CLINICAL MANIFESTATIONS OF ENDOMETRIOSIS

Endometriosis is a disease of the active reproductive life of women. It is unusual before the menarche and is most frequent in women in their twenties and thirties. Pelvic endometriosis in teenagers, may be somewhat more common than has generally been appreciated. With increasing use of laparoscopy, endometriosis has been found more frequently in teenagers than was conventionally believed. In any case, the diagnosis should be considered, even in teenagers, if there are any suggestive physical findings, or if the menstrual discomfort differs from that usually accompanying primary dysmenorrhea in terms of its nature, location, and response to standard therapy.
As would be predicted, it ceases almost entirely to be a problem after menopause because with cessation of cyclic ovarian function the lesions ordinarily atrophy and regress, leading to softening and almost complete disappearance of the secondary surrounding fibrotic nodules and scar tissue deformities. Occasional exceptions to the postmenopausal inactivity of the disease, have been encountered and reported, but they are rare. In some cases reactivation of the disease may have been induced by hormonal therapy. Occasionally, at the time of laparotomy for other causes, in post menopausal women, persistent scarring in the form of cul-de-sac obliteration, old adnexal adhesions, or pelvic tissue plane distortions may point to the probable prior presence of pelvic endometriosis, but microscopic proof is usually absent due to the total atrophy of the endometrial glands and stroma.
Thus, the typical patient is in her twenties or early thirties, is either single or has married late, and has voluntarily delayed childbearing, or is suffering from involuntary sterility. Many nulliparous, and the rest usually have had one or two pregnancies.

The amount of pain associated with the disease, is not related to the extent or size of the implants. Some women with endometriosis have no symptoms, others suffer from severe symptoms, debilitating pain and even infertility.