What is the pathophysiology of endometriosis?

Updated: May 10, 2021
  • Author: G Willy Davila, MD; Chief Editor: Michel E Rivlin, MD  more...
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Ectopic endometrial tissues are most commonly located in the dependent portions of the female pelvis (eg, posterior and anterior cul-de-sac, uterosacral ligaments, tubes, ovaries), but any organ system is potentially at risk (see the following images).

Typical appearance of minimal endometriosis on the Typical appearance of minimal endometriosis on the uterosacral ligaments. Note that some are pigmented (contain hemosiderin), whereas others are not.
Peritoneal erosions and adhesions in the posterior Peritoneal erosions and adhesions in the posterior cul-de-sac. These are typical of more severe endometriosis.

These ectopic foci respond to cyclic hormonal fluctuations in much the same way as intrauterine endometrium, with proliferation, secretory activity, and cyclic sloughing of menstrual material. The products of this metabolic activity, including the concentrated and cyclic release of cytokines and prostaglandins, lead to an altered inflammatory response characterized by neovascularization and fibrosis formation. Some investigators have been able to demonstrate abnormal T- and B-cell function, abnormal complement deposition, and altered interleukin (IL)-6 production in women with this disease.

The associated pain, adhesion formation (see the image below), and anatomic distortion are responsible for the clinical consequences of this disease.

Adhesions due to endometriosis. Adhesions due to endometriosis.

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