Classification of endometriosis

"You have Endometriosis": Making Menstruation-Related Pain Legitimate in a Biomedical World

In this essay, the author reflects on how biomedical and gendered perceptions of reproductive health can impact an illness experience. Using a narrative lens, she relays the frustration of attempting to have her excessive menstrual pain legitimated and treated when loved ones and medical professionals trivialized it and refused to let her take on the sick role. She recounts incidents that demonstrate the embedded and limiting persistence of gendered perceptions of pain. In the end, she argues that only through strong patient self-advocacy and knowledge can one rewrite the social scripts assigned to how women cope with menstrual pain.

Putting Pain to Paper: Endometriosis and the Documentation of Suffering

Although the elusive and subjective nature of pain has been examined in compelling ways in health studies, the implications for systems of pain documentation and measurement remain relatively unexplored. Two systems for the documentation of pain symptoms in women with endometriosis are examined, one developed by a gynaecological association and the other by a woman with the disease. All pain documentation systems must contend with a fundamental problem: that they permit the comparison only of accounts of pain, not of pains themselves. These two instruments shift attention away from the pain itself to evaluations of the perspectives of those accounting for and evaluating pain. It is argued that systems of pain measurement and documentation, rather than offering objective readings of pain, must be seen as the products of epistemological communities with particular interests, aims and methods which affect the construction of pain and its subjects.

Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis: the predictive value of the current classification system

BACKGROUND

To assess the predictive value of the current classification of endometriosis in terms of response to surgical treatment, we studied to what extent disease stage, lesion type and lesion site were associated with post-operative pregnancy rate, symptom recurrence and disease relapse.

METHODS

A total of 729 women with endometriosis undergoing first-line conservative laparoscopic surgery were included. Data on age at surgery, disease stage according to the revised American Fertility Society (AFS) classification, anatomical characteristics of endometriotic lesions, fertility status and types and severity of pain symptoms were collected.

RESULTS

Minimal endometriosis was present in 222 patients, mild in 106, moderate in 197 and severe in 204. The cumulative probability of pregnancy at 3 years from surgery in 537 infertile women was 47% (51% at stage I, 45% at stage II, 46% at stage III and 44% at stage IV; log-rank test, chi(2)3=1.50, P=0.68). The cumulative probability of moderate or severe dysmenorrhoea recurrence in 425 symptomatic subjects was 24% (32% at stage I, 24% at stage II, 21% at stage III and 19% at stage IV; log-rank test, chi2(3)=6.39, P=0.094). The cumulative probability of disease relapse was 12% (3% at stage I, 11% at stage II, 11% at stage III and 23% at stage IV; log-rank test, chi(2)3=24.95, P=0.0001). Using Cox's multivariate proportional hazards regression analysis, no association was observed between endometriosis stage or lesion type and lesion site and any of the considered study outcomes.

CONCLUSIONS

The current classification of endometriosis has an inadequate predictive value with regard to the major clinical outcomes.

Histological classification of endometriosis as a predictor of response to treatment

OBJECTIVES

To evaluate the usefulness of the histological classification of endometriosis in predicting responses to treatment.

METHODS

We evaluated 412 biopsy specimens from 241 patients with pelvic endometriosis. Pain and infertility were evaluated before surgery. Disease location and stage of development were analyzed according to the 1985 American Society of Reproductive Medicine (ASRM) classification. Histological findings were classified as stromal, well-differentiated, undifferentiated, and mixed endometriosis. Clinical response to pain or infertility was evaluated.

RESULTS

Histological findings, disease location and stage of development, and response to treatment were compared. Undifferentiated endometriosis was more frequently associated with stages III/IV than the well-differentiated and stromal histological types. Pure or mixed undifferentiated patterns were more frequently associated with rectovaginal endometriosis. When considering pain symptoms, patients presenting well-differentiated or stromal histological patterns responded better to therapeutic treatment than those who presented undifferentiated histological patterns. There were no significant differences in cases related to sterility.

CONCLUSIONS

The histological categorization of endometriosis can help predict the behavioral patterns of the disease.