Examining Diagnostic Options and Classification Systems Available for Endometriosis

Abstract

Introduction: Endometriosis is characterised by the presence of endometrium-like tissue outside the uterus, and is often associated with chronic pelvic pain, infertility, and compromised quality of life. Development of reliable methods of early diagnosis, staging, and classification of endometriosis would allow for restriction of disease progression by its early detection and strategising towards its early treatment and management. Diagnostic options: Typically, diagnosis and staging of endometriosis include a history and physical examination followed by clinical, imaging, and laparoscopic findings. Surgical inspection of lesions at laparoscopy with histological confirmation remains the most reliable procedure towards the detection of endometriosis and its classification. Although there are many putative peripheral biomarkers having potential diagnostic values for endometriosis, further studies are necessary for their validation. Classification systems: Based on anatomical, clinical, imaging, and several pathophysiological findings, various classifications and staging systems of endometriosis, e.g., revised American Society for Reproductive Medicine (rASRM), ENZIAN, Endometriosis Fertility Index (EFI) and Foci–Ovarian endometrioma–Adhesion–Tubal endometriosis–Inflammation (FOATI) scoring systems, have so far been postulated. However, there is no fool-proof diagnostic and classification approach available for the disease due to the general failure of current systems to reflect reproducible correlation with the major symptoms of endometriosis. Conclusion: A ‘toolbox approach’, using all the available diagnostic and classification systems maximising the information available to healthcare providers and females, is a recent recommendation. Development of collaborative research networks for the harmonisation of patient information, biological sample collection, and its storage, and that of methodological and analytical tools in a wider patient base is necessary to discover reliable leads for future diagnostic options and a classification system for endometriosis.

Progesterone Resistance in Endometriosis

“…Growth of endometrial tissue outside the uterus, frequently but not exclusively, in the pelvic structures gives rise to endometriotic lesions in the peritoneum (peritoneal endometriosis), the ovary (ovarian endometriosis or endometrioma), and the deep pelvis (deep infiltrating endometriosis), and infrequently in the distant organs. 1 According to Sampson's theory, deposits of viable endometrial cells following their reflux into the peritoneal space via the fallopian tubes during menstruation may adhere and grow, and give rise to endometriosis. 2 In an elegant review, Redwine 3 challenged this theory and demonstrated, by analysing a large number of parameters, that endometriosis tissue is primarily reflected dissimilarity than similarity with eutopic endometrium in the uterus, including inadequate secretory differentiation in endometriotic cells under progesterone dominance during the luteal phase.…”