Endometriosis: Diagnostic Debated Pathogenesis

Endometriosis is a debilitating and painful disease estimated to occur in 50% of women seeking treatment for pain and infertility (Prince & Thomas, 2015). Despite its prevalence, there is a significant diagnostic delay associated with endometriosis; the length of time between the first presentation of symptoms to the actual diagnosis averages 6 to 11 years (Yates, 2015). This diagnostic delay stems from widely debated pathogenesis, varied presentation, and standard methods of diagnosis (Prince & Thomas, 2015; Vercellini, Vigano, Somingliana & Luigi, 2014; Yates, 2015).
Debated Pathogenesis
The causation of endometriosis is a subject of widespread debate (Prince & Thomas, 2015). Pathogenically, it is most widely evidenced and supported
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According to Vercellini et al. (2014), the only completely accurate diagnosis of endometriosis involves directly observing the pelvic cavity via laparoscopy. This surgical method that allows for a histological diagnosis (Vercellini et al., 2014). A histological diagnosis involves taking a biopsy of tissue that is then microscopically inspected for disease (Vercellini et al., 2014). However, it is argued that diagnosis of endometriosis can be made without surgically entering the pelvic cavity; pelvic surgery is correlated with significant risk and should be avoided if other options exist (Vercellini et al., 2014). In contrast, one commonly used method for the nonsurgical diagnosis of endometriosis involves a combination of signs, symptoms, and ultrasound data (Yates, 2015). This method involves first evaluating signs and symptoms with a health history assessment and an abdominopelvic examination (Yates, 2015). The examination appraises the presence of masses and pain (Yates, 2015). Although ultrasound methods are non-invasive in nature, the resulting images can identify only one type of endometrial growth, the chocolate cyst (Yates, 2015). When a combination of signs, symptoms, and ultrasound findings fail to diagnose the cause of pelvic pain, diagnosis can be made through the use of gonadotropin-releasing hormone (GnRH) agonists. (Vercellini et al., 2014). Over time, GnRH agonists inhibit ovulation and menstruation by inducing a menopausal state (Vercellini et al., 2014). This induced state suppresses the growth of endometrial tissue (Vercellini et al., 2014). This approach encompasses diagnosis through treatment but does not address the presence of disease; instead, GnRH agonists simply abolish symptoms for the duration of treatment (Vercellini et al., 2014). The contraindications of the most effective method of diagnosis – the laparoscopy – contribute to the

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