Endometriosis and its influence on dysmenorrhoea and menstrual disturbances

Abstract Endometriosis is defined as the presence of endometrium-like glands and stroma outside the uterine cavity and myometrium. Adenomyosis, where such tissue is present within the myometrium, is reviewed in Chapter 24. Current opinion regarding the pathogenesis of endometriosis favours the concept of implantation of endometrial tissue shed during menstruation and passed via the Fallopian tubes into the peritoneal cavity, in contrast to the alternative hypothesis of coelomic metaplasia. The retrograde menstruation theory is consistent with the epidemiology of the condition, which is essentially more common in women who have experienced more episodes of menstruation. Interest presently centres on genetic, environmental, or local factors which might render endometrial tissue more likely to adhere to and invade the pelvic peritoneum and deeper tissues.