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  • Endometriosis is a disorder in which abnormal growths of tissue, histologically resembling the endometrium, are present in locations other than the uterine lining.
  • Although endometriosis can occur very rarely in postmenopausal women, it is found almost exclusively in women of reproductive age.
  • All other manifestations of endometriosis exhibit a wide spectrum of expression.
  • The lesions are usually found on the peritoneal surfaces of the reproductive organs and adjacent structures of the pelvis, but they can occur anywhere in the body (Fig. 56–1).
  • The size of the individual lesions varies from microscopic to large invasive masses that erode into underlying organs and cause extensive adhesion formation.
  • Similarly, women with endometriosis can be completely asymptomatic or may be crippled by pelvic pain and infertility.

Figure 56–1.
Graphic Jump Location

Common sites of endometrial implants (endometriosis).

(Reproduced, with permission, from Way LW (ed). Current Surgical Diagnosis & Treatment. 7th ed. Los Altos, CA: Lange; 1985.)

Endometriosis is a common and important health problem of women. Its exact prevalence is unknown because surgery is required for its diagnosis, but it is estimated to be present in 6–10% of women in the reproductive age group and 25–35% of infertile women. It is seen in 1–2% of women undergoing sterilization or sterilization reversal, in 10% of hysterectomy surgeries, in 16–31% of laparoscopies, and in 53% of adolescents with pelvic pain severe enough to warrant surgical evaluation. Endometriosis is the commonest single gynecologic diagnosis responsible for hospitalization of women aged 15–44, being found in more than 6% of patients.

Cramer DW. Epidemiology of endometriosis. In: Wilson EA (ed): Endometriosis. New York, NY: Alan R. Liss; 1987, p. 5.
Gruppos Italiano per lo Studio Dell'Endometriosi. Prevalence and anatomical distribution of endometriosis in women with selected gynaecological conditions: results from a multicentric Italian study. Hum Reprod 1994;9:1158–1162.  [PubMed: 7962393] .
Olive DL, Schwartz LB. Endometriosis. N Engl J Med 1993; 328:1759–1769.  [PubMed: 8110213] .
Wheeler JM. Epidemiology and prevalence of endometriosis. Infertil Reprod Med Clin North Am 1992;3:545.
Zhao SZ, Wong JM, Davis MB, et al. The cost of inpatient endometriosis treatment: an analysis based on the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Am J Manag Care 1998;4:1127–1134.  [PubMed: 10182888] .


The cause of endometriosis is complex, and the leading theories include retrograde menstruation with transport of endometrial cells, metaplasia of coelomic epithelium, hematogenous or lymphatic spread, and direct transplantation of endometrial cells. A combination of these theories is likely to be responsible.


A theory of retrograde menstruation was proposed during the 1920s. It was postulated that endometriosis occurred because viable fragments of endometrium were shed at the time of menstruation and passed through the fallopian tubes. Once in the pelvic cavity, the tissue became implanted on peritoneal surfaces and grew into endometriotic ...

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