The epidemiology of endometriosis is poorly known since the pathophysiology and the diagnosis are unclear

Abstract Since the diagnosis requires a laparoscopy we only have data in women with pain and/or infertility. Endometriosis has been considered as one disease defined as ‘endometrium like glands and stroma outside the uterus’. However, subtle, typical, cystic ovarian and deep endometriosis lesions should be considered as different pathologies which occur in all combinations and with different severities. All large datasets especially those based on hospital discharge records consider endometriosis as one disease without taking into account severity. Especially the variable prevalence and recognition of subtle lesions is problematic. Reliable surgical data are small series not permitting multivariate analysis. Endometriosis is a hereditary disease. The oxidative stress of heavy menstrual bleeding with retrograde menstruation, and an altered pelvic microbiome are probably associated with more and more severe endometriosis. Whether the prevalence is increasing, or whether endometriosis is associated with fat intake or an increased risk of cardiovascular disease is unclear.