Diagnosis is suspected based on typical symptoms but must be confirmed by biopsy, usually via pelvic laparoscopy but sometimes via laparotomy, vaginal examination, sigmoidoscopy, or cystoscopy. Both endometrial glands and stroma must be present to…

Pelvic pain, pelvic mass, alteration of menses, and infertility are typical. Some women with extensive endometriosis are asymptomatic; some with minimal disease have incapacitating pain. Dyspareunia and midline pelvic pain before or during…

The most widely accepted hypothesis is that endometrial cells are transported from the uterine cavity and subsequently become implanted at ectopic sites. Retrograde flow of menstrual tissue through the fallopian tubes could transport…

Endometriosis is common among women of reproductive age, and its prevalence increases to 30-40% among infertile women. Clinical findings vary greatly depending on the number, size, and extent of the lesions and on the…

Proper counseling of patients with endometriosis requires attention to several aspects of the disorder. Of primary importance is the initial operative staging of the disease to obtain adequate information on which to base future decisions…

Treatment options are dictated by the patient’s desire for future fertility, her symptoms, the stage of her disease, and to some extent her age. It must be emphasized that therapy for endometriosis requires operative inspection…

Several classification schemes to assist in describing the anatomic location and severity of endometriosis at operation have been created. Although none is entirely satisfactory, the scoring systems are useful for reporting operative findings and for…

Complications

It is generally agreed that pelvic pain occurs premenstrually in endometriosis patients. Because of this, pain from endometriosis is thought to be due to stimulation from estrogen and progesterone during the menstrual cycle; the…

The gross appearance of endometriosis at operation is usually quite characteristic and, to an experienced surgeon, is sufficient for diagnosis. The smallest (and presumably earliest) implants are red, petechial lesions on the peritoneal surface. With…