• Presence of endometrial glands and stroma outside the of the normal location.
  • Cells from the lining of the uterus (endometrium) appear and flourish outside the uterine cavity
  • Most commonly found on the pelvic peritoneum but may also be found on the ovaries, rectovaginal septum, ureter, and rarely in the bladder, pericardium, gluteal muscles, abdominal scar and pleura



  • Most women who are diagnosed with endometriosis are aged between 25 to 35 years (reproductive-aged).
  • More common in Caucasian women than in African American or Asian women.
  • Tends to occur most commonly in taller, thin women with a low body mass index (BMI).




  • The endometrium is the inner layer of uterine tissue that is shed during menstruation.
  • The endometrium is at its thinnest immediately following menstruation and thickens during the first two weeks of the menstrual cycle.
  • Once the release of the egg (ovulation) has occurred, the endometrial tissue becomes rich in glands.
  • The whole process prepares the uterus for the attachment of a fertilized egg.
  • If implantation does not occur, the endometrial layer is shed, and bleeding, known as menstruation
  • Endometriosis occurs when growth of this endometrial tissue develops outside the uterus. This growth usually occurs within the pelvic region on the ovaries and other pelvic structures




  • Stage I (Minimal)

–     Findings restricted to only superficial lesions and possibly a few filmy adhesions

  • Stage II (Mild)

–     In addition, some deep lesions are present in the cul-de-sac

  • Stage III (Moderate)

–     As above, plus presence of endometriomas on the ovary and more adhesions.

  • Stage IV (Severe)

–     As above, plus large endometriomas, extensive adhesions.




  • Symptoms of endometriosis-related pain may include:

–     dysmenorrhea – painful, sometimes disabling cramps during menses; pain may get worse over time (progressive pain), also lower back pains linked to the pelvis

–     chronic pelvic pain – typically accompanied by lower back pain or abdominal pain

–     dyspareunia – painful sex

–     dysuria – urinary urgency, frequency, and sometimes painful urination




i) Medical treatments

–     Progesterone or Progestins:

  • Progesterone counteracts estrogen and inhibits the growth of the endometrium.

–     Oral contraceptives

  • Reduce the menstrual pain associated with endometriosis. They may function by reducing or eliminating menstrual flow and providing estrogen support.

–     Danazol (Danocrine) and gestrinone

  • Both agents inhibit the growth of endometriosis but their use remains limited as they may cause hirsutism(excessive hairiness on women) and voice changes.

ii) Surgical Treatments

  • Procedures are classified as

–     Conservative  when reproductive organs are retained

  • Consists of the excision (called cystectomy) of the endometrium adhesions, resection of endometriomas, and restoration of normal pelvic anatomy as much as is possible.

–     Semi-conservative when ovarian function is allowed to continue

  • preserves a healthy appearing ovary, and yet, it also increases the risk of recurrence.

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