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1b) *Regurgitation of the endometrium through the fallopian tubes into the peritoneum during menses
*Implantation of pieces of endometrium during surgery
*Metaplasia of tissue at different sites into endometrial tissue.Since the viscera and muscles of the endometrium are formed from the same type of tissue,each cell has the potential of converting itself into endometrium-like tissue.This convertion is called metaplasia.What stimulates the convertion is not exactly known.
*Spread via the blood stream & lymphatics.
2. Presence of pieces of endometrium outside it's normal location,which will act like endometrium during each menstrual cycle and bleed but without an outlet for blood.Collection of this blood leads to inflammation and engorgement of the pelvic area and symptoms as in this case study.
3. The main factors that have to be taken into consideration before treatment are -- Patient's desire for future pregnancies,Age of the patient,and Severity of disease.The options are a)Hormonal approach,Surgery or Danazol.The rational for using Danazol is that it ia a synthetic hormone that is non estrogenic,non progestogenic and weakly androgenic.It decreases the release of ganodatropins (FSH / LH) from the pituitary,and hence the release of estrogens from the ovaries.It blocks the estrogen receptors in the target tissues like endometrium and breast.
4.It is a known fact that pregnancy prevents endometriosis.During pregnancy the lady has 1)high progesterone levels 2)anovulation.If one can achieve these results artificially,endometriosis might be relieved.Hence the mainstay of hormonal therapy is combined oral contraceptives.It will induce anovulation and a state of pseudo-pregnancy.This leads to arrest and repression of the endometriosis.If the patient is young and does not desire pregnancy,she can be given clinical therapy with oral contraceptives.Only in this case the cycle may even be of 3-4 monthsThis will lead to heavy withdrawl bleeding only 3-4 times a yearHigh dose oral contraceptives are generally chosen.Whenever these patients desire pregnancy,the pills are discontinued.Pregnancy itself will prevent endometriosis.However,they have their own side effects.