Clinical Management of Endometriosis

Abstract

Endometriosis is a common and challenging condition of reproductive-aged women that carries a high individual and societal cost. The many molecular dissimilarities between endometriosis lesions and eutopic endometrium create difficulties in the development of new drug therapies and treatments. Surgery remains the gold standard for definitive diagnosis, but it must be weighed against the risks of surgical morbidity and potential decreases in ovarian reserve, especially in the case of endometriomas. Safe and effective surgical techniques are discussed within this article for various presentations of endometriosis. Medical therapy is suppressive rather than curative, and regimens that are long-term and affordable with minimal side effects are recommended. Recurrences are common and often rapid when medical therapy is discontinued. Endometriosis in the setting of infertility is reviewed and appropriate management is discussed, including when and whether surgery is warranted in this at-risk population. In patients with chronic pain, central sensitization and myofascial pain are integral components of a multidisciplinary approach. Endometriosis is associated with an increased risk of epithelial ovarian cancer; however, the risk is low and currently no preventive screening is recommended. Hormone therapy for symptomatic women with postsurgical menopause should not be delayed as a result of concerns for malignancy or recurrence of endometriosis.

Ultrasound‐guided high‐intensity focused ultrasound treatment for abdominal wall endometriosis: a retrospective study

“…Conventionally, wide surgical excision has been performed, compromising the musculoaponeurotic strut; thus, an incisional hernia may occur in the lower abdominal wall, in the absence of the posterior sheath of the rectus abdominis. [3][4][5] In addition, the success rate of medication has been reported to be low, offering only temporary alleviation of clinical symptoms. 6 Recently, more and more women with benign tumours in China have received ultrasound-guided high-intensity focused ultrasound (USgHIFU) treatment, which is a non-invasive and effective treatment.…”

Ion Channels in The Pathogenesis of Endometriosis: A Cutting-Edge Point of View

“…Endometriosis, defined as the presence of endometrial-like tissue outside the uterine cavity, is an estrogen-dependent benign disease that affects about 10% of reproductive-age women [1][2][3][4]. Of women affected by this pathology, 30%-50% suffer from pelvic pain and/or infertility [3,[5][6][7].…”

Evidence for an association between endometriosis, fibromyalgia, and autoimmune diseases

“…Endometriosis usually presents during a woman's reproductive years and carries a significant burden on quality of life and societal cost . The estimated prevalence in premenopausal women is 10% in clinical studies, and up to 50% among symptomatic patients with pelvic pain and infertility .…”