ENDOMETRIOSIS

Male and Female Clients with General and Specific
Problems in Reproduction Sexuality:
ENDOMETRIOSIS
ENDOMETRIOS
IS
-Refers to the implantation of uterine
endometrium, or nodules, that have
spread from the interior of the uterus to
locations outside the uterus.
-The presence of
functioning endometrium
in sites other than uterine
mucosa.
Endometriosis occurs in as many
as 50% of women, most probably
from regurgitation through the
fallopian tubes at the time of
menstruation. Viable particles of
endometrium that have been
regurgitated in this way begin to
proliferate and grow at the new
sites, impeding fertility in a variety
of ways.
RISK FACTORS
1. Genetics – Genetic predisposition plays a role
• Daughters or sisters of women with endometriosis are at higher risk of developing
endometriosis themselves.
• Low progesterone levels may be genetic and may contribute to a hormonal imbalance.
2. Environmental Toxins – Some factors associated with endometriosis include:

• Not having given birth (nulliparity)
• Prolonged exposure to estrogen (e.g. in late menopause or early menarche)
• Obstruction of menstrual flow (e.g. Mullerian anomalies)
Pathophysiology Endometrio
sis
Under the influence of hormone.
Endometrial tissue that is located outside the uterus,

thickens, breaks down and bleeds each month.
This blood cannot exit the body.
The blood becomes trapped.
Form cysts which leads Irritate the surrounding

to scar tissue, adhesions tissue
Infertility Pain
CLINICAL
MANIFESTATIONS
• Dysmenorrhea – painful, sometimes
disabling cramps during the menstrual
period; pain may get worse over time
(progressive pain), also lower back pains
linked to the pelvis.
• Chronic pelvic pain – typically

accompanied by lower back pain or
abdominal pain.
• Dyspareunia – painful sex
• Dysuria – urinary urgency, frequency and

sometimes painful voiding.
CLINICAL
MANIFESTATIONS
• Infertility – About a third of women with infertility have
endometriosis.
Among women with endometriosis about 40% are infertile.

The pathogenesis of infertility is dependent on the stage of
disease: in early stage disease, it is hypothesized that this is
secondary to an inflammatory response that impairs various
aspects of conception, whereas in later stage disease
distorted pelvic anatomy and adhesions contribute to impaired
fertilization.
• Others – diarrhea or constipation, chronic fatigue, nausea

and vomiting, headaches, low-grade fevers, heavy and/or
irregular periods, and hypoglycemia.
Signs and Symptoms
• Dysmenorrhea
• Dyspareunia
• Deep seated pelvic pain
• Dysuria
• Dyschezia (constipation associated with a defective reflex for
defecation)
• Hematuria
• Infertility
• Tenderness in cul-de-sac
• Nodularity in cul-de-sac
Possible Locations of Endometriosis
1. Fallopian Tube
2. Ovary
3. Bladder
4. Uterus
5. Utero-rectal space (Pouch of Douglas
6. Vagina
Types of Endometriosis
1. Pelvic Endometriosis
• Peritoneal
• Ovarian
• Deep infiltrating
2. Extra Pelvic Endometriosis

• Gastrointestinal tract
• Urinary tract
• Scar Endometriosis
• Vaginal Endometriosis
• Thoracic Endometriosis
Diagnostic Tests
• Health history and physical assessment

• Visual Analog Scale (VAS); VAS and numerical rating scale
(NRS) were the best adapted pain scales for pain measurement
in endometriosis.
• Vaginal Ultrasound
• Laparoscopy
• Immunohistochemistry – has been found to be useful in
diagnosing endometriosis as stromal cells have a peculiar
surface antigen, CD10.
Classification of Endometriosis
1. Stage I: MINIMAL Score 1-5
• Small spots of endometriosis seen at laparoscopy, but no clinical
symptoms.
2. Stage II: Mild Score 6-10

• Scattered fresh superficial lesions
• No scarring or retraction or adnexal adhesions
3. Stage III: Moderate Score 16-40

• Contain endometriomas <2cm in size.
• Minimal peri-tubal and peri-ovarian adhesion.
4. Stage IV: Severe Score >40

• Endometriomas exceed 2cm
• Thickened uterosacral ligaments
• Involvement of bowel and bladder
SURGICAL TREATMENT
Drug Treatment
Treatment of Infertility
Complications
Nursing Management of Endometriosis
THANK YOU FOR
LISTENING
GOD BLESS

ENDOMETRIOSIS

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ENDOMETRIOSIS

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Male and Female Clients with General and Specific

Problems in Reproduction Sexuality:

2. Environmental Toxins – Some factors associated with endometriosis include:

Endometrial tissue that is located outside the uterus,

This blood cannot exit the body.

The blood becomes trapped.

Form cysts which leads Irritate the surrounding

• Chronic pelvic pain – typically

• Dyspareunia – painful sex

• Dysuria – urinary urgency, frequency and

Among women with endometriosis about 40% are infertile.

• Others – diarrhea or constipation, chronic fatigue, nausea

2. Extra Pelvic Endometriosis

• Health history and physical assessment

2. Stage II: Mild Score 6-10

3. Stage III: Moderate Score 16-40

4. Stage IV: Severe Score >40

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