Department of Obstetrics and Gynecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy.
Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Via Olgettina 60, 20136 Milan, Italy.
Nat Rev Endocrinol. 2014 May;10(5):261-75. doi: 10.1038/nrendo.2013.255. Epub 2013 Dec 24.
Endometriosis is defined as the presence of endometrial-type mucosa outside the uterine cavity. Of the proposed pathogenic theories (retrograde menstruation, coelomic metaplasia and Müllerian remnants), none explain all the different types of endometriosis. According to the most convincing model, the retrograde menstruation hypothesis, endometrial fragments reaching the pelvis via transtubal retrograde flow, implant onto the peritoneum and abdominal organs, proliferate and cause chronic inflammation with formation of adhesions. The number and amount of menstrual flows together with genetic and environmental factors determines the degree of phenotypic expression of the disease. Endometriosis is estrogen-dependent, manifests during reproductive years and is associated with pain and infertility. Dysmenorrhoea, deep dyspareunia, dyschezia and dysuria are the most frequently reported symptoms. Standard diagnosis is carried out by direct visualization and histologic examination of lesions. Pain can be treated by excising peritoneal implants, deep nodules and ovarian cysts, or inducing lesion suppression by abolishing ovulation and menstruation through hormonal manipulation with progestins, oral contraceptives and gonadotropin-releasing hormone agonists. Medical therapy is symptomatic, not cytoreductive; surgery is associated with high recurrence rates. Although lesion eradication is considered a fertility-enhancing procedure, the benefit on reproductive performance is moderate. Assisted reproductive technologies constitute a valid alternative. Endometriosis is associated with a 50% increase in the risk of epithelial ovarian cancer, but preventive interventions are feasible.
子宫内膜异位症定义为子宫腔外存在子宫内膜样黏膜。在提出的发病理论（逆行月经、腔室化生和米勒管遗迹）中，没有一种理论可以解释所有不同类型的子宫内膜异位症。根据最具说服力的逆行月经假说模型，子宫内膜碎片通过输卵管逆行流动到达骨盆，然后种植在腹膜和腹部器官上，增殖并引起慢性炎症，形成粘连。月经流量的数量和量以及遗传和环境因素决定了疾病表型表达的程度。子宫内膜异位症依赖于雌激素，在生殖年龄出现，与疼痛和不孕有关。痛经、深部性交痛、排便和排尿困难是最常报告的症状。标准诊断是通过直接观察和病变的组织学检查进行的。疼痛可以通过切除腹膜种植物、深部结节和卵巢囊肿来治疗，也可以通过激素治疗（孕激素、口服避孕药和促性腺激素释放激素激动剂）抑制排卵和月经来抑制病变，从而达到治疗效果。药物治疗是对症治疗，不能减少病变；手术与高复发率相关。虽然消除病变被认为是一种提高生育能力的方法，但对生殖性能的益处是适度的。辅助生殖技术是一种有效的替代方法。子宫内膜异位症会使上皮性卵巢癌的风险增加 50%，但可行预防干预措施。
