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The misplaced endometrium responds to ovarian hormonal stimulation, and, indeed, depends on this for survival. When the uterus goes through the process of menstruation, this tissue bleeds--mostly into areas having no outlet. This is what causes the often debilitating pain, inflammation and adhesions (scar tissue).

At surgery, these lesions are typically small, puckered, brown or blue-black, indicating concealed bleeding. If the endometrial tissue is within an ovarian cyst, there is no outlet for the bleeding and the formation is referred to as a chocolate cyst.

Symptoms vary and may be misleading, since extensive endometriosis may cause few symptoms whereas an isolated lesion may produce considerable problems.

http://www.etnet.com.hk/www/tc/health/LA65168