the development of effective treatment strategies, are surprisingly meager, which is attributed in part to the difficulties in studying the disease in humans. Additionally, endometriosis is closely linked to severely impaired fertility, as it can be diagnosed in 68% of patients suffering from infertility. Endometriosis affects up to 22% of women in their reproductive age and is associated with chronic pelvic pain. Endometriosis, first described in 1860 by von Rokitansky, is a chronic disease that is characterized by the occurrence of endometrial glands and stroma outside the uterine cavity.
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