Human Reproduction, Vol. 15, No. 1, 1-3,
January 2000
© 2000 European Society of Human Reproduction and Embryology
Redefining endometriosis: Is deep endometriosis a progressive disease?
1 Leuven Institute for Fertility and Embryology, Leuven, Belgium, and 2 Department of Reproductive Sciences and Medicine, Division of Paediatrics, Obstetrics and Gynaecology, ICSM at Hammersmith Hospital, London, UK
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Introduction |
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Current literature on endometriosis distinguishes between superficial and deep lesions. Deep lesions are assumed to reflect invasive and progressive disease. The American Fertility Society classification system for endometriosis (American Fertility Society, 1985
) distinguishes lesions, which extend below the surface of the peritoneum and the ovaries by <1, 1–3 and >3 cm and scores them 2–8 times higher than superficial lesions. More recently, some authors have recommended to make a distinction at 6 mm, suggesting that lesions deeper than 5 mm represent progressive disease (Cornillie et al., 1990).
The concept of deep, and therefore progressive disease is based on Sampson's hypothesis that endometriosis is due to the menstrual dissemination into the peritoneal cavity (Sampson, 1927). Although this view may appear logical, there is little evidence that superficial endometriosis progresses to deep endometriosis. Before Sampson the localizations of ectopic endometrial-like tissue were described (Cullen, 1920) to occur
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The microenvironment determines the phenotype of endometrial tissue |
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Peritoneal and ovarian endometriosis are characterized by hormone-dependent bleeding |
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Deep endometriosis is adenomyosis |
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Endometriotic adenomyotic disease is characterized by pleiotropic reproductive abnormalities |
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Clinical implications |
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Acknowledgments |
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Notes |
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References |
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