ENDOMETRIOSIS IN ASSOCIATION WITH MULLERIAN ANOMALIES

There have been many theories proposed regarding etiology and pathogen esis of endometriosis. The theories of retrograde menstruation, celomi c metaplasia, and mullerian remnants are among these. In order to find out whether a higher prevalence exists in patients with mullerian ano malies and to test these theories, we reviewed the case records of our reproductive endocrinology clinic set up between 1989 and 1994. The s tudy group included patients with mullerian anomalies (n = 186) wherea s the control group consisted of patients without mullerian anomalies (n = 3,240). The frequency of endometrioses was 37 of 186 (19.8%) in t he study group as compared with 619 of 3,240 (19.1%) in the controls ( p > 0.05). In 1 patient without functioning endometrium endometriosis was demonstrated. Obstructive anomalies were associated more with endo metriosis as compared with nonobstructive anomalies (p < 0.001). The n onobstructive anomalies did not present a higher prevalence as compare d with controls (p > 0.05). These results show that endometriosis is n ot more frequent in patients with mullerian anomalies as a whole, but ouflow obstruction is an important contributing factor. Evaluating pat ients with mullerian anomalies contributes proof in favor of the theor ies of retrograde menstruation and celomic metaplasia, but against a p ossible relation of a developmental defect of differentiation or migra tion of the mullerian duct system during embryogenesis.