The aetiology and pathogenesis of endometriosis

It is 130 years since the first description of endometriosis and yet this enigmatic disease still continues to confound gynaecologists. In the last five years there has been evidence which suggests that endometriosis is a much more common finding in the pelvis than previously recognized and this has created conflict over the precise definition of the disease. Currently it is difficult for clinicians to be certain what constitutes endometriosis and what is the clinical and pathological significance of the visual diagnosis of the disease. This article will review the evidence about the pathological significance of the visual diagnosis of endometriosis. It will analyze the aetiological factors that predispose to the disease and evidence concerning its pathogenesis. Finally, it will discuss the evidence that points to a particular epithelium being the origin of endometriosis.