Endometriomas are commonly found on the ovaries; fallopian tubes; peritoneal lining; cervix; colon; appendix; vagina; and uterosacral, broad, and round ligaments. In severe cases, adhesions are also found on the bladder, kidney, vulva, arms, legs, lungs, nasal mucosa, spinal column, and sites of previous surgical incisions.2 Two-thirds of women with endometriosis have their ovaries affected; in 30% of women, local lymph nodes are involved; and in 10%-15% of women, the sigmoid colon is affected.2

The immune system is implicated in the development, progression, and symptoms of endometriosis. Both humoral and cell-mediated acquired immune responses are abnormal in women who have this disease. Humoral immune responses are mediated by immunoglobulins or antibodies such as immunoglobulin E (IgE), IgG, IgD, IgA, and IgM. T-lymphocytes mediate the cellular immune responses and have receptors on their membranes, which respond to antigens. Antigens binding to these receptors activate the cells to release a number of cytokines, which cause inflammation and tissue damage. Studies have shown that many of these pro-inflammatory chemical mediators are elevated in the peritonea of women with endometriosis.18 Women with endometriosis have abnormalities in immune functioning cells, such as NK cells, cytotoxic T-cells, B-lymphocytes, macrophages, and monocytes.19 NK cells are responsible for destroying ectopic endometrial cells and are decreased in function and concentration in women with endometriosis.18,20 Studies have also shown that, in affected women, cytotoxic T-cells are decreased and T-suppressor cells are increased. T-suppressor cells reduce the immune response to foreign or host agents; the increase in these cells may reduce the ability of the immune system to identify and remove the ectopic endometrial tissue.21 The macrophage count has been shown to be elevated in the peritoneal fluid in women with endometriosis. Macrophages secrete cellular mediators, such as prostaglandins, fibronectins, integrins,

Symptoms of Endometriosis

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