ENDOMETRIOSIS, 1995 - CONFUSION OR SENSE

Objective: To review current understanding of endometriosis. Method: A review of etiology, pathogenesis, relationship with. infertility, med ical and surgical treatment. Results: It is likely that endometriosis occurs in most women at some stage in their reproductive years. Exposu re to menstruation and estrogen are important etiologically. Current e vidence suggests that implantation of menstrual endometrium is the com monest mechanism of pathogenesis. Clinical symptoms and signs are impo rtant in the diagnosis while laparoscopy remains the prime diagnostic technique. Treatment is not indicated for infertility but is for sympt oms. Danazol and progestogens represent the best first-line therapy al though gonadotropin-releasing hormone agonists are appropriate if econ omically justifiable. Both open and laparoscopic surgery are important especially in reconstructive work. The value of laser ablation in the treatment of infertility is unknown but it is effective in pain. The disease should be regarded as a recurrent problem and treatment strate gies designed appropriately. Conclusion: Endometriosis still represent s an intellectual and-therapeutic challenge but successful treatment i s possible especially if it is individualized for each patient.