Thoracic Endometriosis and Catamenial Pneumothorax

Table of Contents

1. Endometriosis Above the Diaphragm
2. The Forms Thoracic Endometriosis Takes
3. Catamenial Means Timed to the Period
4. Who the Series Describe
5. How Often It Is Found Among Women With a Collapsed Lung
6. Proposed Mechanisms
7. How the Diagnosis Is Made
8. What Surgery Finds and Does
9. Hormonal Suppression After Surgery
10. Recurrence Figures Side by Side
11. Fertility Treatment After Catamenial Pneumothorax
12. What Is Not Known
13. Key Research Papers
14. Connections
15. Featured Videos

Endometriosis Above the Diaphragm

Thoracic endometriosis syndrome (TES) is the name used for endometriosis found in the chest. A 2024 review by Nezhat and colleagues describes thoracic endometriosis syndrome as endometriosis found in the lung tissue, the pleura and the diaphragm — the dome-shaped muscle that separates the chest from the abdomen. The tissue is described as endometrium-like: it is not the lining of the womb itself, but it carries glands and supporting tissue (stroma) that look and behave like it.

That behaviour is the key to the condition. A 2014 pathology study from Paris by Legras and colleagues examined the chest tissue of women operated on for a collapsed lung. Every case of thoracic endometriosis in that series was positive for progesterone and/or estrogen receptors, the docking sites for the two main ovarian hormones. In other words, the tissue in the chest responds to the same monthly hormonal signals as the lining of the womb.

The same 2024 review concludes that thoracic endometriosis syndrome “appears to be a marker of severe endometriosis.” A 2025 radiology review by Xiao and colleagues puts the background in numbers: endometriosis affects about 10% of people of reproductive age assigned female at birth, and it only rarely involves the chest and diaphragm.

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The Forms Thoracic Endometriosis Takes

Reviews describe four well-recognized forms, plus less common ones. A 2014 review in the Journal of Thoracic Disease by Visouli and colleagues calls catamenial pneumothorax the most common form, and lists the others:

• Catamenial pneumothorax — a collapsed lung, caused by air entering the space between the lung and the chest wall, around the time of the period.
• Catamenial hemothorax — blood collecting in that same space around the time of the period.
• Catamenial hemopneumothorax — air and blood together.
• Catamenial hemoptysis — coughing up blood around the time of the period, from tissue inside the airways or lung.
• Endometriosis lung nodules — small spots of endometrium-like tissue in the lung, sometimes found on a scan without symptoms.

The 2024 review by Nezhat and colleagues adds that thoracic endometriosis syndrome may cause no symptoms at all, or may show up as chest pain or shoulder pain alone.

The oldest large summary, a 1996 analysis of 110 published cases by Joseph and Sahn, gave the relative frequency of the four main forms:

• Pneumothorax: 80 of 110 (73%).
• Hemothorax: 15 (14%).
• Hemoptysis: 8 (7%).
• Lung nodules: 7 (6%).

A much larger 2024 systematic review by Nikolettos and colleagues, covering 592 published patients from 202 studies between 1950 and March 2024, found catamenial pneumothorax to be the most common presentation at 68.4%.

A rarer complication is a hole in the diaphragm large enough for abdominal organs to pass into the chest. A 2024 surgical series by Bobbio and colleagues described 20 women (median age 36) operated on for an endometriosis-related diaphragmatic hernia over twenty years at one centre. The hernia was found together with an endometriosis-related pneumothorax in 13 of them and while investigating period-timed chest pain in the other seven. Eighteen were on the right side, and the median hernia diameter was 8 cm.

Sudden one-sided chest pain with breathlessness is the typical start of a collapsed lung, and hospitals treat it as urgent whatever the cause; the warning signs and emergency care are described on the Pneumothorax page.

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Catamenial Means Timed to the Period

“Catamenial” comes from the Greek for “monthly” and simply means linked to menstruation. The 2014 review by Visouli and colleagues states that the lung usually collapses less than 72 hours after the period starts. A 2026 imaging review by Lojanica and colleagues describes the window as most commonly within 72 hours before or after the onset of menstruation. The diagnosis is clinical as much as anatomical: the pattern of repeated collapses lining up with the cycle is itself the main clue.

The other striking pattern is the side. Joseph and Sahn found the right side of the chest involved in more than 90% of all forms except nodules. In the 2024 review of 592 patients, lesions were found mainly in the right lung alone (79.9%). In the 2005 Philadelphia series by Marshall and colleagues, every one of eight period-timed pneumothoraces was on the right. The right-sided pattern is one of the observations the diaphragm-based explanations described further down try to account for.

Pain sometimes comes first. In a 2011 study of 156 women operated on for spontaneous pneumothorax, Rousset-Jablonski and colleagues found that over a quarter of the women with catamenial or endometriosis-related pneumothorax had a previous history of recurring chest or shoulder-blade pain during their periods. The authors describe this pain as often preceding the pneumothorax and as highly specific for thoracic endometriosis.

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Who the Series Describe

The published series describe women of reproductive age, most in their thirties.

• Age. In the 1996 analysis of 110 cases, the mean age was 35, with a range of 15 to 54. The peak age for thoracic endometriosis syndrome was 30–34, against 24–29 for pelvic endometriosis; the chest form occurred approximately five years after the pelvic form. The 2024 systematic review gives a median age of 33.8. The 2014 review by Visouli and colleagues gives the most common age as 30–40, and notes cases diagnosed in girls as young as 10.
• Older than women with ordinary pneumothorax. In the 2011 French study, women with catamenial or endometriosis-related pneumothorax had their first collapse at a mean age of 34.0, against 28.7 for women whose pneumothorax had no identified cause. In a 2026 German series of 25 years of surgery, the median age at first diagnosis was 39 in women with catamenial pneumothorax and 32 in the others.
• Pelvic endometriosis. Joseph and Sahn reported a significant association between pelvic endometriosis and the chest form. Pelvic endometriosis was found in 51% of the women with catamenial or endometriosis-related pneumothorax in the 2011 French study, and was reported in 39.5% of the 182 patients pooled in a 2017 systematic review by Bricelj and colleagues. So a sizeable share of women with the chest form have no known pelvic disease when the chest problem appears.
• Infertility and uterine procedures. After adjusting for other factors, the 2011 French study found infertility (odds ratio 4.21) and a history of pelvic surgery involving the uterus or uterine scraping (odds ratio 2.85) to be the strongest predictors of catamenial or endometriosis-related pneumothorax.

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How Often It Is Found Among Women With a Collapsed Lung

Catamenial pneumothorax is often described as rare. Series from surgical centres that look for it carefully report much higher figures among women referred for an operation on a spontaneous pneumothorax (one with no injury behind it). The numbers differ widely, mainly because the centres used different definitions and different ways of asking about the cycle:

• Paris, 2003 (prospective). Alifano and colleagues asked every woman of reproductive age about the timing of her collapses before surgery. Over 18 months, 8 of 32 women referred for surgery had a catamenial pneumothorax — one in four. The authors concluded that it is more frequent than expected.
• Philadelphia, 2005. Marshall and colleagues found that in 8 of 24 women operated on for spontaneous pneumothorax, the collapses were timed with menses, and described catamenial pneumothorax as representing up to one-third of women with spontaneous pneumothorax.
• Paris, 2011. Of 156 premenopausal women referred for surgery, 49 (31.4%) had catamenial and/or endometriosis-related pneumothorax.
• Paris, 2014. Of 229 women of child-bearing age operated on between 2000 and 2011, the pneumothorax was catamenial in 80 (35%) and thoracic endometriosis was confirmed under the microscope in 54 (24%). Sorting every case, 17% were catamenial and endometriosis-related, 6% endometriosis-related but not timed to the period, and 60% had no identified cause.
• Heidelberg, 2026. Of 4,581 pneumothoraces operated on between 2000 and 2025, 1,253 (27.4%) were in women. Among 211 women with spontaneous pneumothorax and no structural lung disease, catamenial pneumothorax was identified in 15 episodes in 14 patients (7.1%).

The Heidelberg authors explain their lower figure themselves: a link with the period was documented in 57.1% of their catamenial cases, while in 35.7% no one had asked. They conclude that catamenial pneumothorax is likely underdiagnosed in surgical series of women with spontaneous pneumothorax, and that the main limitation is incomplete history-taking rather than a lack of findings at operation.

All of these figures come from women sent to a surgical centre, who tend to have repeated or difficult collapses. They do not tell how often thoracic endometriosis lies behind a collapsed lung in women in general.

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Proposed Mechanisms

No single explanation has been proven, and the papers present their explanations as hypotheses. The ones that appear in the studies read for this page are:

• Movement through the diaphragm (proposed). Joseph and Sahn considered the most plausible explanation to be peritoneal-pleural movement of endometrial tissue through defects in the diaphragm. In this picture, endometrial tissue in the abdominal cavity reaches the diaphragm and passes into the chest through small holes in it. The right-sided pattern and the diaphragm holes found at surgery are consistent with this idea.
• Spread through pelvic veins (proposed). The same 1996 analysis also named microembolization — tiny fragments of tissue travelling through the pelvic veins to the lungs. This could explain lesions inside the lung, such as those behind coughing up blood or nodules, which a route through the diaphragm explains less easily.
• Diaphragm defects as the central lesion (proposed). In the 2003 prospective study, every woman with catamenial pneumothorax had diaphragm abnormalities at surgery, and the authors concluded that these “seem to play a fundamental role” in its development.
• Residual tissue after surgery (hypothesis). The 2023 Japanese study by Tsuboshima and colleagues hypothesizes that hormonal therapy after surgery works by controlling endometrial tissue that remains in the chest when it cannot all be removed.

How an implant on the lung or diaphragm leads to air entering the chest at the time of the period is not settled in these papers. Lesions on the lung surface, holes in the diaphragm, and blebs (small air blisters) are all found in different women, and some women have none of them.

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How the Diagnosis Is Made

The diagnosis rests on three things put together: the history, the findings at operation, and examination of removed tissue under the microscope.

The history. The 2014 review by Visouli and colleagues notes that the diagnosis can be hinted at by repeated collapses in a woman of reproductive age with endometriosis, and that the blood marker cancer antigen 125 (CA-125) is raised. The Heidelberg authors argue that systematically asking about the timing of each collapse in relation to the period is the step most often missed.

Imaging. A 2026 review by Lojanica and colleagues describes chest X-ray and computed tomography (CT) as useful for documenting the acute event, such as a collapse or blood in the chest, but finds imaging often nonspecific and unable to make the diagnosis on its own. The 2024 systematic review found ground-glass nodules and cystic lesions to be the most common CT findings. The 2025 radiology review by Xiao and colleagues argues that magnetic resonance imaging (MRI) shows soft tissue and blood products better than X-ray or CT, and describes a dedicated MRI protocol for the diaphragm: images in two extra planes to follow its dome shape, breath-holding to limit motion blur, and sequences that make blood products and small fluid-filled spots stand out.

Thoracoscopy. The 2014 review names video-assisted thoracoscopy (keyhole surgery of the chest) or medical thoracoscopy as the way the diagnosis is confirmed. Surgeons describe looking in particular at the diaphragm. The findings reported are endometrial implants and small holes (perforations or fenestrations) in the diaphragm. A 2004 Zurich report by Korom and colleagues describes three women whose earlier keyhole operations had not stopped their collapses; at a later operation, multiple small perforations in the tendinous part of the right diaphragm, with nearby endometrial implants, were found. The authors stress that inspection of the diaphragm during the operation is paramount.

Tissue under the microscope. Confirmation under the microscope is often missing even when the operation shows suggestive findings. In the Heidelberg series, findings at operation suggested thoracic endometriosis in 85.7% of women with catamenial pneumothorax, but tissue confirmation was achieved in only 14.3%. In the 2014 Paris pathology study, the features that independently pointed to thoracic endometriosis were right-sided pneumothorax, abnormalities of the diaphragm, a return of the collapse after surgery on one side, and iron-laden cells left behind by old bleeding (hemosiderin-laden macrophages). Emphysema-like changes at the top of the lung were found in 86% of the women who had that area removed, and they were linked with the absence of thoracic endometriosis.

Diagnostic delay in endometriosis in general is discussed on the Diagnosis Delay and Imaging page.

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What Surgery Finds and Does

Surgery for catamenial pneumothorax is usually video-assisted thoracoscopic surgery (VATS), done through small cuts in the side of the chest. The published series describe three main parts to the operation:

• Treating the diaphragm. Implants and holes are removed by cutting out the affected part of the diaphragm (resection), or the area is folded and stitched (plication). In the 2003 prospective study, limited diaphragm abnormalities were removed with a stapler through the keyhole approach; where they could not be reached, a small additional opening in the chest was used.
• Treating the lung. Implants or blebs on the lung surface are removed.
• Pleurodesis. The lung lining is made to stick to the chest wall, mechanically or with talc, so the space in which air collects is closed off. Pleurodesis in general is covered on the Pneumothorax page.

What the surgeons find varies. In the 2003 prospective study, all eight women with catamenial pneumothorax had diaphragm abnormalities: holes alone in one, implants alone in three, and both in four. Diaphragmatic endometriosis was confirmed under the microscope in seven of the eight. Korom and colleagues’ 2004 literature review of 229 published cases found thoracic endometriosis diagnosed in 73 of the 140 operated women with detailed findings (52.1%), and diaphragm lesions in 54 (38.8%); pleurodesis, with or without diaphragm repair or removal of a wedge of lung, was performed in 81.7% of cases. The 2017 systematic review by Bricelj and colleagues, covering 182 patients operated on since keyhole chest surgery began, found endometrial implants in 59.3%, diaphragm perforations in 57.0%, and no abnormality at all in 2.9%.

The 2026 systematic review by Mekhail and colleagues, covering 37 studies and more than 1,800 patients, highlights the diaphragm. One included study reported recurrence in 12.5% when diaphragm surgery was combined with pleurodesis, against 100% with pleurodesis alone. Another found that diaphragm resection was an independent protective factor against recurrence (hazard ratio 0.16).

Surgery carries its own burden. A 2026 meta-analysis by Amin and colleagues of 28 studies and 1,182 operated patients with thoracic endometriosis syndrome found an overall complication rate of 30.8%, a prolonged air leak in 24.2%, chest drains in place for an average of 4.4 days and an average hospital stay of 6.1 days. The 2024 review by Nezhat and colleagues describes managing thoracic endometriosis syndrome conservatively as far as possible, with surgery reserved for cases that do not respond, sometimes combining chest keyhole surgery with laparoscopy of the abdomen. The wider debate on surgery for pelvic disease is on the Laparoscopy: Excision vs Ablation page.

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Hormonal Suppression After Surgery

Because the chest implants respond to ovarian hormones, many centres add hormonal treatment that stops or quiets the menstrual cycle. The 2024 systematic review lists the drug groups used: gonadotropin-releasing hormone (GnRH) analogues, progestins, androgens and combined oral contraceptives, mostly together with surgery and sometimes on their own. How these drug groups work in endometriosis generally is described on the Hormonal Therapy Options page.

• Pooled results. The 2026 systematic review by Mekhail and colleagues reports a pooled recurrence rate of 17.3% with hormonal therapy after surgery, against 54.2% without it. Younger age was independently associated with a higher risk of recurrence.
• The largest single series. In a 2023 Japanese study of 248 women operated on for thoracic endometriosis-related pneumothorax, 67 (27.0%) had a recurrence. Seventy (28.2%) received hormonal therapy after surgery; the progestin dienogest was the drug most often given, to 56.7% of those treated. After adjustment for other factors, postoperative hormonal therapy was associated with a lower risk of recurrence (hazard ratio 0.28).
• Drugs that still allow periods. In the small 2005 Philadelphia series, all six women taking estrogen/progesterone preparations had recurrences before surgery, and two of three had recurrences after surgery while on them. No patient had a pneumothorax while taking a gonadotropin-releasing hormone agonist (two patients before and three after surgery). The authors concluded that hormonal agents that allow for menses were ineffective in their series. The numbers are very small.
• Hormones without surgery. The 1996 analysis of 110 cases found that surgical pleurodesis led to a lower recurrence rate for pneumothorax or hemothorax than hormonal treatment with danazol or oral contraceptives alone.

The Mekhail review concludes that surgery addressing the diaphragm, combined with pleurodesis and hormonal therapy after the operation, is consistently associated with reduced recurrence, while warning that the data are observational and are to be interpreted with caution.

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Recurrence Figures Side by Side

Catamenial pneumothorax is known for coming back, even after an operation. The figures below show how much the reported rates vary with the kind of study and the treatment given:

• Before specialist treatment. In the Heidelberg series, recurrence was 92.9% in women with catamenial pneumothorax against 42.4% in other women with spontaneous pneumothorax.
• After surgery, all approaches pooled. 28.2% in the 2026 meta-analysis of 1,182 patients, with a reoperation rate of 14.0%; 26.9% in the 2017 systematic review of 182 patients; 27.0% in the 2023 Japanese series of 248 patients.
• With or without hormonal therapy after surgery. 17.3% with against 54.2% without, pooled across studies in the 2026 systematic review.
• Pleurodesis with or without diaphragm surgery. 12.5% with diaphragm surgery against 100% with pleurodesis alone, in one study included in the same review.
• All treatments, all published cases. 10.1% of cases after treatment in the 2024 review of 592 published patients — a figure drawn largely from case reports, which tend to describe successes.

The Bricelj review sums it up: keyhole chest surgery gives good diagnostic and treatment results, but about one in four patients had a recurrence despite adequate treatment.

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Fertility Treatment After Catamenial Pneumothorax

Infertility is common in this group, and fertility treatment raises hormone levels sharply, which raises the question of whether it can set off a collapse. A 2026 case series from Paris by Fornelli and colleagues followed 11 women aged 18 to 43 whose catamenial pneumothorax had been treated with surgery, and who had assisted reproductive technology (ART) before and/or after their chest operation.

• Ten of the 11 (91%) had right-sided disease, and five (45%) had had surgery for pelvic endometriosis before the chest operation.
• Four women (36%) had their first pneumothorax within four months of fertility treatment.
• Nineteen ovarian stimulation cycles were performed; among the infertile women, seven of ten (70%) had at least one live birth.
• No chest recurrences were observed after surgery, despite later ovarian stimulation.

The authors call for prospective studies; eleven women is too few to estimate the risk with confidence. Fertility planning in endometriosis is covered on the Fertility and Endometriosis page.

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What Is Not Known

• How common it really is. Figures among women with spontaneous pneumothorax range from 7.1% to about 35% in surgical series, depending on how carefully the cycle is asked about and how the condition is defined. No population-wide figure exists.
• The cause. Movement through the diaphragm and spread through the veins are both proposed explanations; neither is proven, and neither explains every case.
• The best treatment. There is no randomized trial. The 2026 systematic review by Mekhail and colleagues calls optimal management uncertain and the evidence observational, and the 2026 meta-analysis by Amin and colleagues notes the absence of standardized guidelines.
• Which hormonal drug, and for how long. The studies pool different drug groups and durations. Head-to-head comparisons between them in thoracic endometriosis were not found.
• Diagnosis without tissue. Many cases are diagnosed on the history and the surgical findings alone, because tissue confirmation is often not achieved. The 2026 review by Lojanica and colleagues describes the combined clinical, imaging and surgical approach as a pragmatic framework, not a validated algorithm.
• Long-term outcomes. The 2026 meta-analysis calls for more research on quality of life and outcomes reported by patients themselves.

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Key Research Papers

1. Joseph J, Sahn SA. Thoracic endometriosis syndrome: new observations from an analysis of 110 cases. Am J Med. 1996;100(2):164-70. PubMed PMID: 8629650
2. Alifano M, Roth T, Broët SC, Schussler O, Magdeleinat P, Regnard JF. Catamenial pneumothorax: a prospective study. Chest. 2003;124(3):1004-8. PubMed PMID: 12970030
3. Korom S, Canyurt H, Missbach A, Schneiter D, Kurrer MO, Haller U, Keller PJ, Furrer M, Weder W. Catamenial pneumothorax revisited: clinical approach and systematic review of the literature. J Thorac Cardiovasc Surg. 2004;128(4):502-8. PubMed PMID: 15457149
4. Marshall MB, Ahmed Z, Kucharczuk JC, Kaiser LR, Shrager JB. Catamenial pneumothorax: optimal hormonal and surgical management. Eur J Cardiothorac Surg. 2005;27(4):662-6. PubMed PMID: 15784370
5. Rousset-Jablonski C, Alifano M, Plu-Bureau G, Camilleri-Broet S, Rousset P, Regnard JF, Gompel A. Catamenial pneumothorax and endometriosis-related pneumothorax: clinical features and risk factors. Hum Reprod. 2011;26(9):2322-9. PubMed PMID: 21685141
6. Legras A, Mansuet-Lupo A, Rousset-Jablonski C, Bobbio A, Magdeleinat P, Roche N, Regnard JF, Gompel A, Damotte D, Alifano M. Pneumothorax in women of child-bearing age: an update classification based on clinical and pathologic findings. Chest. 2014;145(2):354-360. PubMed PMID: 24091546
7. Visouli AN, Zarogoulidis K, Kougioumtzi I, Huang H, Li Q, Dryllis G, et al. Catamenial pneumothorax. J Thorac Dis. 2014;6(Suppl 4):S448-60. PubMed PMID: 25337402
8. Bricelj K, Srpčič M, Ražem A, Snoj Ž. Catamenial pneumothorax since introduction of video-assisted thoracoscopic surgery: a systematic review. Wien Klin Wochenschr. 2017;129(19-20):717-726. PubMed PMID: 28762057
9. Tsuboshima K, Kurihara M, Okumura G, Ohashi K, Takahashi K, Shiko Y, Ozawa Y, Seyama K. Postoperative hormonal therapies reduce the recurrence of thoracic endometriosis-related pneumothorax. Eur J Cardiothorac Surg. 2023;64(4):ezad331. PubMed PMID: 37773983
10. Nikolettos K, Patsouras A, Kotanidou S, Garmpis N, Psilopatis I, Garmpi A, et al. Pulmonary endometriosis: a systematic review. J Pers Med. 2024;14(11):1085. PubMed PMID: 39590577
11. Bobbio A, Gherzi L, Tormen F, Sion A, Prieto M, Daffre E, Fournel L, Alifano M. A surgical series on endometriosis-related diaphragmatic hernia. Gen Thorac Cardiovasc Surg. 2024;72(10):668-673. PubMed PMID: 38461451
12. Nezhat C, Amirlatifi N, Najmi Z, Tsuei A. Thoracic endometriosis syndrome: a comprehensive review and multidisciplinary approach to management. J Clin Med. 2024;13(24):7602. PubMed PMID: 39768527
13. Xiao L, White D, Kruger LF, Alwatari Y, Blackmon S, Burnett T, Khan Z, Chamié LP, Feldman M, VanBuren W. Thoracic endometriosis syndrome: imaging findings and the value of a dedicated MRI protocol. Abdom Radiol (NY). 2025;50(9):4423-4436. PubMed PMID: 39964372
14. Amin A, Baryshnikov I, Shafique MA, Naruka V, Kajitani S, Chavan H, Hirsch M, Hallifax RJ, Asadi N. Thoracic endometriosis syndrome: a systematic review and meta-analysis of surgical outcomes among 1,182 patients over 25 years. J Minim Invasive Gynecol. 2026;33(5):546-556. PubMed PMID: 41419079
15. Mekhail A, Kilby J, Macalister S, Manivannan PC, Seitz M. Surgical management of catamenial pneumothorax: a systematic review. J Cardiothorac Surg. 2026;21(1):433. PubMed PMID: 42063108
16. Lojanica MV, Ivanovic S, Milic N, Jovic N, Rakic N, Pilic I, et al. Thoracic endometriosis and catamenial pneumothorax: imaging pitfalls and an integrated diagnostic approach. J Clin Med. 2026;15(12):4517. PubMed PMID: 42355685
17. Deissner H, Niedermaier B, Griffo R, Wimmer C, Polke M, Trudzinski FC, et al. Catamenial pneumothorax as an underrecognized manifestation of thoracic endometriosis: a 25-year single-center experience. J Clin Med. 2026;15(13):4941. PubMed PMID: 42452403
18. Fornelli G, Bourdon M, Maignien C, Melka L, Gherzi L, Mantelet LM, Patrat C, Somigliana E, Alifano M, Santulli P. Assisted reproductive technology in women with endometriosis and a history of catamenial pneumothorax: reproductive outcomes and safety considerations. J Minim Invasive Gynecol. 2026;33(7):955-962. PubMed PMID: 41633483

PubMed Topic Searches

1. PubMed: catamenial pneumothorax
2. PubMed: thoracic endometriosis syndrome
3. PubMed: diaphragmatic endometriosis
4. PubMed: catamenial hemoptysis
5. PubMed: hormonal therapy and recurrence in thoracic endometriosis

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Connections

• Endometriosis — the parent page on the disease as a whole
• Pneumothorax — collapsed lung, its types, emergency signs and treatment
• Hormonal Therapy Options — the drug groups used to suppress the cycle
• Diagnosis Delay and Imaging — why endometriosis is found late
• Laparoscopy: Excision vs Ablation — surgery for the pelvic disease
• Fertility and Endometriosis — infertility, a risk factor in these series
• Pleural Effusion — fluid in the chest lining and thoracoscopy
• Lymphangioleiomyomatosis — another cause of repeated collapsed lung in women

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