The pathology and natural history of endometriosis

Endometriosis is a puzzling condition responsible for considerable morbidity. The literature is characterised by a large number of reports but there is surprisingly little agreement on the aetiology and pathophysiology. In particular the relationship between mild endometriosis and subfecundity is uncertain. The aim of the studies described in this thesis was to document the incidence, and symptomatology of endometriosis in the fertile and infertile population, to study the natural history of endometriosis in infertile women and to study folliculogenesis, fertilisation and pathophysiology of periovulatory events in spontaneous menstrual cycles. The relevant literature has been extensively reviewed in the first chapter. By using diagnostic laparoscopy, a large group of fertile and infertile women in the premenopausal age group were studied to document the incidence of endometriosis. Endometriosis was more common in the infertile women. Prolonged usage of combined oral contraceptive pill might have a protective effect against the development of endometriosis. A questionnaire based study of menstrual symptomatology concluded that deep dyspareunia was equally frequent among women harbouring pelvic pathology whether ... (continues)