From the Guidelines
The most recent and relevant gynecologic journal article regarding endometriosis is the 2024 study published in the Journal of the American College of Radiology, which discusses the ACR appropriateness criteria for endometriosis and highlights the importance of preoperative imaging in reducing morbidity and mortality 1.
Recent Studies on Endometriosis
Several recent studies have focused on improving the diagnosis and treatment of endometriosis.
- The use of expanded protocol transvaginal ultrasound (TVUS) has been shown to be effective in identifying and "mapping" deep endometriosis (DE) 1.
- MRI protocols tailored for the detection of DE have also been recommended, with moderate bladder distention and vaginal contrast helping to improve lesion conspicuity 1.
- Additionally, research has explored the use of novel diagnostic approaches, such as artificial intelligence to analyze endometrial tissue samples, and the potential of specific probiotic formulations in reducing inflammation markers and improving pain symptoms 1.
Diagnosis and Treatment
The diagnosis of endometriosis can be challenging due to variable presenting symptoms and nonspecific physical examination findings 1.
- Historically, the diagnosis of endometriosis was made by diagnostic laparoscopy with histologic inspection, but preoperative imaging is now recommended to reduce morbidity and mortality 1.
- Treatment of endometriosis is variable and largely determined by the patient's individualized goals, with medical therapies available to temporize symptoms and surgical excision by a specialist considered the definitive treatment 1.
Classification of Endometriosis
The classification of endometriosis has remained controversial and challenging, with various systems proposed, including the revised American Society for Reproductive Medicine (r-ASRM) classification and the Enzian classification for deep endometriosis 1.
- However, these classification systems have been criticized for their poor correlation with disease symptoms and lack of predictive prognosis 1.
- The World Endometriosis Society consensus on the classification of endometriosis highlights the need for a classification system that can inform counseling and treatment decisions 1.
From the Research
Overview of Endometriosis
- Endometriosis is a common, benign, and chronic gynecological disorder that can result in substantial morbidity, including pelvic pain, progressive dysmenorrhea, dyspareunia, infertility, and repeat surgeries 2.
- It is an estrogen-dependent disorder, and its severity can range from asymptomatic to debilitating symptoms that have a major impact on women's lives 3.
Medical Treatment of Endometriosis
- The primary goal of medical treatment for endometriosis is to halt the growth and activity of endometriosis lesions 2.
- Current medical treatments for endometriosis include non-steroidal anti-inflammatory drugs, gonadotropin-releasing hormone (GnRH) agonists, combined oral contraceptive pills, progestogens, and levonorgestrel intrauterine system 4.
- GnRH antagonists, aromatase inhibitors, and selective progesterone receptor modulators are also being explored as potential treatments for endometriosis 5, 6.
Emerging Therapies
- Elagolix, a new oral GnRH antagonist, has shown promising preliminary data in multicenter Phase III trials, but non-inferiority RCT data are required to compare it with first-line therapies for endometriosis 6.
- Future research should continue to look for the genetic trigger for endometriosis, which can lead to its underlying pathogenesis and eventually a cure or prevention 3.
Treatment Strategies
- The choice of medical treatment for endometriosis should be based on efficacy, patient preference, incidence and severity of adverse effects, and cost 5.
- Early diagnosis of endometriosis is key in preventing severe, debilitating symptoms and progression of disease, and long-term medical therapy is often required to control symptoms 3.