Last updated: September 29, 2022

Summarytoggle arrow icon

Endometriosis is a common, benign, and chronic disease in women of reproductive age that is characterized by the occurrence of endometrial tissue outside the uterus. The etiology of endometriosis is not yet fully established; however, retrograde menstruation is one of several factors involved. Symptoms include dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. Treatment is based on the individual disease manifestation and may either involve the administration of pain relievers and hormonal therapy or surgical removal of endometriotic tissue. Endometriosis tends to recur, but symptoms and disease spread improve after pregnancy in many cases, as well as in menopause.

Epidemiologytoggle arrow icon

  • Age of onset: 20–40 years
  • Incidence: 2–10% of all women
  • Ethnicity: In the US, endometriosis is more common in white and Asian women than in black and Hispanic women.

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

Pathophysiologytoggle arrow icon

Clinical featurestoggle arrow icon

Clinical features of endometriosis
Location of endometriotic lesions Clinical features
Uterus (common)
  • Uterosacral tenderness and/or nodularity [3]
Ovaries (common)
Urinary tract [4]
Abdominal wall (rare)
  • Painful, palpable abdominal mass
Thorax (rare)

Endometriosis is often asymptomatic and may be an incidental finding during surgery for other conditions.

Diagnosticstoggle arrow icon

Normally the severity of the findings does not correlate with the severity of symptoms.

Pathologytoggle arrow icon

Macroscopic findings

  • Endometrium: endometrial implants that present as yellow-brown (sometimes reddish-blue) blebs, islands, or pinpoint spots
  • Ovaries
    • Gunshot lesions or powder-burn lesions
      • Black, yellow-brown, or bluish nodules or cystic structures
      • Seen on the serosal surfaces of the ovaries and peritoneum
    • Ovarian endometriomas or chocolate cysts; : cyst-like structures that contain blood, fluid, and menstrual debris
  • Fallopian tubes: salpingitis isthmica nodosa
    • Nodular tube changes, resulting in:

Microscopic findings

Differential diagnosestoggle arrow icon

For more information, see “Differential diagnosis of dysmenorrhea and menorrhagia.


The differential diagnoses listed here are not exhaustive.

Treatmenttoggle arrow icon

Asymptomatic endometriosis [7]

Symptomatic endometriosis

Pharmacological therapy

Surgical therapy

Complicationstoggle arrow icon

We list the most important complications. The selection is not exhaustive.

Referencestoggle arrow icon

  1. Falcone T, Luc J. Practice Bulletin No. 114: Management of Endometriosis. Obstetrics & Gynecology. 2010; 116 (1): p.223-236.doi: 10.1097/aog.0b013e3181e8b073 . | Open in Read by QxMD
  2. Bulletti C, Coccia ME, Battistoni S, Borini A. Endometriosis and infertility.. J Assist Reprod Genet. 2010; 27 (8): p.441-7.doi: 10.1007/s10815-010-9436-1 . | Open in Read by QxMD
  3. Matorras R, Rodríguez F, Pijoan JI, et al. Are there any clinical signs and symptoms that are related to endometriosis in infertile women?. Am J Obstet Gynecol. 1996; 174 (2): p.620-623.doi: 10.1016/s0002-9378(96)70438-6 . | Open in Read by QxMD
  4. Leonardi M, Espada M, Kho RM, et al. Endometriosis and the Urinary Tract: From Diagnosis to Surgical Treatment. Diagnostics. 2020; 10 (10): p.771.doi: 10.3390/diagnostics10100771 . | Open in Read by QxMD
  5. Levy G, Dehaene A, Laurent N, et al. An update on adenomyosis. Diagnostic and Interventional Imaging. 2013; 94 (1): p.3-25.doi: 10.1016/j.diii.2012.10.012 . | Open in Read by QxMD
  6. Cunningham RK, Horrow MM, Smith RJ, Springer J. Adenomyosis: A Sonographic Diagnosis. RadioGraphics. 2018; 38 (5): p.1576-1589.doi: 10.1148/rg.2018180080 . | Open in Read by QxMD
  7. Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Human Reproduction Open. 2022; 2022 (2).doi: 10.1093/hropen/hoac009 . | Open in Read by QxMD
  8. Quevedo A, Pasic R, Connor A, Chamseddine P. Fertility sparing endometriosis surgery: A review. Gynecology and Obstetrics Clinical Medicine. 2021; 1 (3): p.112-118.doi: 10.1016/j.gocm.2021.07.002 . | Open in Read by QxMD
  9. Saraswat L, Ayansina D, Cooper K, et al. Pregnancy outcomes in women with endometriosis: a national record linkage study. BJOG. 2016; 124 (3): p.444-452.doi: 10.1111/1471-0528.13920 . | Open in Read by QxMD
  10. Berlanda N, Vercellini P, Fedele L. Endometriosis: Clinical Manifestations and Diagnosis of Rectovaginal or Bowel Disease. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: June 18, 2017. Accessed: December 11, 2017.
  11. Wei J-J, William J, Bulun S. Endometriosis and Ovarian Cancer. International Journal of Gynecological Pathology. 2011; 30 (6): p.553-568.doi: 10.1097/pgp.0b013e31821f4b85 . | Open in Read by QxMD
  12. Endometriosis. Updated: August 20, 2016. Accessed: February 17, 2017.
  13. Kumar V, Abbas AK, Aster JC. Robbins & Cotran Pathologic Basis of Disease. Elsevier Saunders ; 2015
  14. Dutta DC, Konar H. DC Dutta's Textbook of Gynecology. Jaypee Brothers Medical Publishers ; 2013

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