Pathogenesis of endometriosis

Abstract

Endometriosis is a common gynecologic disorder characterized by the presence of endometrial tissue outside the uterine cavity. Various theories have been put forth to explain the mechanisms for the development of this disease. Although no single theory can explain all cases of endometriosis, the retrograde menstruation theory has gained the widest acceptance. This theory proposes that viable endometrial tissue is refluxed through the fallopian tubes during menstruation and implants on peritoneal surface or pelvic organs. Retrograde menstruation occurs in 76% to 90% of women. The much lower prevalence of endometriosis suggests that additional factors determine susceptibility to endometriosis. Once in the peritoneal cavity, the survival and implantation of endometrial cells seem to be mediated by abnormal MMP and TIMP expression, altered immune milieu, aberrant local aromatase activity, and genetic and environmental factors.

Abdominal Scar Endometriosis

“…Since it is a rare entity, abdominal scar endometriosis should be kept in mind in any woman of childbearing age complaining of a cyclical painful mass in a scar following a previous obstetric or gynecological procedure [6]. Endometriosis results due to direct implantation of viable endometrial cell, in the subcutaneous or subfacial planes exposed by the surgical incision on the abdominal wall [7]. Although spillage of endometrial cells into the surgical incision probably occurs quite frequently during gynecological or obstetric surgery, endometriosis occurs with much lower frequency.…”

“…Although spillage of endometrial cells into the surgical incision probably occurs quite frequently during gynecological or obstetric surgery, endometriosis occurs with much lower frequency. This implies that factors such as environmental, genetic, immune system (cellular and humoral), and hormonal (estrogen) abnormalities may confer susceptibility to the development of endometriosis in some people [7]. These cellular and humoral factors are due to the ability of the endometrial cell to regulate the cytotoxic immune activity and their capability to resist immune-mediated apoptosis [8].…”

Endometriosis: The gynecologist's opinion

“…La predisposizione familiare è stata dimostrata in campioni clinici e di popolazione e negli studi condotti sui gemelli (10,11). Le caratteristiche ereditarie dell'endometriosi sono state riconosciute più di 10 anni fa quando, in uno studio, il rischio di endometriosi è stato riportato essere maggiore di 6 volte tra le donne con parenti di primo grado affette da endometriosi rispetto a quelle pazienti con parenti non affetti (12). L'endometriosi è ereditata in maniera poligenica, con una prevalenza del 4-9% in parenti di primo grado (13).…”

Diet – A New Approach To Treating Endometriosis – What Is The Evidence?

“…The precise pathogenesis of endometriosis is unclear, and several theories have been proposed. Retrograde menstruation is widely accepted as a contributing factor to the disease but, as the phenomenon occurs in up to 90% of women, other factors in the pathogenesis of the disease have been suggested 8 . The immune response to endometriotic tissue outside the uterus seems to be impaired with inadequate removal of lesions as a result.…”