Snapshot A 29-year-old nulligravida presents with severe pain with menses and an inability to conceive after 24 months of unprotected intercourse. She reports feeling pain with defecation and intercourse. On pelvic exam, her uterus is found to be retroverted and there is nodularity of the uterosacral ligament on retrovaginal examination. SUmmary Clinical definition a nonmalignant condition where the endometrial glands and stroma are located outside of the uterus Associated conditions chronic pelvic pain endometrioma ("chocolate cyst") endometriosis affecting the ovary subfertility Prognosis natural history of disease endometriosis may self-stabilize without treatment; however, login to view 1 more bullet Epidemiology incidence 7-10% of women in the US demographics only in female most commonly in those 25-29 years of age location ovaries (most common) uterosacral ligaments retrouterine pouch (pouch of Douglas) peritoneum risk factors family history early menarche nulliparity ETIOLOGY Pathophysiology pathobiology ectopic endometrial tissue leads to an estrogen-stimulated inflammatory response Presentation Symptoms dysmenorrhea dyspareunia (painful intercourse) dyschezia (painful defecation) infertility chronic pelvic pain Physical exam nodular thickening of uterosacral ligament a fixed retroverted uterus tender, fixed adnexal masses Imaging Ultrasonography indications first-line imaging modality to assess for endometriosis Studies Laparoscopic visualization with histologic confirmation provides definitive diagnosis of endometriosis classically may see "powder burn" appearance Histology endometrial glandular tissue Differential Adenomyosis Endometritis Ovarian torsion Treatment Observation indicated for patients with asymptomatic endometriosis that is discovered incidentally Medical combined hormonal or progestin-only contraceptives indications login to view 1 more bullet gonadotropin-releasing hormone (GnRH) agonist indications login to view 1 more bullet mechanism login to view 2 more bullets levonorgestrel-releasing intrauterine device (IUD) indications login to view 1 more bullet danazol indications login to view 1 more bullet mechanism login to view 1 more bullet Operative laparoscopic ablation indications login to view 1 more bullet total abdominal hysterectomy with lysis of adhesions indications login to view 1 more bullet Complications Complications infertility