a.子宮内膜症の最近の話題(1.内分泌)

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Endometriosis is one of the leading diseases affecting women at reproductive age. Based on large scaled investigation carried out in 1998, the number of women nuder treatment for endometriosis amounted to approximately 130 thousand in Japan. Now that women have fewer children along with delayed child dearing age, the incidence of the disease is supposed to be on the increase. Despite the recent extensive research on endometriosis, there remained a lot of enigmas as regards pathogenesis, mechanisms for infertility and pain, the modalities of treatment, etc. As for pathogenesis, the most widely accepted theory has been implantation of endometrial cells transported through Fallopian tubes. However, several recent studies are in support of metaplasia theory advanced by Meyer. Although the issues about etiologies of endomatriosis is not resolved yet, many agree that menstrual reflux is a prerequisite for the occuence of endometriosis. Recent data have highlighted a significance of angiogenic factors for the development and progression of endometriosis. Manipulation of angiogenic activities may represent a new therapeutic approach. Endometriosis is known to be strongly associated with infertily. There has been much debate about whether edometriosis per se effects adverse influences on fertility and, if so, how the disease does this. A recent popularized idea as an explanation for infertility has been the deranged peritoneal environment as manifested by an increase in the number of activated macrophages, elevated levels of various cytokines. However, more recent studies challenge this concept by demonstrating that the peritoneal environmental changes might be characteristic with infertile women with endomertiosis, but not fertile women with endomertiosis. It is further shown that the peritoneal environmental changes are seen is unexplained infertility without endometriosis, thus complicating the interpretation of roles cytokines and macrophages in the peritoneal cavity as possible causes for infertility. Dysmenorrhea and chronic pelvic pain are considered to be cardinal symptoms with endometriosis. A great number of works attempted to find correlation between disease location/stage and severity and frequency of pain, only to demonstrate no consistent relation. Thus, optimal treatment of pain due to endometriosis remains challenging. The most common form of treatment is surgery including removal of the disease, lysis of adhesion. However, it is skeptical that surgical procedures may work well in the cases with minimal/mild endometriosis. Increased awareness has been directed toward a link between endometriosis and ovarian cancer, both disease having common risk factors like low parity, tubal patency and so on. Recent molecular studies demonstrated the higher incidence of genomic abnormalities in endometriotic tissues, suggesting a premalignant potentiality of endometriosis. This subject merit further investigation in the hope that the prevention of endometriosis may also serve as a preventative measure for ovarian cancer.
社団法人日本産科婦人科学会の論文
2000-08-01

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