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Managing endometriosis

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Endometriosis is a condition in which hormonally responsive endometrial tissue is found outside the uterus, resulting in chronic inflammation.1 Endometriosis is generally confined to women of reproductive age.

It is estimated that endometriosis occurs in five to 15 per cent of pre-menopausal women. The prevalence is much higher in infertile patients and those with chronic pelvic pain.2 The incidence is six times higher among first-degree relatives of women with endometriosis.2

Endometriosis tends to affect the peritoneum overlying the uterosacral ligaments, the ovarian fossae, broad ligaments, ovarian surfaces and fallopian tubes. The bladder, bowel and, less commonly, the lung can also be affected.3 The aetiology is unknown, although it has been proposed that endometrial tissue may implant in the peritoneal cavity secondary to retrograde menstruation. Alternative theories include haematogenous spread, lymphatic spread or coelomic metaplasia. Affected women are at a higher risk of developing ovarian cancer.3

Clinical presentation
The clinical features include pelvic pain, usually before or during menses, but sometimes throughout the cycle. The pain may be attributed to tissue oedema and extravasation of blood-stimulating mechanoreceptors. Importantly, the level of pain may not necessarily be related to disease severity.2

Around 30 to 40 per cent of women with endom

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