Page 14 - Diagnostic delay of endometriosis

is characterized by the presence of ovarian cysts also referred to as endometrioma. Deep endometriosis is defined as endometriosis deeper than 5 mm under the peritoneal surface. It includes nodules and plaques which can involve and infiltrate several organs and structures, including (but not limited to) the parametria, uterosacral ligaments, pouch of Douglas, the rectovaginal septum, bladder, ureters and rectosigmoid. Endometriotic lesions can be observed at locations outside the pelvis as well, such as the liver, diaphragm, pleura, lung and umbilicus, although these structures are less frequently involved as compared to pelvic structures. Depending on the size, location and depth of infiltration, the lesions can cause severe pain and impairment in function of affected organs.
Clinical presentation and diagnosis
Signs and symptoms
Dysmenorrhea, dyspareunia, chronic pelvic pain and subfertility are considered characteristic symptoms of endometriosis. Women with endometriosis may present with one or more of these complaints, while others are completely asymptomatic. However, a wide variety of symptoms may be presented, with many of them rather prevalent in young women, non-specific or overlapping
12 | Chapter 1