Endometriosis: advances in understanding and management.

Endometriosis is a commonly encountered disease, yet most aspects of its pathogenesis, pathophysiology, and treatment remain controversial. Recent advances, however, have increased our understanding of this enigmatic disorder. While many theories persist regarding the pathogenesis of endometriosis, the transplantation hypothesis is by far the most widely accepted. Evidence continues to accumulate in support of this theory as the primary mode of generating ectopic endometrium. In addition, recent work has begun to uncover factors critical to the growth and maintenance of such implants. Advances in pathophysiology have strongly suggested a cause-effect relationship between endometriosis and pelvic pain; conversely, such a relationship between implants and infertility is becoming more tenuous. Treatment trials, in both animals and humans, have begun to clarify the role of specific interventions in combating endometriosis. In addition, as new pathophysiologic mechanisms have been proposed, an intriguing array of new modalities have been developed as treatment options.