Endometriosis is a common disorder, yet it is among the mostenigmatic of gynecologic diseases. The literature on endometriosisis extensive, though often contradictory or inadequate, andreflects our frequent inability to decipher even the most fundamentalaspects of common diseases. Recent studies have produced newinsights into this complex disorder, however.
In this review we shall critically evaluate what we know --and do not know -- about endometriosis. Established facts willbe separated from unsupported impressions, and areas of controversywill be highlighted.
Definition
Endometriosis is classically defined as the presence of endometrialglands and stroma outside the uterine . . . [Full Text of this Article]
Pathogenesis
Prevalence and Epidemiologic Factors
Clinical Presentation
Diagnosis
Pathological Features
Pathophysiology
Pain
Infertility
Classification
Treatment
Future Directions
Source Information
From the Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Yale University School of Medicine, 333 Cedar St., New Haven, CT 06510, where reprint requests should be addressed to Dr. Schwartz.
Guo, S.-W., Simsa, P., Kyama, C. M., Mihalyi, A., Fulop, V., Othman, E.-E. R., D'Hooghe, T. M.
(2009). Reassessing the evidence for the link between dioxin and endometriosis: from molecular biology to clinical epidemiology. Mol Hum Reprod
15: 609-624
[Abstract][Full Text]
Steinkeler, J. A., Woodfield, C. A., Lazarus, E., Hillstrom, M. M.
(2009). Female Infertility: A Systematic Approach to Radiologic Imaging and Diagnosis. RadioGraphics
29: 1353-1370
[Abstract][Full Text]
Tsuno, A., Nasu, K., Yuge, A., Matsumoto, H., Nishida, M., Narahara, H.
(2009). Decidualization Attenuates the Contractility of Eutopic and Ectopic Endometrial Stromal Cells: Implications for Hormone Therapy of Endometriosis. J. Clin. Endocrinol. Metab.
94: 2516-2523
[Abstract][Full Text]
Yetkin, G., Uludag, M., Citgez, B., Polat, N.
(2009). Endometriosis of the appendix presenting as acute appendicitis. BMJ Case Reports
2009: bcr0420091820-bcr0420091820
[Abstract][Full Text]
Guo, S.-W., Hummelshoj, L., Olive, D. L., Bulun, S. E., D'Hooghe, T. M., Evers, J. L.H.
(2009). A call for more transparency of registered clinical trials on endometriosis. Hum Reprod
24: 1247-1254
[Abstract][Full Text]
Choudhary, S., Fasih, N., Papadatos, D., Surabhi, V. R.
(2009). Unusual Imaging Appearances of Endometriosis. Am. J. Roentgenol.
192: 1632-1644
[Abstract][Full Text]
Tran, L. V. P., Tokushige, N., Berbic, M., Markham, R., Fraser, I. S.
(2009). Macrophages and nerve fibres in peritoneal endometriosis. Hum Reprod
24: 835-841
[Abstract][Full Text]
Levy, A. D., Shaw, J. C., Sobin, L. H.
(2009). From the Archives of the AFIP@;DELIM@;Continuing Medical Education: Secondary Tumors and Tumorlike Lesions of the Peritoneal Cavity: Imaging Features with Pathologic Correlation1. RadioGraphics
29: 347-373
[Abstract][Full Text]
Wang, C., Mavrogianis, P. A., Fazleabas, A. T.
(2009). Endometriosis Is Associated with Progesterone Resistance in the Baboon (Papio anubis) Oviduct: Evidence Based on the Localization of Oviductal Glycoprotein 1 (OVGP1). Biol. Reprod.
80: 272-278
[Abstract][Full Text]
Bulun, S. E.
(2009). Endometriosis. NEJM
360: 268-279
[Full Text]
Sahn, S. A.
(2009). Pleural Pearls. ACCP Pulmonary Med Brd Rev
25: 547-562
[Full Text]
Fujii, E. Y., Nakayama, M., Nakagawa, A.
(2008). Concentrations of Receptor for Advanced Glycation End Products, VEGF and CML in Plasma, Follicular Fluid, and Peritoneal Fluid in Women With and Without Endometriosis. Reproductive Sciences
15: 1066-1074
[Abstract]
Takeuchi, M., Matsuzaki, K., Nishitani, H.
(2008). Susceptibility-Weighted MRI of Endometrioma: Preliminary Results. Am. J. Roentgenol.
191: 1366-1370
[Abstract][Full Text]
Langseth, H, Hankinson, S E, Siemiatycki, J, Weiderpass, E
(2008). Perineal use of talc and risk of ovarian cancer. J. Epidemiol. Community Health
62: 358-360
[Abstract][Full Text]
Faccioli, N., Manfredi, R., Mainardi, P., Chiara, E. D., Spoto, E., Minelli, L., Mucelli, R. P.
(2008). Barium Enema Evaluation of Colonic Involvement in Endometriosis. Am. J. Roentgenol.
190: 1050-1054
[Abstract][Full Text]
Dassen, H., Punyadeera, C., Kamps, R., Delvoux, B., Van Langendonckt, A., Donnez, J., Husen, B., Thole, H., Dunselman, G., Groothuis, P.
(2007). Estrogen metabolizing enzymes in endometrium and endometriosis. Hum Reprod
22: 3148-3158
[Abstract][Full Text]
Siristatidis, C., Bhattacharya, S.
(2007). Unexplained infertility: does it really exist? Does it matter?. Hum Reprod
22: 2084-2087
[Abstract][Full Text]
Nasu, K., Nishida, M., Ueda, T., Yuge, A., Takai, N., Narahara, H.
(2007). Application of the nuclear factor-{kappa}B inhibitor BAY 11-7085 for the treatment of endometriosis: an in vitro study. Am. J. Physiol. Endocrinol. Metab.
293: E16-E23
[Abstract][Full Text]
Bobbio, A., Carbognani, P., Ampollini, L., Rusca, M.
(2007). Diaphragmatic Laceration, Partial Liver Herniation and Catamenial Pneumothorax. Asian Cardiovasc. Thorac. Ann.
15: 249-251
[Abstract][Full Text]
Yuge, A., Nasu, K., Matsumoto, H., Nishida, M., Narahara, H.
(2007). Collagen gel contractility is enhanced in human endometriotic stromal cells: a possible mechanism underlying the pathogenesis of endometriosis-associated fibrosis. Hum Reprod
22: 938-944
[Abstract][Full Text]
Lawson, C, Al-Akoum, M, Maheux, R, Akoum, A
(2007). Increased expression of interleukin-1 receptor type 1 in active endometriotic lesions. Reproduction
133: 265-274
[Abstract][Full Text]
Horcajadas, J.A., Pellicer, A., Simon, C.
(2007). Wide genomic analysis of human endometrial receptivity: new times, new opportunities. Hum Reprod Update
13: 77-86
[Abstract][Full Text]
Nishida, M., Nasu, K., Ueda, T., Yuge, A., Takai, N., Narahara, H.
(2006). beta-Hydroxyisovalerylshikonin induces apoptosis and G0/G1 cell-cycle arrest of endometriotic stromal cells: a preliminary in vitro study. Hum Reprod
21: 2850-2856
[Abstract][Full Text]
Del Frate, C., Girometti, R., Pittino, M., Del Frate, G., Bazzocchi, M., Zuiani, C.
(2006). Deep Retroperitoneal Pelvic Endometriosis: MR Imaging Appearance with Laparoscopic Correlation. RadioGraphics
26: 1705-1718
[Abstract][Full Text]
Jones, G., Jenkinson, C., Taylor, N., Mills, A., Kennedy, S.
(2006). Measuring quality of life in women with endometriosis: tests of data quality, score reliability, response rate and scaling assumptions of the Endometriosis Health Profile Questionnaire. Hum Reprod
21: 2686-2693
[Abstract][Full Text]
Santhyadka, G., Chavko, R., Ogirala, R.
(2006). THORACIC ENDOMETRIOSIS: A CASE REPORT. Chest Meeting
130: 319S-319S
[Abstract]
Gleicher, N., Barad, D.
(2006). Unexplained infertility: Does it really exist?. Hum Reprod
21: 1951-1955
[Abstract][Full Text]
Alifano, M., Trisolini, R., Cancellieri, A., Regnard, J. F.
(2006). Thoracic Endometriosis: Current Knowledge. Ann. Thorac. Surg.
81: 761-769
[Abstract][Full Text]
Wu, Y., Kajdacsy-Balla, A., Strawn, E., Basir, Z., Halverson, G., Jailwala, P., Wang, Y., Wang, X., Ghosh, S., Guo, S.-W.
(2006). Transcriptional Characterizations of Differences between Eutopic and Ectopic Endometrium. Endocrinology
147: 232-246
[Abstract][Full Text]
Nasu, K., Nishida, M., Ueda, T., Takai, N., Bing, S., Narahara, H., Miyakawa, I.
(2005). Bufalin induces apoptosis and the G0/G1 cell cycle arrest of endometriotic stromal cells: a promising agent for the treatment of endometriosis. Mol Hum Reprod
11: 817-823
[Abstract][Full Text]
Guo, S.-W.
(2005). Glutathione S-transferases M1/T1 gene polymorphisms and endometriosis: a meta-analysis of genetic association studies. Mol Hum Reprod
11: 729-743
[Abstract][Full Text]
Bhanoori, M., Babu, K. A., Deenadayal, M., Kennedy, S., Shivaji, S.
(2005). The Interleukin-6 -174G/C Promoter Polymorphism Is Not Associated With Endometriosis in South Indian Women. Reproductive Sciences
12: 365-369
[Abstract]
Bhanoori, M., Arvind Babu, K., Pavankumar Reddy, N.G., Lakshmi Rao, K., Zondervan, K., Deenadayal, M., Kennedy, S., Shivaji, S.
(2005). The vascular endothelial growth factor (VEGF) +405G>C 5'-untranslated region polymorphism and increased risk of endometriosis in South Indian women: a case control study. Hum Reprod
20: 1844-1849
[Abstract][Full Text]
Muto, M. G., O'Neill, M. J., Oliva, E.
(2005). Case 18-2005 - A 45-Year-Old Woman with a Painful Mass in the Abdomen. NEJM
352: 2535-2542
[Full Text]
Wolfler, M.M., Nagele, F., Kolbus, A., Seidl, S., Schneider, B., Huber, J.C., Tschugguel, W.
(2005). A predictive model for endometriosis. Hum Reprod
20: 1702-1708
[Abstract][Full Text]
Kataoka, M. L., Togashi, K., Yamaoka, T., Koyama, T., Ueda, H., Kobayashi, H., Rahman, M., Higuchi, T., Fujii, S.
(2005). Posterior Cul-de-Sac Obliteration Associated with Endometriosis: MR Imaging Evaluation. Radiology
234: 815-823
[Abstract][Full Text]
Wu, M.-H., Wang, C.-A., Lin, C.-C., Chen, L.-C., Chang, W.-C., Tsai, S.-J.
(2005). Distinct Regulation of Cyclooxygenase-2 by Interleukin-1{beta} in Normal and Endometriotic Stromal Cells. J. Clin. Endocrinol. Metab.
90: 286-295
[Abstract][Full Text]
Coeman, V, Sciot, R, Van Breuseghem, I
(2005). Rectus abdominis endometriosis: a report of two cases. Br. J. Radiol.
78: 68-71
[Abstract][Full Text]
Nishida, M., Nasu, K., Ueda, T., Fukuda, J., Takai, N., Miyakawa, I.
(2005). Endometriotic cells are resistant to interferon-{gamma}-induced cell growth inhibition and apoptosis: a possible mechanism involved in the pathogenesis of endometriosis. Mol Hum Reprod
11: 29-34
[Abstract][Full Text]
Asghar, T., Yoshida, S., Kennedy, S., Negoro, K., Zhuo, W., Hamana, S., Motoyama, S., Nakago, S., Barlow, D., Maruo, T.
(2004). The tumor necrosis factor-{alpha} promoter -1031C polymorphism is associated with decreased risk of endometriosis in a Japanese population. Hum Reprod
19: 2509-2514
[Abstract][Full Text]
Matsuzaki, S., Canis, M., Vaurs-Barriere, C., Pouly, J.L., Boespflug-Tanguy, O., Penault-Llorca, F., Dechelotte, P., Dastugue, B., Okamura, K., Mage, G.
(2004). DNA microarray analysis of gene expression profiles in deep endometriosis using laser capture microdissection. Mol Hum Reprod
10: 719-728
[Abstract][Full Text]
Parazzini, F., Chiaffarino, F., Surace, M., Chatenoud, L., Cipriani, S., Chiantera, V., Benzi, G., Fedele, L.
(2004). Selected food intake and risk of endometriosis. Hum Reprod
19: 1755-1759
[Abstract][Full Text]
Wu, R., Van der Hoek, K. H., Ryan, N. K., Norman, R. J., Robker, R. L.
(2004). Macrophage contributions to ovarian function. Hum Reprod Update
10: 119-133
[Abstract][Full Text]
Akande, V. A., Hunt, L. P., Cahill, D. J., Jenkins, J. M.
(2004). Differences in time to natural conception between women with unexplained infertility and infertile women with minor endometriosis. Hum Reprod
19: 96-103
[Abstract][Full Text]
Francica, G., Giardiello, C., Angelone, G., Cristiano, S., Finelli, R., Tramontano, G.
(2003). Abdominal Wall Endometriomas Near Cesarean Delivery Scars: Sonographic and Color Doppler Findings in a Series of 12 Patients. J Ultrasound Med
22: 1041-1047
[Abstract][Full Text]
Alifano, M., Roth, T., Broet, S. C., Schussler, O., Magdeleinat, P., Regnard, J.-F.
(2003). Catamenial Pneumothorax: A Prospective Study. Chest
124: 1004-1008
[Abstract][Full Text]
Darai, E., Detchev, R., Hugol, D., Quang, N. T.
(2003). Serum and cyst fluid levels of interleukin (IL) -6, IL-8 and tumour necrosis factor-alpha in women with endometriomas and benign and malignant cystic ovarian tumours. Hum Reprod
18: 1681-1685
[Abstract][Full Text]
Cobellis, L., Latini, G., Felice, C.D., Razzi, S., Paris, I., Ruggieri, F., Mazzeo, P., Petraglia, F.
(2003). High plasma concentrations of di-(2-ethylhexyl)-phthalate in women with endometriosis. Hum Reprod
18: 1512-1515
[Abstract][Full Text]
Mihalich, A., Reina, M., Mangioni, S., Ponti, E., Alberti, L., Vigano, P., Vignali, M., Di Blasio, A. M.
(2003). Different Basic Fibroblast Growth Factor and Fibroblast Growth Factor-Antisense Expression in Eutopic Endometrial Stromal Cells Derived from Women with and without Endometriosis. J. Clin. Endocrinol. Metab.
88: 2853-2859
[Abstract][Full Text]
Koga, K., Osuga, Y., Yano, T., Momoeda, M., Yoshino, O., Hirota, Y., Kugu, K., Nishii, O., Tsutsumi, O., Taketani, Y.
(2003). Characteristic images of deeply infiltrating rectosigmoid endometriosis on transvaginal and transrectal ultrasonography. Hum Reprod
18: 1328-1333
[Abstract][Full Text]
Ishii, K., Takakuwa, K., Kashima, K., Tamura, M., Tanaka, K.
(2003). Associations between patients with endometriosis and HLA class II; the analysis of HLA-DQB1 and HLA-DPB1 genotypes. Hum Reprod
18: 985-989
[Abstract][Full Text]
Wieser, F., Hefler, L., Tempfer, C., Vlach, U., Schneeberger, C., Huber, J., Wenzl, R.
(2003). Polymorphism of the Interleukin-1{beta} Gene and Endometriosis. Reproductive Sciences
10: 172-175
[Abstract]
Tanahatoe, S. J., Hompes, P. G.A., Lambalk, C. B.
(2003). Investigation of the infertile couple: Should diagnostic laparoscopy be performed in the infertility work up programme in patients undergoing intrauterine insemination?. Hum Reprod
18: 8-11
[Abstract][Full Text]
Wieser, F., Fabjani, G., Tempfer, C., Schneeberger, C., Sator, M., Huber, J., Wenzl, R.
(2003). Analysis of an Interleukin-6 Gene Promoter Polymorphism in Women With Endometriosis Polymorphism in Women With Endometriosis By Pyrosequencing. Reproductive Sciences
10: 32-36
[Abstract]
Tazuke, S.I., Milki, A.A.
(2002). Endometrioma of uterine serosa in a woman with mosaic Turner's syndrome receiving hormone replacement therapy: Case report. Hum Reprod
17: 2977-2980
[Abstract][Full Text]
Wieser, F., Fabjani, G., Tempfer, C., Schneeberger, C., Zeillinger, R., Huber, J. C., Wenzl, R.
(2002). Tumor Necrosis Factor-{alpha} Promotor Polymorphisms and Endometriosis. Reproductive Sciences
9: 313-318
[Abstract]
Gurates, B., Sebastian, S., Yang, S., Zhou, J., Tamura, M., Fang, Z., Suzuki, T., Sasano, H., Bulun, S. E.
(2002). WT1 and DAX-1 Inhibit Aromatase P450 Expression in Human Endometrial and Endometriotic Stromal Cells. J. Clin. Endocrinol. Metab.
87: 4369-4377
[Abstract][Full Text]
Bennett, G. L., Slywotzky, C. M., Giovanniello, G.
(2002). Gynecologic Causes of Acute Pelvic Pain: Spectrum of CT Findings. RadioGraphics
22: 785-801
[Abstract][Full Text]
Cunha-Filho, J.S., Gross, J.L., Lemos, N.A., Dias, E.C., Vettori, D., Souza, C.A., Passos, E.P.
(2002). Prolactin and growth hormone secretion after thyrotrophin-releasing hormone infusion and dopaminergic (DA2) blockade in infertile patients with minimal/mild endometriosis. Hum Reprod
17: 960-965
[Abstract][Full Text]
Stefansson, H., Geirsson, R.T., Steinthorsdottir, V., Jonsson, H., Manolescu, A., Kong, A., Ingadottir, G., Gulcher, J., Stefansson, K.
(2002). Genetic factors contribute to the risk of developing endometriosis. Hum Reprod
17: 555-559
[Abstract][Full Text]
Ishii, K., Takakuwa, K., Mitsui, T., Tanaka, K.
(2002). Studies on the human leukocyte antigen-DR in patients with endometriosis: genotyping of HLA-DRB1 alleles. Hum Reprod
17: 560-563
[Abstract][Full Text]
Szamatowicz, J., Laudanski, P., Tomaszewska, I.
(2002). Matrix metalloproteinase-9 and tissue inhibitor of matrix metalloproteinase-1: a possible role in the pathogenesis of endometriosis. Hum Reprod
17: 284-288
[Abstract][Full Text]
Tsai, S.-J., Wu, M.-H., Lin, C.-C., Sun, H. S., Chen, H.-M.
(2001). Regulation of Steroidogenic Acute Regulatory Protein Expression and Progesterone Production in Endometriotic Stromal Cells. J. Clin. Endocrinol. Metab.
86: 5765-5773
[Abstract][Full Text]
Pauwels, A., Schepens, P.J.C., D'Hooghe, T., Delbeke, L., Dhont, M., Brouwer, A., Weyler, J.
(2001). The risk of endometriosis and exposure to dioxins and polychlorinated biphenyls: a case-control study of infertile women. Hum Reprod
16: 2050-2055
[Abstract][Full Text]
Ramachandran, S., Song, M., Murphy, A. A., Parthasarathy, S.
(2001). Expression of Scavenger Receptor Class B1 in Endometrium and Endometriosis. J. Clin. Endocrinol. Metab.
86: 3924-3928
[Abstract][Full Text]
Bofinger, D. P., Feng, L., Chi, L.-H., Love, J., Stephen, F. D., Sutter, T. R., Osteen, K. G., Costich, T. G., Batt, R. E., Koury, S. T., Olson, J. R.
(2001). Effect of TCDD Exposure on CYP1A1 and CYP1B1 Expression in Explant Cultures of Human Endometrium. Toxicol Sci
62: 299-314
[Abstract][Full Text]
Gagnon, R. F., Arsenault, D., Pichette, V., Tanguay, S.
(2001). Acute renal failure in a young woman with endometriosis. Nephrol Dial Transplant
16: 1499-1502
[Full Text]
Cotroneo, M. S., Lamartiniere, C. A.
(2001). Pharmacologic, but Not Dietary, Genistein Supports Endometriosis in a Rat Model. Toxicol Sci
61: 68-75
[Abstract][Full Text]
Woodward, P. J., Sohaey, R., Mezzetti, T. P. Jr
(2001). Endometriosis: Radiologic-Pathologic Correlation. RadioGraphics
21: 193-216
[Abstract][Full Text]
Gogusev, J., de Joliniere, J.B., Telvi, L., Doussau, M., du Manoir, S., Stojkoski, A., Levardon, M.
(2000). Genetic abnormalities detected by comparative genomic hybridization in a human endometriosis-derived cell line. Mol Hum Reprod
6: 821-827
[Abstract][Full Text]
Westhoff, C., Britton, J. A., Gammon, M. D., Wright, T., Kelsey, J. L.
(2000). Oral Contraceptives and Benign Ovarian Tumors. Am J Epidemiol
152: 242-246
[Abstract][Full Text]
Calhaz-Jorge, C., Costa, A.P., Barata, M., Santos, M.C., Melo, A., Palma-Carlos, M.L.
(2000). Tumour necrosis factor {alpha} concentrations in the peritoneal fluid of infertile women with minimal or mild endometriosis are lower in patients with red lesions only than in patients without red lesions. Hum Reprod
15: 1256-1260
[Abstract][Full Text]
Gogusev, J., de Joliniere, J. B., Telvi, L., Doussau, M., Stojkoski, A., Levradon, M.
(2000). Cellular and Genetic Constitution of Human Endometriosis Tissues. Reproductive Sciences
7: 79-87
[Abstract]
Garcia-Velasco, J.A., Arici, A., Zreik, T., Naftolin, F., Mor, G.
(1999). Macrophage derived growth factors m odulate Fas ligand expression in cultured endometrial stromal cells: a role in endometriosis. Mol Hum Reprod
5: 642-650
[Abstract][Full Text]
Taylor, H. S., Bagot, C., Kardana, A., Olive, D., Arici, A.
(1999). HOX gene expression is altered in the endometrium of women with endometriosis. Hum Reprod
14: 1328-1331
[Abstract][Full Text]
Ricci, M. S., Toscano, D. G., Mattingly, C. J., Toscano, W. A. Jr.
(1999). Estrogen Receptor Reduces CYP1A1 Induction in Cultured Human Endometrial Cells. J. Biol. Chem.
274: 3430-3438
[Abstract][Full Text]
Zeitoun, K., Takayama, K., Michael, M. D., Bulun, S. E.
(1999). Stimulation of Aromatase P450 Promoter (II) Activity in Endometriosis and Its Inhibition in Endometrium Are Regulated by Competitive Binding of Steroidogenic Factor-1 and Chicken Ovalbumin Upstream Promoter Transcription Factor to the Same cis-Acting Element. Mol. Endocrinol.
13: 239-253
[Abstract][Full Text]
Zeitoun, K., Takayama, K., Sasano, H., Suzuki, T., Moghrabi, N., Andersson, S., Johns, A., Meng, L., Putman, M., Carr, B., Bulun, S. E.
(1998). Deficient 17{beta}-Hydroxysteroid Dehydrogenase Type 2 Expression in Endometriosis: Failure to Metabolize 17{beta}-Estradiol. J. Clin. Endocrinol. Metab.
83: 4474-4480
[Abstract][Full Text]
Marcoux, S., Maheux, R., Berube, S., The Canadian Collaborative Group on Endometriosis,
(1997). Laparoscopic Surgery in Infertile Women with Minimal or Mild Endometriosis. NEJM
337: 217-222
[Abstract][Full Text]
Shah, M., Tager, D., Feller, E.
(1995). Intestinal Endometriosis Masquerading as Common Digestive Disorders. Arch Intern Med
155: 977-980
[Abstract]
Villa, M. L., Olive, D. L.
(1994). Endometriosis. NEJM
330: 70-70
[Full Text]
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