[Clinical presentation and natural history of endometriosis]

Natural history of endometriosis is unpredictable. Some recent data show that endometriosis is a progressive disease. Minimal lesions are transient and peritoneal implants are reorganized continuously. So, minimal endometriosis could be considered like a transient statement close to physiology. In favourable statement such as the decreased activation of NK cells, the variable secretions of cytokines, pelvic macrophages and growth factors, the peritoneal implants evoluted like a progressive disease until severe endometriosis. Endometriosis is a frequent cause of pelvic pain with dysmenorrhea, dyspareunia, chronic pelvic pain and infertility. The diagnosis can be suspected by a clinical examination preferentially during menstruation with fixed uterine retroversion peritoneal infiltration, retraction of the rectum and retrovaginal endometriosis, and adnexal cyst.