Endometriosis symptoms and the limitations of pathology-based classification of severity

Consideration of symptoms reveals serious shortcomings in pathology-based classifications of endometriosis. Premenstrual spotting may be associated with the underlying physiologic or biochemical disturbance. Once the biochemical basis for spotting can be established, noninvasive tests may be developed for diagnosis and assessment. Endometriosis-related infertility is best assessed by its duration. A tenfold difference in fecundity at the start of attempts to conceive attenuates to a twofold difference in fecundity after 5 years of no pregnancy.