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Endometriosis in Clinical Practice

This book is wide ranging in content and covers both the clinical aspects of endometriosis and many of the areas of basic science that underpin the clinician's management of the disease.

The chapters are well arranged, with basic science occupying most of the first two-thirds. Readers are reminded of the normal menstrual cycle and a basis is laid for the understanding of the role of receptors, cytokines and adhesion molecules in implantation and cellular change. The aetiology of subfertility in endometriosis is explored, with particular and detailed reference to current research on factors influencing implantation, including pinopods, growth factors and genes. Following a discussion of uterine morphology, there is an excellent chapter on the epidemiology of the disease. The difficulties underlying the determination of the prevalence of endometriosis and its natural progression are explained and the problems associated with the establishment of valid epidemiological data are well elucidated. Following is a detailed account of disease pathogenesis and an exposition of the inflammatory changes associated with the condition. There is a certain amount of recapitulation, with further detailed chapters discussing the role of cytokine regulation, matrix metalloproteinases and aromatase.

The clinical section of the book investigates the causation of pain and there is a worthwhile, if short, section on ‘atypical’ endometriosis involving the bowel and bladder. There is detailed discussion of clinical examination and the assessment of health status before a discussion of the role of medical and surgical treatment. There follows a chapter on in vitro fertilisation and endometriosis and the book concludes with a good assessment of the direction for future research.

Endometriosis in Clinical Practice draws together many of the different strands of knowledge and for the most part it succeeds in presenting them coherently and in a logical order. In many of the areas involving basic science, the average gynaecologist or, indeed, the surgeon specialising in endometriosis, are, at best, only moderately well informed. For the clinician, knowledge of the basic science should help to explain the rationale for a particular mode of disease management.

The reasons behind the highly variable prevalence rates are explained well through the exploration of problems with diagnosis and determination of natural disease progression. The book provides an invaluable reference source for those wishing to undertake further research on any of the topics discussed.

From the clinician's viewpoint there is, perhaps, somewhat too much summation of the basic science involved. The book tries to be all encompassing and largely presents data for the clinician to interpret, without ever trying to be prescriptive in terms of disease management. In a way, this becomes something of a problem in that the clinician who hopes to receive some guidance regarding management is liable to be disappointed. In this regard, a more clinically oriented or problem-based approach could have been invaluable in helping the clinician to understand the rationale for a particular plan of management.

I would have liked to see some further discussion of embryological rests, particularly pertaining to bowel and bladder disease, which is underdiagnosed and ill understood, and of the pathogesesis of its presentation. Radical fertility-preserving laparoscopic surgery for advanced disease is now being performed in various centres with excellent results; it is a pity that there was no discussion or even mention of this.

Overall, the book is a worthwhile addition to the literature. It is especially strong in its explanation of the underlying science but perhaps not quite so helpful in enabling the clinician to decide the best course of treatment. This is, perhaps, not entirely surprising, given the lack of consensus surrounding almost every aspect of this common and often debilitating disease.

James English, MD MRCOG, Consultant Gynaecologist¹

^1. Worthing Hospital, West Sussex, UK

Taylor & Francis, 2004
ISBN 9781841843438
Hardback, 240 pages, £130.00

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