Endometriose em adultos: Patogênese, epidemiologia e impacto clínico

Abstract

Introduction: Endometriosis is a chronic disease that affects 10% of women worldwide. Defined by endometrial tissue outside the uterine cavity, it is estrogen-dependent and in women of reproductive age it can manifest asymptomatically or be related to infertility. Abdominal and/or pelvic pain, dyspareunia, dyschezia, dysuria and irregular uterine bleeding impact the quality of life and productivity of these women. Both the pelvic region (ovaries, uterosacral ligaments and retroperitoneum) and the bladder and intestine (rectosigmoid, colon) can have such implants, making early diagnosis difficult and adding morbidity. Objective: to understand endometriosis and its clinical presentation, evaluation and diagnostic possibilities. Methodology: Integrative literature review based on articles from the scientific databases of Scielo, PubMed and VHL. This research was carried out from March to May 2024, with descriptors in English “endometriosis”, “pathogenesis”, “epidemiology” and “clinical impact” and their corresponding ones in Portuguese. Full articles from the last five years (2019-2024) were included, with a total of 91 studies. After reading the abstracts, studies from other categories were excluded, with 05 articles for reading in full. Results and Discussion: It is demonstrated that the physical examination in patients with endometriosis is imprecise and variable, depending on the location and size of the implants. Pain and intensity do not correspond to severity. Suggestive findings include: fixation of the cervix, adnexa or uterus; tend adnexal mass or nodule; lateral displacement of the cervix to touch. Although the definitive diagnosis requires histological confirmation by tissue biopsy, the presumptive diagnosis gains prominence from signs and symptoms with imaging findings (USG/MRI). There are no specific laboratory markers for endometriosis. Ovarian endometriomas, infiltrative nodules or bladder lesions are suggestive on imaging. Surgery is reserved for women with severe symptoms and refractory to the use of hormonal contraceptives or other therapies. Staging according to the American Society for Reproductive Medicine (ASRM) is mostly performed via laparoscopy and direct treatment. Conclusion: Surgical diagnosis of endometriosis is highlighted as the gold standard, as this condition rarely undergoes malignant transformation into cancer. Delayed diagnosis of chronic pelvic pain impacts quality of life and is still a constant, despite medical training and technological advances.