Endometriosis has no known cause; however, many ideas exist. Retrograde menstruation is the
hypothesis that endometrial cells travel back via the fallopian tubes, rooting and growing. Another
idea states that endometrial cells are transported via the bloodstream. Other ideas suggest that
endometriosis may be inherited families, or that an incorrect immune response may lead to its
development. Many women's bodies include cells that can grow into endometrial cells if genetic or
environmental factors impact them later in life (Story, 2018).
The American Society of Reproductive Medicine has created an endometriosis stage system. Stages
include: Stage 1, minimum; Stage 2, mild; Stage 3, moderate; and Stage 4, severe (John Hopkins
Medicine, 2019). Endometrial tissue location, quantity, depth, and size determine endometriosis
stage. Criteria include: the extent of spread of tissue, the involvement of pelvic structures, the
extent of pelvic adhesions, and the blockage of the fallopian tubes (John Hopkins Medicine, 2019).
Most women with endometriosis will have one or more of the symptoms listed below, however
they may manifest in different ways for individual women. Endometriosis can cause symptoms such
as: pain, especially excessive menstrual cramps, pain during intercourse, abnormal or heavy
menstrual flow, infertility, painful urination during menstruation, painful bowel movements during
menstruation, and other gastrointestinal problems such as diarrhea, constipation, and/or nausea
(John Hopkins Medicine, 2019).
Diagnostic testing for endometriosis includes patient history, physical examination, laparoscopy,
and pelvic ultrasound. A laparoscopy is a form of surgery that examines the abdomen or a woman's
genitalia. A laparoscope is used in laparoscopic surgery. Intra-abdominal incision for insertion of a
tube that features a camera. The camera feeds footage to a monitor. This permits a surgeon to see
within the body without causing substantial harm (Laparoscopy: MedlinePlus Lab Test Information,
2018).
Concept and Etiology:
Pelvic inflammatory disease (PID) is a clinical syndrome that results from the ascension of
microorganisms from the cervix and vagina to the upper genital tract. PID is a serious complication
of chlamydia and gonorrhea, two of the most common reportable infectious diseases and sexually
transmitted diseases (STDs) in the US. c According to the CDC, PID diagnoses are in an average of 5%
of all U.S. women will have PID in their lifetime. c It most often occurs when sexually transmitted
bacteria spread from your vagina to your uterus, fallopian tubes, or ovaries.
Classification:
Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. It most often
occurs when sexually transmitted bacteria spread from your vagina to your uterus, fallopian tubes,
or ovaries. Sexually transmitted organisms, especially Gonorrhea and Chlamydia, are implicated in
many cases.
Clinical Manifestations:
The signs and symptoms of pelvic inflammatory disease can be subtle or mild. Some women do not
experience any signs or symptoms; however, some signs and symptoms could be:
oral temperature >101°F (>38.3°C);
abnormal cervical mucopurulent discharge or cervical friability;
presence of abundant numbers of WBC on saline microscopy of vaginal fluid;
elevated erythrocyte sedimentation rate;
elevated C-reactive protein; and
laboratory documentation of cervical infection with N. gonorrhoeae or C. trachomatis.
As a result, you might not realize you have it until you have trouble getting pregnant or you develop
chronic pelvic pain.
Diagnostic Tests:
History
Physical examination
Discharge culture
Pap smear
CBC
pelvic ultrasound
CT
The most specific criteria for diagnosing PID include:
endometrial biopsy with histopathologic evidence of endometritis;
transvaginal sonography or magnetic resonance imaging techniques showing thickened, fluid-filled
tubes with or without free pelvic fluid or tubo-ovarian complex, or Doppler studies suggesting pelvic
infection (e.g., tubal hyperemia); or
laparoscopic findings consistent with PID.
References
Mayo Foundation for Medical Education and Research. (2020, April 23). Pelvic inflammatory disease
(PID). Mayo Clinic. Retrieved November 26, 2021, from https://www.mayoclinic.org/diseases-
conditions/pelvic-inflammatory-disease/symptoms-causes/syc-20352594.
Story, L. (2018). Pelvic Inflammatory Disease. In Pathophysiology: A practical approach (pp. 242–
243). essay, Jones & Bartlett Learning.
Center for Disease Control and Prevention (2020). Pelvic inflammatory disease (PID). CDC.
November 26, 2021 from https://www.cdc.gov/std/pid/stdfact-pid-detailed.htm c
John Hopkins Medicine. (2019). Endometriosis. Johns Hopkins Medicine.
https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis
Laparoscopy: MedlinePlus Lab Test Information. (2018). Medlineplus.gov.
https://medlineplus.gov/lab-tests/laparoscopy/
Story, L. (2018). Pathophysiology: a practical approach (3rd ed.). Jones & Bartlett Learning.
