Pathophysiology, diagnosis, and management of endometriosis

ABSTRACTEndometriosis affects approximately 190 million women and people assigned female at birth worldwide. It is a chronic, inflammatory, gynecologic disease marked by the presence of endometrial-like tissue outside the uterus, which in many patients is associated with debilitating painful symptom...

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Bibliographic Details
Published in:BMJ (Online) 2022-11, Vol.379, p.e070750
Main Authors: Horne, Andrew W, Missmer, Stacey A
Format: Article
Language:English
Subjects:
Abdomen
Bias
Chronic illnesses
Chronic pain
Clinical Review
Comorbidity
Cysts
Delayed Diagnosis
Endometriosis
Endometriosis - diagnosis
Endometriosis - therapy
Endometrium
Female
Humans
Iatrogenesis
Infant, Newborn
Infertility
Medical diagnosis
Medical treatment
Ovaries
Pain - complications
Patients
Population
Sample size
Surgery
Uterus
Womens health
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Summary:ABSTRACTEndometriosis affects approximately 190 million women and people assigned female at birth worldwide. It is a chronic, inflammatory, gynecologic disease marked by the presence of endometrial-like tissue outside the uterus, which in many patients is associated with debilitating painful symptoms. Patients with endometriosis are also at greater risk of infertility, emergence of fatigue, multisite pain, and other comorbidities. Thus, endometriosis is best understood as a condition with variable presentation and effects at multiple life stages. A long diagnostic delay after symptom onset is common, and persistence and recurrence of symptoms despite treatment is common. This review discusses the potential genetic, hormonal, and immunologic factors that lead to endometriosis, with a focus on current diagnostic and management strategies for gynecologists, general practitioners, and clinicians specializing in conditions for which patients with endometriosis are at higher risk. It examines evidence supporting the different surgical, pharmacologic, and non-pharmacologic approaches to treating patients with endometriosis and presents an easy to adopt step-by-step management strategy. As endometriosis is a multisystem disease, patients with the condition should ideally be offered a personalized, multimodal, interdisciplinary treatment approach. A priority for future discovery is determining clinically informative sub-classifications of endometriosis that predict prognosis and enhance treatment prioritization.
ISSN:1756-1833
1756-1833
DOI:10.1136/bmj-2022-070750