Endometriosis, a gynecologic pathology, is defined by the presence of a tissue similar to uterine endometrium, which is located in places other than physiologically appropriate. These endometrial heterotopic islets contain glands and stroma and are functionally capable of responding to exogenous, endogenous, or local hormonal stimuli. Endometriosis affects 8%–10% of women of reproductive age; in 30% of the women, the condition is associated with primary or secondary infertility. In several instances, endometriosis persists as a minimal or mild disease, or it can resolve on its own. Other cases of endometriosis show severe symptomatology that ends when menopause occurs. Endometriosis can, however, reactivate in several postmenopausal women when iatrogenic or endogenous hormones are present. Endometriosis is occasionally accompanied by malignant ovarian tumors, especially endometrioid and clear cell carcinomas. Its pathogenesis is widely debated, and its variable morphology appears to represent a continuum of individual presentations and progressions. Endometriosis has no pathognomonic signs or symptoms; it is therefore difficult to diagnose. Because of its enigmatic etiopathogenesis, there is currently no satisfactory therapy for all patients with endometriosis. Treatments include medications, surgery, or combined therapies; currently, the only procedures that seem to cure endometriosis are hysterectomy and bilateral salpingo-oophorectomy. In this paper, we review the most controversial and enigmatic aspects of this disease. 1. Introduction Endometriosis is a gynecologic pathology that is frequently considered enigmatic; it is defined by the presence of a tissue similar to uterine endometrium that is located in places other than physiologically appropriate (i.e., uterine endometrial cavity), most commonly in the pelvic cavity, including the ovaries, the uterosacral ligaments, and the pouch of Douglas. These endometrial heterotopic islets contain glands and stroma and are functionally capable of responding to exogenous, endogenous, or local hormonal stimuli. Despite its first description as a pathology three centuries ago and recognition as a clinical entity by Sampson since 1918–1920 [1], the issue of the proper characterization of endometriosis as a disease, a clinical entity or a pathology is still a topic of discussion today. However, endometriosis affects 8%–10% of women of reproductive age; in 30% of these women, endometriosis is associated with primary or secondary infertility [2, 3]. The presentation and evolution of the disease are variable; in
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