International Journal of Clinical Obstetrics and Gynaecology Nexovation

Endometriosis Unmasked: rethinking diagnosis and management

Aseel Abdulameer Mohammed¹, Zainab Abd Alkathem Fatnan²

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Abstract

Endometriosis is a chronic, estrogen-dependent inflammatory disorder affecting 6–10% women of reproductive age and possibly one of the most under-recognized causes of chronic pelvic pain and infertility. Although awareness is increasing, the average time between symptom onset and a diagnosis confirmed through surgery remains 5 to 10 years (because of heterogeneous clinical presentation and reliance on invasive laparoscopy for definitive diagnoses). In the past years, there has been tremendous movement in both diagnostic and therapeutic paradigms. Newer guidelines by the European Society of Human Reproduction and Embryology (ESHRE), National Institute for Health and Care Excellence (NICE) and national societies now lean towards a clinical, history- and imaging-based diagnostic pathway, with laparoscopy being recommended only in equivocal or treatment-refractory cases. This review focuses on: the role of transvaginal ultrasonography and pelvic magnetic resonance imaging in detecting deep infiltrating disease; the ongoing investigation of circulating and menstrual-effluent biomarkers towards a non-invasive diagnostic test. On the therapeutic front, second-line medical options have extended beyond combined hormonal contraceptives, progestins and GnRH agonists to include oral gonadotropin-releasing hormone (GnRH) antagonists-elagolix, relugolix and linzagolix-whereas deep and bowel endometriosis is better managed via refinement in minimally invasive excisional surgery. The review provides an overview of recent evidence on the epidemiology and pathogenesis involved in endometriosis, advances in clinical and imaging detection methods, promising non-invasive biomarkers, medical and surgical management updates as well as current gaps in care.

Keywords: endometriosisGnRH antagonistbiomarkerspelvic paininfertility

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Licensed under CC BY 4.0.