From the Guidelines
The most effective approach to managing endometriosis involves a multidisciplinary treatment plan that includes medical therapies, surgical excision by a specialist, and lifestyle modifications, with the goal of reducing symptoms, improving quality of life, and preserving fertility when desired. According to the most recent study on endometriosis, published in 2024 in the Journal of the American College of Radiology 1, the diagnosis of endometriosis is challenging due to variable presenting symptoms and nonspecific physical examination findings.
Diagnosis and Treatment
The study highlights the importance of preoperative imaging in reducing morbidity and mortality, and the need for repeat surgeries by reducing the number of incomplete surgeries 1. Some key points to consider in the diagnosis and treatment of endometriosis include:
- The use of expanded protocol transvaginal ultrasound (TVUS) studies to identify and "map" deep endometriosis (DE) 1
- The importance of special training for performing these expanded TVUS examinations, which are associated with a learning curve of at least 40 examinations 1
- The use of MRI protocol tailored for detection of DE, with moderate bladder distention and vaginal contrast recommended to help improve lesion conspicuity involving these structures 1
- The potential role of fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)-PET/CT and fluoroestradiol in detecting endometriosis, although further studies are needed to confirm their effectiveness 1
Medical Therapies
Medical therapies for endometriosis may include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen to manage pain
- Hormonal therapies such as combined oral contraceptives, progestins, or GnRH agonists to reduce symptoms and slow disease progression
- Lifestyle modifications such as regular exercise, stress reduction techniques, and anti-inflammatory diets to help manage symptoms
Surgical Options
Surgical options for endometriosis may include:
- Laparoscopic excision or ablation of endometriotic lesions to provide significant pain relief
- Fertility treatments for women wanting to conceive It is essential to note that endometriosis requires individualized treatment, and therapy should be aimed at controlling pain, slowing disease progression, and preserving fertility when desired 1.
From the Research
Definition and Prevalence of Endometriosis
- Endometriosis is an estrogen-dependent chronic disease 2 and an inflammatory condition caused by the presence of endometrial tissue in extra-uterine locations 3.
- It is one of the most common gynecologic disorders, affecting up to 10% of people of reproductive age 3.
Symptoms of Endometriosis
- Presentation of endometriosis can vary widely, from infertility in asymptomatic people to debilitating pelvic pain, dysmenorrhea, and period-related gastrointestinal or urinary symptoms 3.
- Symptoms can include severe dysmenorrhea, pelvic pain, and infertility [(2,3,4)].
Diagnosis of Endometriosis
- Diagnosis of endometriosis in the primary care setting is clinical and often challenging, frequently resulting in delayed diagnosis and treatment 3.
- Transvaginal ultrasonography is used to evaluate endometriosis of deep pelvic sites to rule out other causes of pelvic pain, while magnetic resonance imaging is preferred if deep infiltrating endometriosis is suspected 3.
- Laparoscopy with biopsy remains the definitive method for diagnosis [(3,4)].
Treatment Options for Endometriosis
- Combined hormonal contraceptives with or without nonsteroidal anti-inflammatory drugs are first-line options in managing symptoms 3.
- Progestogens or oral contraceptives may be used as first-line therapy for endometriosis 5.
- Gonadotropin-releasing hormone (GnRH) agonists, GnRH receptor antagonists, and danazol are second-line treatments 3.
- Aromatase inhibitors are reserved for severe disease [(2,3)].
- The levonorgestrel-releasing intrauterine system (LNG-IUD), laparoscopic ablation, and excision are associated with relief of pain due to endometriosis 4.