Diagnosis and treatment of endometriosis

ABSTRACT

Endometriosis is a common gynecological condition characterized by chronic pelvic pain, dysmenorrhea and subfertility. However, the pathophysiology of the disease remains unclear and accurate non-invasive diagnostic methods are unavailable. Although clinical symptoms, serum biomarkers, and imaging studies, such as transvaginal ultrasonography and magnetic resonance imaging are useful diagnostic aids, laparoscopy remains the gold standard for the diagnosis of endometriosis. The treatment of endometriosis should be individualized and a multi-disciplinary approach is recommended based on degree of disease-associated symptoms, patient characteristics and preferences, reproductive plans, and desired quality of life. Surgical management is effective for subfertility, chronic pain, and ovarian endometriomas. The principle of surgery is removal of all ectopic endometrial lesions while ensuring that no lesions are missed. Currently, numerous medical treatment options are available to manage endometriosis-associated symptoms; however, all modalities are suppressive rather than curative. Further studies are needed to clarify the exact pathophysiology of endometriosis to enable the development of non-invasive diagnostic tools for early detection and to indicate potential therapeutic targets for this chronic and frustrating disease.