Endometriosis is the presence of endometrium at ectopic sites but is it a disease? The widespread dissemination of endometrium at the time of menstruation is common if not ubiquitous and consequently ectopic endometrium may be observed that is not related to the illness the patient experiences. The relationship between ectopic endometrium and symptoms is most unclear in infertility and consequently there remains a doubt over the appropriateness of some therapies. In severe cases, surgery may play a role but at all stages of the disease, there is a place for assisted conception. In the management of pain, medical therapy is effective in a large proportion of cases. Again, surgery is effective for more deeply seated disease but may be complex. Surgeons should only undertake such surgery if they have specific expertise in this area.
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