Rise and Rise of Endometriosis-An Enigma.

Endometriosis is considered 'silent disease' but is debilitating that impacts quality of life. It is chronic, benign condition which is oestrogen dependent and has chronic inflammatory component. Endometriosis is associated with menstruation with increased sensitivity to oestrogen receptors and with low progesterone levels. Locally produced prostaglandins from endometriotic lesions leads to pain. There is delay in diagnosis by several years, as symptoms are not specific. This can lead to decline in fertility and quality of life. Imaging techniques and bio markers are not very specific but definitive diagnosis can be with Laparoscopy and histopathology. The first line of therapy will be medical, for relief of pain and fertility. Surgery is advised after failure of medical therapy, for severe degree of disease and deep infiltrating endometriosis (DIE). Assisted reproductive technology (ART) therapy is proposed for improved fertility outcome after surgery. Recurrence is known to occur after therapy.