This review explains a severe form of endometriosis where tissue grows deep into pelvic organs, sometimes affecting the bowel or bladder. It describes how hormones and immune cells play a role, how doctors can spot it with ultrasound or MRI, and lists medical (including hormone pills and GnRH drugs) and surgical ways to treat it. The information is mainly useful for women with this condition, not for general health or performance hacking.

Deep infiltrative endometriosis (DIE) is characterized by the infiltration of endometrial tissue into the pelvic organs, such as the rectovaginal septum, utero-ovarian, and uterosacral ligaments. Bowel involvement occurs in approximately 3.8-37% of cases, whereas urinary tract involvement is less common (1-6%). The pathophysiology of DIE includes deep infiltration of endometrial tissue into the peritoneum, with the gastrointestinal system being a common site. The pathogenesis of endometriosis involves hormonal functional changes in estrogen and progesterone receptors and the influence of immune factors like peritoneal macrophages, natural killer cells, and lymphocytes. Diagnostic methods, including transvaginal ultrasonography (TVUS) and magnetic resonance imaging (MRI), play crucial roles in identifying and assessing endometriosis. Medical treatment options include oral contraceptives, progesterone pills and devices, and gonadotropin-releasing hormone (GnRH) analogs or antagonists. Surgical treatment options are shave excision, disc excision, and colorectal resection. This review provides a comprehensive overview of DIE, its pathophysiology, diagnostic methods, treatment options, as well as implications for fertility and pregnancy outcomes.