Endometriosis

Endometriosis is a chronic benign disease characterized by the presence and proliferation of endometrial tissue outside the uterine cavity. It affects approximately 6–10% of women. Typically this disease interests women in their reproductive period and affects quality of life. The pathogenesis of endometriosis has not been definitively established; the most accredited theories are retrograde menstruation, blood and lymphatic dissemination, and metaplasia of celomic epithelium and stem cell. Ectopic implants cause a local inflammatory response, accompanied by angiogenesis, adhesions, fibrosis, scarring, neuronal infiltration, and anatomical distortion. The main clinical manifestations are pain and infertility. Currently, endometriosis is classified in clinical practice in superficial or peritoneal, ovarian, and deep endometriosis. Ovary is the most affected organ. Diagnosis is based on clinical history and pelvic examination, supported by radiological investigations including transvaginal ultrasound examination that represents the first imaging approach. Endometriosis requires a lifelong management plan with the goal of maximizing the use of medical treatment and avoiding repeated surgical procedures.