Endometriosis

Endometriosis is a chronic inflammatory condition in which tissue similar to the lining of the uterus (the endometrium) occurs outside the uterus. The ectopic tissue responds to hormonal cycles, causing bleeding, inflammation, adhesions, and scar formation that can result in pelvic pain, painful periods, and sometimes infertility. Common sites include the ovaries, the peritoneum, the uterosacral ligaments, and other pelvic structures; less commonly it may affect the bowel, bladder, and other organs.

The condition is estimated to affect about 2 to 10 percent of women of reproductive age, with higher rates among those experiencing chronic pelvic pain or infertility. Onset typically occurs in adolescence or early adulthood, and symptoms may vary in intensity over time. The most frequent symptoms are dysmenorrhea, chronic pelvic or lower abdominal pain, deep dyspareunia, and sometimes pain with bowel movements or urination during menses. Some individuals have little or no pain but experience infertility or other symptoms.

Diagnosis relies on clinical history and physical examination, supported by imaging studies such as transvaginal ultrasound or magnetic resonance imaging. Laparoscopy with histopathological confirmation remains the gold standard for diagnosis, particularly when noninvasive tests are inconclusive. Imaging can help identify extensive disease or deep infiltrating endometriosis.

Treatment aims to reduce pain, limit disease progression, and preserve fertility when possible. Medical therapy includes nonsteroidal anti-inflammatory drugs for pain, and hormonal treatments (combined oral contraceptives, progestins, GnRH agonists or antagonists, and in some cases other agents) to suppress estrogen production. Surgical management may involve conservative removal of endometriotic implants and cysts, with the goal of pain relief and improved fertility; hysterectomy is considered only in selected cases after childbearing is complete. Endometriosis is a chronic condition with possible recurrence, though symptoms and quality of life often improve with appropriate treatment.