![]() Low telomesase activity predisposes women to poor function of their oocytes and put the endometriosis patients on the path to premature ovarian failure. In endometriosis telomerase activity is inhibited and this results in a shortening of the chromosomes. With each cell division chromosomes tend to break and become shorter and the lost portion of the chromosome is normally repaired by the enzyme telomerase. The ovarian granulosa cells from endometriosis patients are also affected. This promotes fibrosis, reduces blood supply with a loss of stroma in the ovarian cortex and the subsequent reaction is follicular death with a lower follicular density. The proinflammatory substances present in endometriosis results in oxidative stress through the production of reactive oxygen spices. The inflammatory response fails to activate the enzymes necessary for implantation. In endometriosis however, we have a more proinflammatory response with relatively low progesterone and high estrogen levels. ![]() This is represented as an anti-inflammatory response. The inflammatory response is not only active in the pelvic peritoneal cavity, but it is also affecting the entire body with effects such as fatigue, altered bowl and bladder function, dysfunction of liver and adipose tissue and even the central nervous system with the development of symptoms such as anxiety and depression.ĭuring normal implantation of the embryo the progesterone levels after the ovulation are high and the estrogen levels relatively low. This reaction creates a more proinflammatory environment and further promotes the development of an increased amount of endometriosis. The endometriotic Implants create a pronounced inflammatory response with production of multiple inflammatory proteins which result in an altered autoimmune response. ![]() In the past laparoscopy used to be the main stay for the diagnosis but over the years new laboratory studies as well as careful use of sonograms have indicated that even indirect observations can result in an adequate diagnosis.Įndometriosis is a hormone dependent inflammatory disease. In some women symptoms direct the attention to the diagnosis of endometriosis but in the majority of women the symptoms are very limited and it is not uncommon to have a delay of 5 – 6 years from the start of symptoms until the final diagnosis is made. Even minimal endometriosis may be marked with reduced fertility raising the need for diagnosis and early treatment. If they have tried to have a baby for more than a year that figure goes down to less than 4 %. The normal fertility rate for couples attempting to have a baby is approximately 25 – 30 % for the first 3 months whereas patients with endometriosis only achieve a pregnancy rate of approximately 2- 10 % under the same circumstances. Patients with pelvic pain and infertility has a much higher prevalence that may be as high as 35 – 50 %. Endometriosis affect between 6-10% of all reproductive age women.
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