ABSTRACT
The natural history of endometriosis is unknown, and well controlled experiments are difficult to perform because of the need for repeated surgical procedures to assess endometriotic lesions over time. The placebo group of women in placebo-controlled trials provides some evidence of the natural history of the disease. Endometriosis can both deteriorate and improve spontaneously. The symptoms of endometriosis are variable and often unrelated to the extent of the disease. The most frequent complaints among women with endometriosis are dysmenorrhoea, dyspareunia and pelvic pain. The symptoms of endometriosis are similar to those of other common gynaecological conditions or disorders of the gastrointestinal and urogenital systems. The diagnosis of endometriosis should be considered in all women of reproductive age who have cyclical pelvic pain that is worse in the premenstrual and menstrual phases of the cycle. Vaginal examination may reveal tender nodules of the uterosacral ligaments felt through the posterior vaginal fornix.
