Endometriosis occurs when tissue, similar to the lining of the endometrium, grows outside the uterus. The tissue that grows outside the uterus in endometriosis is not the same as endometrial tissue, but they have some features in common.

The tissue can develop anywhere in the body, but it usually affects the pelvic area, including:
the ovaries
the fallopian tubes
tissues that support the uterus
the outside of the uterus
Endometrial tissue can also develop in other areas, including the digestive tract, the lungs, and around the heart.

The body usually expels this type of tissue during menstruation, but the tissue that forms in endometriosis may remain in the body, which can lead to inflammation. As tissue decomposes, scar tissue can form.

Endometriosis can significantly affect a person’s quality of life. In addition to the pain, they may experience pressures relating to:
chronic pain
employment
the cost of medical care
relationships
difficulty maintaining a social life
concerns about not being able to become pregnant
stress, anxiety, and depression
A 2019 study notes that previous research has indicated that, globally, there is an average delay of 7 to 9 years to receive an accurate endometriosis diagnosis.

Causes and risk factors
Experts do not know exactly why endometriosis happens.
Two known risk factors are starting menstruation before the age of 11 years and heavy and prolonged menstruation, but other factors may play a role.

These include:
genetic factors, as it appears to run in families
problems with menstrual flow, resulting in blood and tissue not leaving the body
immune system problems, in which the immune system does not eliminate unwanted tissue
high levels of the hormone estrogen in the body
surgery to the abdominal area, such as a cesarean delivery or hysterectomy
shorter menstrual cycle
alcohol and caffeine consumption
Experts have linked some health conditions with endometriosis. These include:

allergies
asthma
sensitivity to some chemicals
some autoimmune diseases
chronic fatigue syndrome
ovarian cancer and breast cancer
Researchers have also found links between endometriosis and exposure to phthalates, particularly during fetal development. Phthalates are a group of chemicals that help make plastics flexible and durable.

Symptoms:
Symptoms of endometriosis include:
painful cramping, similar to menstrual cramps
long-term lower back and pelvic pain
heavy menstrual bleeding
bowel and urinary problems, including pain, diarrhea, constipation, and bloating
blood in the stool or urine
nausea and vomiting
fatigue
pain during sex
spotting or bleeding between periods
difficulty becoming pregnant
Pain is the most common indication of endometriosis, but the severity of the pain does not always correlate with the extent of the disease.
Pain often disappears after menopause, when the body stops producing estrogen. However, if a person uses hormone therapy during menopause, symptoms may persist.
Pregnancy may provide temporary relief from symptoms.

Diseases with similar symptoms
Endometriosis can be difficult to diagnose. One reason for this is that other medical conditions have similar symptoms. These include:
pelvic inflammatory disease
ovarian cysts
irritable bowel syndrome
Complications of endometriosis include:
infertility
a higher risk of certain types of cancer, such as ovarian cancer
ovarian cysts
inflammation
scar tissue and adhesion development
intestinal and bladder complications
Monitoring symptoms and seeking help may help prevent long-term complications. People should let their doctor know if they experience severe pain or unexpected bleeding.

Diagnosis
It can be difficult for a medical professional to diagnose endometriosis because no specific test can confirm it, and the symptoms may be hard to see. The symptoms can also resemble the symptoms of other conditions.
Possible diagnostic strategies include:
a pelvic exam
imaging tests, such as an ultrasound or MRI scan
laparoscopy, a biopsy
Surgical laparoscopy is the only way to confirm a diagnosis of endometriosis. This is a minimally invasive procedure in which a doctor inserts a laparoscope through a small incision in the pelvic area. This provides images of tissue changes.

Stages
There are different ways of staging endometriosis. In 1996, the American Society of Reproductive Medicine (ASRM) set out four stages to describe the severity of endometriosis, ranging from minimal to severe:
Minimal: Features include isolated implants and no significant adhesions.
Mild: Features include superficial implants on the peritoneum and ovaries, with no significant adhesions.
Moderate: Features include multiple implants, both superficial and deeply invasive. Adhesions may be present about the tubes and ovaries.
Severe: Features include Multiple superficial and deep implants and large ovarian endometriomas. Also, there are dense, filmy adhesions in most cases.
The stages of endometriosis are not specifically linked to levels of pain, the impact on mental health, and other factors.
Research from 2022 found that severe endometriosis negatively affects developing egg cell quality, ovarian response, and embryos. However, the researchers found no difference in fertilization rate between the different endometriosis stages.
There is controversy regarding the stages. Some experts say they do not help doctors decide which treatment to offer, as they do not adequately reflect how the disease affects an individual.

Reference:
https://www.cdc.gov/hiv-data/nhss/hiv-diagnoses-deaths-prevalence.html
https://www.webmd.com/hiv-aids/hiv-aids-difference
https://www.ncbi.nlm.nih.gov/books/NBK534860/

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