Recent comparative studies and developments in our understanding of the pathogenesis and pathophysiology of endometriosis have led to increasing doubts concerning whether or not it should be considered a disease.
Widespread use of laparoscopy for gynecological investigation and treatment, recognition of non-pigmented lesions that are more active than classical implants, and also the documentation of microscopic lesions in visually normal peritoneum, have all resulted in a rise in the frequency with which endometriosis is diagnosed. Recent studies recommend a prevalence of up to 80th in girls complaining of infertility or pelvic pain, however also in up to 22nd of fertile asymptomatic girls undergoing sterilization.
Perhaps it’s a standard physiological variant, being present in such a high proportion of the population. circumstantial evidence suggests this could be so, and also the results with placebo treatment in controlled trials recommend that endometriosis is self-limiting and can regress or disappear spontaneously in 58 of ladies. The frequency and severity of symptoms that are usually plausible to result from endometriosis don’t correlate with the extent or site of lesions. most girls are pain-free.
There is no dysmenorrhoea in up to 77, no dyspareunia in up to 70th, and no pelvic pain at all in up to 61 of ladies with endometriosis. The pathophysiology of pain associated with endometriosis isn’t understood. there’s no medical or conservative surgical procedure that’s wholly effective for symptom relief, and there’s appreciable placebo benefit. All treatments have risks or side-effects, and recurrent symptoms can develop in up to 45th of ladies within five years.
For these reasons treatment ought to only be used wherever endometriosis fulfils the standards of a disease, showing signs of progression with tissue damage or physiological disturbance.
Asymptomatic endometriosis without tissue damage should not be considered a disease and will not be treated. Treatment of pain related to minor endometriosis, or prophylactic treatment to prevent progression, should be considered empirical and not the particular requirement to control what’s a questionable disease.