It is for those of you who suffer endometriosis or have friends or relatives who have the diagnosis of this disease. You will therefore know that for many sufferers the path to diagnosis may be long, usually after many general practice and gynaecological consultations, the symptoms being dismissed as simple dysmenorrhoea in a teenager or as a manifestation of unidentified psychological problems.

Usually too there may be a number of poorly monitored and assessed attempts at medical treatment culminating in the use of stronger and stronger analgesics, leading to chronic constipation and fatigue and even addiction.

The problem is that endometrial tissue (lining of the uterus) can grow in the wrong place; usually in the embryological developmental part of the uterus, tube and ovaries very early in the embryonic life in the first few weeks of development two tubes of tissue called the Malarian ducts form at the level of the kidneys. 

They grow down to fuse together in the midline to grow into the upper vagina, cervix, uterus, tubes and ovaries. In some people, for whatever reason, it has been suggested, but not proved that small groups or "rests" of cells are left behind and these have the capacity to develop into endometriotic tissue, under the influence of oestrogen once puberty is reached.

These areas of endometriosis can sometimes be recognised at laparoscopy. Laparoscopy is a procedure that is usually carried out under general anaesthetic, which allows a thorough and detailed inspection of the pelvis using fine fibre optic instruments. Some endometriotic lesions are brown or black and obvious but others are more subtle, looking white or like sago grains or small pearls and these are frequently missed by less experienced observers.

The only sure way of diagnosing endometriosis is to submit the tissue to histological examination, which is to fix and stain the tissue and subject it to minute microscopic examination.

Endometriosis has recently been linked to industrial pollutants such as dioxin, which is an industrial solvent, which has oestrogenic effects. A recent report of an experiment with monkeys developing severe endometriosis sparked off a series of investigations looking at dioxin as a possible cause of endometriosis. This led to fears that dioxin bleached tampons may have been responsible. It is probably not the case, but small quantities of dioxin may be ingested with breast milk and be responsible for some cases. Endometriosis does seem to be more common in areas of high pollution such as Belgium or Hong Kong.

The rationale of treatment needs to be based on a thorough understanding of the disease and sufferers will know the bewildering variety of hormone manipulation available for endometriosis. The effects of treatment are often worse that the symptoms of the disease. These are all based on suppressing ovarian function and with it the cyclical changes in the endometrium, which are part of the female cycle. This suppresses the disease and offers symptomatic relief, but does not tackle the cause.

Surgery, is diagnostic and in many cases may be associated with attempts to ablate the areas of endometriosis, usually by destroying the tissue in any number of different ways but fundamentally heating and destroying the tissue.