What is the cause of stage four pelvic endometriosis?

Patient's question:

I have an itchy lower body, and my underwear is always yellow. What's going on? What is stage four endometriosis of the pelvic cavity?

Doctor's answer:

Endometriosis is caused by active endometrium, which flows back into the pelvic cavity through the fallopian tubes during menstruation and implants itself into tissues outside the uterine cavity. With the changes in the menstrual cycle, the implanted endometrium intermittently grows and sheds. When it implants in the ovaries, it forms chocolate cysts that gradually shrink with cyclical pain. When it implants in the pelvic cavity, it forms painful nodules, and the pain progressively worsens.

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