Endometriosis

Endometriosis is a chronic oestrogen-dependent gynaecological disease present in approximately 10% of women of reproductive age and up to 30–50% of women with infertility and/or pain. It is defined as the presence of endometrial-like tissue outside the uterus. The pathogenesis remains enigmatic but the most common hypothesis is Sampson’s theory of retrograde menstruation. Over the last decade, the roles of inflammation, angiogenesis, and the immune system have been well documented. Diagnosis of endometriosis is difficult since physical examination, ultrasonography, and magnetic resonance imaging can detect but not exclude the presence of endometriosis. Therefore, the gold standard for diagnosis of endometriosis remains laparoscopic visualization with histological confirmation. Medical treatment options are combined oral contraceptives, progestogens, or gonadotropin-releasing hormone analogues. Surgical management is necessary in patients who want to become pregnant or those who are refractory to medical treatment. These complex surgical procedures, with significant risks and recurrence rates, should be performed by experienced teams only.