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Thomas M. D’Hooghe
Endometriosis is diagnosed by visual inspection of the pelvis during laparoscopy, ideally with histological confirmation; positive histology confirms the diagnosis, but negative histology does not exclude it.
Endometriosis can be associated with subfertility, pelvic pain, i.e., dysmenorrhea, dyspareunia and nonmenstrual pain, and reduced quality of life.
Severe or deeply infiltrating endometriosis should be managed in a facility with the necessary expertise to provide treatment in a multidisciplinary context, including advanced laparoscopic surgery and laparotomy.
Classification systems for endometriosis are subjective and correlate poorly with pain symptoms, but have some value in determining the prognosis and management of infertility.
Suppression of ovarian function for 6 months reduces pain associated with endometriosis. Hormonal drugs are equally effective in reducing pain but have differing side effects and cost.
Ablation of endometriotic lesions with laparoscopic uterine nerve ablation (LUNA) in minimal to moderate disease reduces pain associated with endometriosis; however, because LUNA used alone has no effect on dysmenorrhea associated with endometriosis, there is no evidence that LUNA is a necessary component of treatment.
Ablation of endometriotic lesions plus adhesiolysis in minimal to mild endometriosis is more effective than diagnostic laparoscopy alone in improving fertility.
Suppression of ovarian function is not effective in improving subsequent fertility in patients with endometriosis.
Endometriosis is defined as the presence of endometrial tissue (glands and stroma) outside the uterus. The most frequent sites of implantation are the pelvic viscera and the peritoneum. Endometriosis varies in appearance from a few minimal lesions on otherwise intact pelvic organs, to massive ovarian endometriotic cysts that distort tubo-ovarian anatomy and extensive adhesions involving bowel, bladder, and ureter. It is estimated to occur in 10% of reproductive-age women and is associated with pelvic pain and infertility. Considerable progress in understanding the pathogenesis, spontaneous evolution, diagnosis, and treatment of endometriosis has occurred. The European Society for Human Reproduction and Embryology (ESHRE) guidelines for the clinical management of endometriosis are published and regularly updated to present emerging clinical evidence (1).
Prevalence Endometriosis is found predominantly in women of reproductive age but is reported in adolescents and in postmenopausal women receiving hormonal replacement (2). It is found in women of all ethnic and social groups. Estimates of the frequency of endometriosis vary widely, but the prevalence of the condition is assumed to be around 10% (3,4). Although no consistent information is available on the incidence of the disease, temporal trends suggest an increase among women of reproductive age (4).