Objective: This overview is aimed to summarize the pathogenic theories of endometriosis and to relate them to
the various disease localizations and secondly, to sketch a pathophysiology model for the disease progress, namely the
development of pain syndromes and subfertility.
Materials-Methods: A yield of articles and reviews in Medline using key words in various combinations such as
endometriosis, inflammatory mediators, oxidative stress, pathogenesis, pathophysiology, infertility, immunity, theory,
pain, mullerianosis disease, and peritoneal reaction, has been reviewed and shortlisted on the basis of their reference to a
particular pathogenesis mechanism or relation to pain and infertility.
Results: An attempt to synthesize the collected information in an orderly manner has reinforced the notion of a holistic
approach in the pathogenesis of the disease. “Endometriosis” is a rather collective term encompassing different disease
entities. All mechanisms of pathogenesis may contribute in different combinations according to the disease phenotype.
The same is true for the variety of pathophysiology mechanisms leading to pain syndromes and infertility, the two major
components of the disease expression.
Conclusion: The key issue in management is to recognize the multifactorial aspect of the disease in each case scenario
before planning a therapeutical intervention.