There are many other inconsistencies- endometriosis should be genetically identical to endometrium, yet it is not. Based on this theory, women in their 40s should have endo everywhere, yet they have no greater number of lesions than younger patients. Based on this theory, there should be endo anywhere on the bowel including the mesentery, yet lesions are almost always found directly across from the mesentery (the antimesenteric surface). Based on this theory, there should be more endo on the gallbladder than the diaphragm, but endo has only been reported 3 or 4 times on the gallbladder, and while diaphragmatic disease is rare, it’s numbers are probably in the many hundreds to thousands of cases. Prominent doctors and researchers have done intellectual contortions trying to make their observations conform to this theory, trying to use the “clockwise peritoneal fluid circulation” to explain why lesions are more common in some areas, such as why there’s more endo found on the left uterosacral ligament and sidewall than on the right. Most people, including gynecologists, believe that endo is caused by retrograde menstruation (Sampson’s Theory), a process by which endometrial cells from the uterine cavity flow backwards through the fallopian tubes and wind up in the pelvis.
What causes endo? Again, popular opinion and the medical facts diverge, mysteriously. This tells us that endo doesn’t metastasize like cancer, but grows fairly slowly in place, and where it is initially is where it will be in the future.
Redwine wrote a paper looking at this very subject, and what he found was that older women don’t have more locations of endometriosis, but they do tend towards having deeper disease with more bowel involvement in women in their 30s than in their 20s.
We do have snapshots of the disease in different women at various ages that allows us to know some things.
ENDO MEANING PHILIPPINES INSTALL
Unfortunately, because we can’t install a permanent time-lapse camera in the pelvis, or even do repeated laparoscopies every year for 10-20 years, we don’t have a great understanding of how the disease progresses. This is referred to as Deeply Infiltrating Endometriosis (DIE). There may be 2 separate varieties of endo- that which stays superficial within the peritoneum, and that which infiltrates the deeper tissues of the pelvis such as the rectovaginal septum, bowel wall, bladder wall, and ovaries. When it does grow, it typically stays in the same location and grows only deeper. It can also be found less often on the diaphragm, lung, and has been reported in the brain and male prostate.Ĭontrary to popular opinion, it does not spread from one location to another, and can remain rather static. It also is commonly found on the intestines (large and small bowel, appendix), in the wall of the bladder, and in the muscle of the uterus where it is called adenomyosis. The most frequent locations are the uterosacral ligaments, culdesac, pelvic sidewalls (under the ovaries), and over the bladder. Most often, it is found in the pelvic peritoneum, or the lining of our abdominal cavity. Essentially, it is tissue that resembles the endometrium (lining of the uterus), that exists other places. So back to endo- the formal definition is “endometrial glands and stroma existing outside the endometrial cavity”. For details on this, please see My Philosophy on Treating Pelvic Pain Patients. Pain is perceived differently by different individuals. In reality it’s really no more mysterious than considering that Tiger Woods played a whole round of golf on a broken leg, while my mother can fall down and get no more than a bruise and stay in bed for 3 days. This has led physicians and researchers to call endometriosis “enigmatic”, meaning perplexing or mysterious. What this means is that one person may have mild disease and severe pain, whereas someone else could have severe disease and minimal symptoms. The severity of pain varies from person to person, just as the severity of disease does, however they are not linked. Endometriosis, frequently referred to as just “endo”, is a genetic disease that affects women and causes pain, inflammation, and infertility.
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