The epidemiology of endometriosis is poorly known as the pathophysiology and diagnosis are unclear

• Published in: Best practice & research. Clinical obstetrics & gynaecology Vol. 71; pp. 14 - 26
• Main Authors: Koninckx, Philippe R., Ussia, Anastasia, Adamyan, Leila, Tahlak, Muna, Keckstein, Jörg, wattiez, Arnaud, Martin, Dan C.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.03.2021
• Subjects: Endometriosis; Endometriosis - diagnosis; Endometriosis - epidemiology; Endometrium; Epidemiology; Epigenetics; Female; Genetics; Histology; Humans; Menstruation Disturbances; Ovarian Cysts; Pathogenesis; Pelvis; Epigenetics; Endometriosis; Genetics; Histology; Pathogenesis; Epidemiology
• ISSN: 1521-6934; 1532-1932; 1532-1932
• DOI: 10.1016/j.bpobgyn.2020.08.005

As the diagnosis requires a laparoscopy, we only have data in women with pain and/or infertility. Endometriosis has been considered to be a single disease defined as ‘endometrium like glands and stroma outside the uterus’. However, subtle, typical, cystic ovarian and deep endometriosis lesions should be considered to be different pathologies which occur in all combinations and with different severities. All large datasets, especially those based on hospital discharge records, consider endometriosis to be a single disease without taking into account severity. In particular, the variable prevalence and recognition of subtle lesions is problematic. Reliable surgical data are small series not permitting multivariate analysis. Endometriosis is a hereditary disease. The oxidative stress of heavy menstrual bleeding with retrograde menstruation and an altered pelvic microbiome are probably associated with increasingly severe endometriosis. Whether the prevalence is increasing, or whether endometriosis is associated with fat intake or an increased risk of cardiovascular disease is unclear. •Endometriosis is defined histologically as glands and stroma outside the uterus.•The diagnosis requires a laparoscopy which is performed in symptomatic women only.•‘Endometriosis’ is a misnomer as it refers to several different diseases.•The G-E theory explains all aspects of endometriosis, including pollution, heredity, and infertility.•There is no evidence that prevalence or severity are increasing or that endometriosis is associated with cardiovascular incidents.