Thursday, April 20, 2017

Musings on mullerian

This is purely my conjecture based on my readings. The literature refers to peritoneal endometriosis,  ovarian endometriosis,  and deep infiltrating endometriosis. Current theory points to defects when our pelvic organs are developed (Mullerianosis) that leave stem cells in the wrong place. This might also explain why other mullerian disorders such as adenomyosis are frequently seen in endometriosis patients as well.  These stem cells are acted upon by hormones (puberty) to develop as glands and stroma and begin the process of making nerves and blood vessels to support itself - as any good stem cell should. However that tissue should not be in those wrong sites and an inflammatory response happens.  Factors from the environment (food, physical activity,  stress,  etc) play a role in presentation of illness. This is why diet etc might affect symptoms but will not rid the person of the lesions. The different locations of stem cells left behind might influence how they are acted upon by hormones and affect their presentation and the ability to extract them all (trying to spare the ovarian tissue for fertility). https://www.hindawi.com/journals/ogi/2013/527041/abs/

The literature also refers to different stages of the lesions based on color - clear,  white,  tan,  red,  black. The different stage can produce different effects on the amount of pain and inflammation it causes.

Monday, March 6, 2017

Symptoms of endometriosis review

Author(s) [Ref.]
Year
Results for symptoms
Results for signs
Valle [14]
2002
Pelvic pain that often is worse just before and during menstruation, hypermenorrhea, premenstrual staining, dyspareunia, suprapubic pain, dysuria, hematuria, painful defecation (dyschezia), lower back pain.
Local tenderness in cul de sac or uterosacral ligaments, adnexal enlargement or tenderness, pelvic masses.
Spaczynski and Duleba. [15]
2003
Chronic pelvic pain consists of dysmenorrhea, intermenstrual pain, and dyspareunia.
Bluish implants typical of endometriosis or red, hypertrophic lesions bleeding on contact, usually in the posterior fornix. lateral cervical displacement, cervical stenosis. Retroversion, decreased or absent mobility of uterus and tenderness. Tender masses, nodules, and fibrosis appreciated on palpation of the upper vagina, cul-de-sac, uterosacral ligaments, or rectovaginal septum.
Kennedy et al. [16]
2005
Severe dysmenorrhea, deep dyspareunia, chronic pelvic pain, ovulation pain, cyclical or perimenstrual symptoms (e.g. bowel or bladder associated) with or without abnormal bleeding, infertility and chronic fatigue.
Pelvic tenderness, a fixed retroverted uterus, tender uterosacral ligaments or enlarged ovaries on examination. The diagnosis is more certain if deeply infiltrating nodules are found on the uterosacral ligaments or in the pouch of Douglas, and/or visible lesions are seen in the vagina or on the cervix. The findings may, however, be normal.
Mounsey et al. [17]
2006
Pelvic pain, back pain, dyspareunia, dysmenorrhea loin pain, dyschezia, pain with micturition and infertility.
Tender nodules in the posterior vaginal fornix, uterine motion tenderness, a fixed and retroverted uterus, or tender adnexal masses.
Denny and Mann. [18]
2007
Pain around menstruation, dyspareunia, dyschezia, cyclical dysuria and extreme fatigue.
Not discussed.
Amer [19]
2008
Dysmenorrhoea, dyschezia, hematochezia, dysurea, haematurea, dyspareunia, chronic pelvic pain, heavy and/or irregular periods, premenstrual spotting, infertility.
Tenderness on cervical movement, thickening and tenderness of the uterosacral ligaments, fullness or mass in the pouch of Douglas (POD), fixation and retroversion of the uterus, rectovaginal nodule. Adnexal (or even a pelvi-abdominal) mass in women with large endometriomas.
Luisi et al. [2]
2009
Severe dysmenorrhea, deep dyspareunia, chronic pelvic pain, ovulation pain, cyclical or perimenstrual symptoms with or without abnormal bleeding, infertility and chronic fatigue.
Not discussed.
Giudice. [20]
2010
Chronic pelvic pain (lasting ≥6 months), dysmenorrhea, dyspareunia, deep pelvic pain, and lower abdominal pain with or without back and loin pain. The pain can be continuous, and it can be dull, throbbing, or sharp, and exacerbated by physical activity. Bladder- and bowel associated symptoms (nausea, distention, and early satiety) are typically cyclic. Burning or hypersensitivity symptoms that are suggestive of a neuropathic component (infrequently).
A pelvic mass, immobile pelvic organs, and rectovaginal nodules.
Altman and Wolcyzk. [21]
2010
Chronic pelvic pain, dysmenorrhea, dyspareunia, infertility, back pain, dyschezia, rectal pain, diarrhea, constipation, dysuria, hematuria, infertility, chronic fatigue and psychosocial stressors.
Palpable tender nodules in the cul-de-sac or uterosacral ligaments; localized tenderness in the cul-desac, uterosacral ligaments, or rectovaginal septum; pain with uterine movement; enlarged or tender adnexal masses; and fixation of adnexa or uterus in a retroverted position. Red, blue, or hemorrhagic nodules may also be visualized on the external genitalia, vagina, or cervix.
Okeke and Ikeako. [9]
2011
Dysmenorrhea, dyspareunia, menorrhagia and infertility.
Not discussed.
Koninckx et al. [22]
2012
Hypogastric pain, especially dysmenorrhea, deep dyspareunia, severe chronic pain, mictalgia, and dyschezia.
Not discussed.
AciƩn and Velasco [23]
2013
Dysmenorrhea (during and at the end of menstruation), deep dyspareunia, chronic pelvic pain, and infertility premenstrual spotting for 2–4 days, headache, irritability, or premenstrual tension syndrome.
Not discussed.
Carneiro M M et al. [24]
2013
Dysmenorrhea, dyspareunia, dyschezia, gastrointestinal symptoms, chronic pelvic pain, infertility.
Pelvic tenderness, a fixed retroverted uterus, tender uterosacral ligaments or enlarged ovaries, uterosacral nodularity.
Schrager et al. [25]
2013
Debilitating pelvic pain, dysmenorrhea, dyspareunia, and decreased fertility.
Not discussed.
Mehedintu et al. [26]
2014
Severe dysmenorrhea, non-cyclical chronic pelvic pain, dysfunctional uterine bleeding, infertility, dyspareunia, painful defecation during menstruation, urinary tract symptoms and gastrointestinal symptoms
Not discussed.
Bhattacharjee et al. [27]
2014
Dysmenorrhea, deep dyspareunia, infertility, abnormal uterine bleeding, non-cyclic pain, menstrual cycle abnormalities, constipation, chronic fatigue, heavy or long uncontrollable menstrual periods with small or large blood clots, gastrointestinal problems including diarrhea, bloating and painful defecation, extreme pain in legs and thighs, back pain, mild to extreme pain during intercourse, pain from adhesions which may bind an ovary to the side of the pelvic wall, or they may extend between the bladder and the bowel, uterus, extreme pain with or without the presence of menses, premenstrual spotting, mild to severe fever, headaches, depression, hypoglycemia and anxiety.
Non-specific pelvic tenderness, localized tenderness in the pouch of Douglas, thickened nodular uterosacral ligaments, fixed retroverted uterus, palpable fixed cystic adnexal mass or an obliterated pouch of Douglas, masses, fixity of organs, displacements of cervix & presence of nodules in the rectovaginal pouch or uterosacral ligaments, nodularity or tenderness in the uterosacral ligament, bluish or red powder burn lesions may be seen in the cervix or posterior fornix of the vagina (which may be tender or bleed on touch), bluish nodules in the posterior fornix, a fixed retroverted tender uterus or a firm fixed pouch of Douglas.


https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-015-0196-z