Burney, R. O., & Giudice, L. C. (2012). Pathogenesis and pathophysiology of endometriosis. Fertility and Sterility, 98(3), 511-519. https://doi.org/10.1016/j.fertnstert.2012.06.029
Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertility and Sterility. 2012;98(3):511-519. doi:10.1016/j.fertnstert.2012.06.029
Burney, Richard O., and Linda C. Giudice. "Pathogenesis and pathophysiology of endometriosis." Fertility and Sterility, vol. 98, no. 3, 2012, pp. 511-519.
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Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Madigan Healthcare System, Tacoma, WA; Department of Clinical Investigation, Madigan Healthcare Syst...01sfyq865
Retrograde menstruation is a widely accepted route for endometriosis
A 2012 review of lab and clinical studies says retrograde menstruation is a widely accepted explanation for how endometrial cells spread in the body. Why some cells take root is unknown.
Key Findings
Menstrual blood turned up in the abdominal fluid in as many as 90% of healthy women with open fallopian tubes who had laparoscopy near their period.
Retrograde menstruation has a 90% prevalence against nearly 10% for the disease, and the review says implantation propensity best accounts for the gap.
Close relatives (first degree) of women with severe endometriosis carry a risk six times higher than relatives of unaffected women.
Trials that used a placebo and a repeat laparoscopy found 71-83% of untreated lesions progressed or stayed stable across 12 months.
Women exposed to diethylstilbestrol in utero had a twofold increased risk of endometriosis in epidemiologic studies.
Interpretation
This review examines how genes, hormones, and inflammation work together to cause endometriosis. The authors link retrograde menstruation, cell implantation, family risk, and exposure in the womb as parts of one disease process. They say genes and environment are not yet proven to cause the disease. The findings support larger studies on how these factors work together.
RRM Context
Restorative reproductive medicine treats endometriosis as a disease with a cause to find. The review names four hallmarks: genes, estrogen dependence, progesterone resistance, and inflammation. It also tracks lesions as they change from early red spots to scarred growths, based on a large surgical study.
Our editorial summary of this paper, not the article's abstract.
Abstract
Originally described over three hundred years ago, endometriosis is classically defined by the presence of endometrial glands and stroma in extrauterine locations. Endometriosis is an inflammatory, estrogen-dependent condition associated with pelvic pain and infertility. This work reviews the disease process from theories regarding origin to the molecular basis for disease sequelae. A thorough understanding of the histopathogenesis and pathophysiology of endometriosis is essential to the development of novel diagnostic and treatment approaches for this debilitating condition.
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