Endometriosis is the presence of endometrial tissue at sites outside the uterine cavity. These sites invade other tissues and are spread by local extension, intraperitoneal seeding, and blood vessels. Although it may occur in almost any part of the body, the most common sites are the ovaries, fallopian tubes, the uterosacral and broad ligaments of the uterus, and the anterior and posterior cul-de-sac.

The specific cause is unknown. Theories indicate that immunologic or genetic factors may play a role in the cause and progression of the disease. Other studies suggest that the condition develops from a combination of factors such as retrograde menstruation, migration of endometrial cells during fetal development, or possible spread via the lymphatic system. Prior surgery may also play a role in its cause.

Signs and symptoms may depend on the site where endometrial tissue has settled. Manifestations may include: inflammation, fibrosis, adhesion, tubal occlusion, infertility, dysmenorrhea, pelvic pain, abdominal pain, painful intercourse, spontaneous abortion, backache, urinary difficulty, hematuria, tenesmus, diarrhea, and dyschezia. On examination, the uterus may be displaced and fixed, the ovaries enlarged, and nodules found. Symptoms may be periodic or constant, abrupt or slow in development, and many patients may have no symptoms. Symptoms may subside after menopause.

Tests may include: direct visualization by laparoscopy, biopsy, disease staging, sigmoidoscopy, cystoscopy, ultrasound, barium enema, intravenous (IV) urography, computed tomography (CT) scan, magnetic resonance imaging (MRI), infertility studies, papanicolaou (PAP) smear, and blood tests such as serum markers.

Treatment may depend on the severity of symptoms, desire for fertility, and stage of the disease. Measures may include: hormone replacement therapy (HRT), annual physical and pelvic examinations, pain management, and varying levels of surgery from laparoscopy to total hysterectomy and bilateral salpingoopherectomy.

Pain may be chronic. Life-long hormone therapy may be needed. Certain hormone treatments may produce menopausal symptoms including osteoporosis, and a potential for hyperplasia or malignancy to develop. Recurrence of the disease after medical therapy is common. There may be infertility. There may be an impact on relationships and sexuality that may require counseling and support groups in dealing with the diagnosis.

• None.

• Diagnosis of endometriosis must be substantiated by laparoscopy.
• Natural menopause, primary amenorrhea, and pregnancy and childbirth are not disabilities for rating purposes. Chronic residuals of medical or surgical complications of pregnancy may be disabilities for rating purposes.
• When evaluating any claim involving loss or loss of use of one or more creative organs or anatomical loss of one or both breasts, refer to 38 CFR 3.350 to determine whether the Veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, almost any condition in 38 CFR 4.116 might, under certain circumstances, establish entitlement to special monthly compensation.