title: Endometriosis: a disease that remains enigmatic.
abstract: Endometriosis, a gynecologic pathology, is defined by the presence of a tissue similar to uterine endometrium, which is located in places other than physiologically appropriate. These endometrial heterotopic islets contain glands and stroma and are functionally capable of responding to exogenous, endogenous, or local hormonal stimuli. Endometriosis affects 8%-10% of women of reproductive age; in 30% of the women, the condition is associated with primary or secondary infertility. In several instances, endometriosis persists as a minimal or mild disease, or it can resolve on its own. Other cases of endometriosis show severe symptomatology that ends when menopause occurs. Endometriosis can, however, reactivate in several postmenopausal women when iatrogenic or endogenous hormones are present. Endometriosis is occasionally accompanied by malignant ovarian tumors, especially endometrioid and clear cell carcinomas. Its pathogenesis is widely debated, and its variable morphology appears to represent a continuum of individual presentations and progressions. Endometriosis has no pathognomonic signs or symptoms; it is therefore difficult to diagnose. Because of its enigmatic etiopathogenesis, there is currently no satisfactory therapy for all patients with endometriosis. Treatments include medications, surgery, or combined therapies; currently, the only procedures that seem to cure endometriosis are hysterectomy and bilateral salpingo-oophorectomy. In this paper, we review the most controversial and enigmatic aspects of this disease.
authors: Department of Obstetrics and Gynecology, San Juan University Hospital, 03550 Alicante, Spain ; Department/Division of Gynecology, School of Medicine, Miguel Hernandez University, Campus of San Juan, 03550 Alicante, Spain ; Instituto de Ginecología P.A.A., 03002 Alicante, Spain ; Departamento/Area de Ginecología, Facultad de Medicina de la Universidad "Miguel Hernández," Campus de San Juan, 03550 Alicante, Spain.
authors: Pedro
authors: P
authors: Acién
authors: Irene
authors: I
authors: Velasco
references: Mod Pathol. 2008 May;21(5):591-8
references: 18246050
references: Gynecol Obstet Invest. 1999;47 Suppl 1:47-9; discussion 50
references: 10087428
references: Nat Genet. 2011 Jan;43(1):51-4
references: 21151130
references: Gynecol Endocrinol. 2013 May;29(5):444-7
references: 23347089
references: Histopathology. 1997 Mar;30(3):249-55
references: 9088954
references: Hum Reprod. 2009 Sep;24(9):2385
references: 19625308
references: Curr Opin Obstet Gynecol. 1994 Jun;6(3):231-41
references: 8038409
references: Fertil Steril. 1979 Dec;32(6):633-4
references: 510564
references: Fertil Steril. 1992 Nov;58(5):924-8
references: 1426377
references: Hum Reprod. 2004 Jan;19(1):160-7
references: 14688176
references: Hum Reprod. 2011 Feb;26(2):274-81
references: 21131296
references: Fertil Steril. 2006 Apr;85(4):866-70
references: 16580366
references: Hum Reprod. 2008 Sep;23(9):2017-23
references: 18556683
references: Eur J Obstet Gynecol Reprod Biol. 2005 Oct 1;122(2):213-7
references: 16219522
references: Fertil Steril. 2008 Nov;90(5):1559-70
references: 18993168
references: Gynecol Obstet Invest. 2003;55(2):96-104
references: 12771456
references: J Steroid Biochem Mol Biol. 2005 May;95(1-5):57-62
references: 16024248
references: Fertil Steril. 2005 Aug;84(2):300-4
references: 16084868
references: J Med Genet. 2013 Jan;50(1):43-6
references: 23142796
references: J Minim Invasive Gynecol. 2007 Jan-Feb;14(1):54-8
references: 17218230
references: Obstet Gynecol. 2010 Nov;116(5):1101-9
references: 20966695
references: Gynecol Obstet Invest. 2005;60(4):224-31
references: 16244488
references: Eur J Obstet Gynecol Reprod Biol. 2001 May;96(1):21-34
references: 11311757
references: J Clin Endocrinol Metab. 1996 Jan;81(1):174-9
references: 8550748
references: Am J Obstet Gynecol. 1980 Jun 1;137(3):332-7
references: 7377253
references: Obstet Gynecol. 1987 Mar;69(3 Pt 1):412-5
references: 3822289
references: Reprod Biomed Online. 2010 Jul;21(1):4-5
references: 20627684
references: J Hum Genet. 2010 Dec;55(12):816-21
references: 20844546
references: Am J Obstet Gynecol. 1980 Jun 1;137(3):327-31
references: 7377252
references: J Reprod Med. 1999 Mar;44(3):233-40
references: 10202740
references: Fertil Steril. 1997 Oct;68(4):585-96
references: 9341595
references: Fertil Steril. 1999 Jul;72(1):10-4
references: 10428141
references: Gynecol Obstet Invest. 2011;71(3):170-6
references: 21160141
references: Fertil Steril. 1997 May;67(5):817-21
references: 9130884
references: Fertil Steril. 1997 Nov;68(5):912-9
references: 9389825
references: Hum Reprod. 2012 Mar;27(3):683-94
references: 22252088
references: Eur J Obstet Gynecol Reprod Biol. 2005 Oct 1;122(2):144-50
references: 16157442
references: Int J Gynecol Pathol. 2011 Nov;30(6):553-68
references: 21979592
references: Fertil Steril. 2009 Nov;92(5):1525-31
references: 18930216
references: Fertil Steril. 1987 Mar;47(3):382-4
references: 3556618
references: Fertil Steril. 2011 Sep;96(3):678-684.e1
references: 21762900
references: Reprod Sci. 2011 Jul;18(7):614-22
references: 21266664
references: Reprod Fertil Dev. 2011;23(3):403-16
references: 21426858
references: PLoS One. 2013;8(3):e58257
references: 23472165
references: Acta Obstet Gynecol Scand. 2007 Oct;86(10):1158-64
references: 17851817
references: Fertil Steril. 2007 Jul;88(1):32-8
references: 17336977
references: Hum Reprod. 1995 Dec;10 Suppl 2:91-7
references: 8745306
references: Clin Cancer Res. 2013 Mar 1;19(5):1213-24
references: 23362326
references: Am J Obstet Gynecol. 1986 Jan;154(1):39-43
references: 3946502
references: Fertil Steril. 1995 Nov;64(5):909-16
references: 7589633
references: Semin Reprod Med. 2010 Jan;28(1):59-68
references: 20104429
references: Gynecol Oncol. 2012 Nov;127(2):398-402
references: 22910690
references: Hum Reprod. 2008 Apr;23(4):846-51
references: 18281681
references: Chemosphere. 2009 Feb;74(7):944-9
references: 19027927
references: Indian J Gastroenterol. 2012 Jul;31(4):195-7
references: 22763897
references: Microvasc Res. 2007 Sep-Nov;74(2-3):121-30
references: 17574280
references: Fertil Steril. 2013 Jul;100(1):162-9.e1-2
references: 23579005
references: Ann N Y Acad Sci. 2008 Apr;1127:92-100
references: 18443335
references: Hum Reprod. 2012 May;27(5):1292-9
references: 22422778
references: Gen Comp Endocrinol. 2010 Sep 15;168(3):318-25
references: 20350546
references: Am J Obstet Gynecol. 2013 Oct;209(4):307-16
references: 23500453
references: J Obstet Gynaecol Can. 2011 Aug;33(8):830-837
references: 21846438
references: J Reprod Immunol. 2010 Mar;84(2):199-205
references: 20074813
references: Int J Gynaecol Obstet. 2010 Jan;108(1):16-20
references: 19782981
references: Aust N Z J Obstet Gynaecol. 1992 Nov;32(4):384-5
references: 1337826
references: Arch Gynecol Obstet. 2013 Sep;288(3):569-76
references: 23503974
references: Semin Immunopathol. 2007 Jun;29(2):193-210
references: 17621704
references: Hum Pathol. 1988 Sep;19(9):1080-4
references: 3417292
references: J Clin Endocrinol Metab. 2013 Jan;98(1):281-9
references: 23118427
references: Gynecol Obstet Invest. 1986;22(2):102-7
references: 3770530
references: Reprod Biomed Online. 2010 May;20(5):681-8
references: 20211585
references: Rev Assoc Med Bras (1992). 2011 Jul-Aug;57(4):448-52
references: 21876930
references: Gynecol Endocrinol. 2012 Nov;28(11):903-5
references: 22621645
references: Fertil Steril. 1998 Sep;70(3):425-31
references: 9757870
references: Biol Reprod. 2013 May 16;88(5):122
references: 23575144
references: Obstet Gynecol. 1979 Mar;53(3):318-23
references: 424103
references: Obstet Gynecol. 1953 Sep;2(3):283-9
references: 13087921
references: Gynecol Obstet Invest. 2010;69(3):203-11
references: 20051692
references: Mol Hum Reprod. 2006 Jun;12(6):377-81
references: 16641167
references: Hum Reprod. 2002 Mar;17(3):777-81
references: 11870135
references: Gynecol Oncol. 2000 May;77(2):298-304
references: 10785482
references: Mol Reprod Dev. 2013 Jun;80(6):441-50
references: 23576334
references: Hum Reprod. 2013 Mar;28(3):835-9
references: 23315067
references: Front Biosci (Elite Ed). 2012 Jan 01;4(5):1724-30
references: 22201988
references: Rev Prat. 1999 Feb 1;49(3):258-62
references: 10189793
references: Ann N Y Acad Sci. 2002 Mar;955:11-22; discussion 34-6, 396-406
references: 11949940