In some women, more severe forms present as either cystic ovarian or deep infiltrating disease. Cystic ovarian endometriosis always has been recognised as a severe form because of its association with pelvic adhesions, infertility, and pelvic pain. Clinical examination during menstruation can diagnose reliably deep endometriosis, cystic ovarian endometriosis, or cul-de-sac adhesions. This test, preferentially combined with a follicular phase CA-125 assay, should be used to decide whether a preparation for bowel surgery should be given.
Endometriosis is a chronic, progressive disease and may lead to severe destructions of reproductive organs and infertility in advanced stages.
Approximately 30% to 50% of women with this diagnosis also struggle with infertility. Twenty five percent to 50% of women diagnosed with infertility also have endometriosis, but the disease may not be severe enough to be the primary cause of infertility. White women have been reported to be more likely than African American women to have endometriosis. In addition, risk factors for endometriosis include below average body mass index, smoking, and alcohol use.
Endometriosis commonly present with painful menstruation, pelvic pain, pain during intercourse, infertility, and pelvic mass.
The correlation between the symptoms of endometriosis and the severity of disease is poor. Currently available laboratory markers are of limited value. At present, the best marker, serum CA-125, is usually elevated only in advanced stages and therefore not suitable for routine screening. Severity of this disease is difficult to determine from its symptoms. Usually symptoms are expressed according to area of involvement not depth of disease.
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