True complications of endometriosis are few. Implants over the bowel or ureters may cause obstruction and silent impairment of renal function. The erosive nature of the lesions in advanced aggressive disease can cause a myriad of symptoms, depending on the tissue damaged. Endometriomas can cause ovarian torsion or can rupture and spill their irritating contents into the peritoneal cavity, resulting in a chemical peritonitis. Excision of endometriosis causing catamenial seizures or pneumothorax may be necessary.
The varied presentations of endometriosis mandate that it be considered in the differential diagnosis of virtually all pelvic disease. In particular, the pain, infertility, and adhesions associated with endometriosis must be distinguished from similar symptoms accompanying pelvic inflammatory disease and pelvic tumors.
Usually this will require operative evaluation. A patient with a persistent adnexal mass greater than 5 cm should never be presumed to have an endometrioma even if endometriosis has been diagnosed previously. Such masses require surgical diagnosis.
Prevention of endometriosis is not currently possible. Traditionally, women with relatives affected by endometriosis - or in whom the diagnosis has recently been made - are advised not to postpone childbearing. The merits of this advice have not been proved. A more thorough understanding of the pathophysiology of endometriosis is required before preventative strategies can be devised.