Which statement best characterises the natural history of endometriosis?

Answer: A. It is an oestrogen-dependent disease that is cured by menopause

Natural history of endometriosis

Endometriosis is fundamentally an oestrogen-dependent disease, and this single fact explains both its course and its treatment.

Key characteristics

• Oestrogen-dependent: ectopic tissue responds to cyclical oestrogen, so the disease is active during reproductive years.
• Menopause cures it: with the loss of ovarian oestrogen, deposits regress.
• Pregnancy and lactation alleviate but do not cure: the hormonal milieu suppresses activity temporarily.
• Recurrent, relentless course during the reproductive years.

Treatment logic follows the biology

Because the disease feeds on oestrogen, medical treatment works by suppressing oestrogen synthesis, interrupting the cycle of stimulation and bleeding, and inducing atrophy of ectopic lesions - via the COC (pseudopregnancy), GnRH agonists (pseudo-menopause), progestins, and danazol. Surgical removal of the ovaries (BSO) is definitive because it removes the oestrogen source.

Malignant potential

Endometriosis itself is not premalignant in the usual exam sense; it is a benign but morbid condition, so describing it as premalignant is incorrect.