All aspects of endometriosis reviewed with focus on modern management

A comprehensive review on endometriosis

Key Points

Highlights:

• As it is already well known in current social appreciation, endometriosis is a prevalent chronic inflammatory disease with the presence of ectopic endometrial tissue causing pelvic pain and infertility.
• Non-invasive modalities such as transvaginal ultrasound and magnetic resonance imaging are increasingly being used for the diagnosis of endometriosis.
• Contemporary endometriosis management should be personalized, utilizing a patient-centered, multi-modal interdisciplinary combination.

Importance:

• Endometriosis is a public health problem with effects on the quality of life of women besides resulting in a substantial economic burden.
• Endometriosis currently necessitates surgery and histopathological diagnosis. 
• It is time to reestablish the understanding of endometriosis, diagnosis and management strategies.

What's done here:

• Authors have made a comprehensive review regarding all aspects of endometriosis, from definition and pathogenesis to treatment modalities with contemporary suggestions. 
• A conclusion is made on individualizing endometriosis management through a patient-centered, multi-modal and interdisciplinary integration.

Lay Summary

Dr. Chapron and associates from academic centers in France published in Nature Review Endocrinology, a comprehensive review on endometriosis. The article is inclusive of all aspects of endometriosis but especially focuses on the management of the disease with its contemporary status. 

Having a heterogeneous nature, endometriosis has a well- recognized subgroups namely, superficial peritoneal lesions, ovarian endometriomas, and deep infiltrating endometriosis. Additionally, endometriosis may be seen in extragenital locations, e.g. pleural, diaphragmatic or umbilical.

Adenomyosis is a condition characterized by infiltrating endometrial tissue into the myometrium. This condition is frequently associated with endometriosis and contributes, independently of endometriosis, to pain, infertility, and abnormal uterine bleeding with substantial negative effects on the quality of life.

The main aim of this review is to introduce the concept of ‘endometriosis life’. This model is comprehensive, all components, i.e. pathogenetic mechanisms, diagnosis, and management models of the endometriosis. This approach should be individualized to the patient through an interdisciplinary integration for being the most contemporary and ideal one as well as the best fitting the needs of the patients. 

Endometriosis related pain  should be treated  without any delay to avoid central sensitization, as this has a risk of becoming autonomous. Medical treatment is the first line of treatment for patients with pelvic pain without immediate desire for pregnancy. Assisted reproductive technologies can be performed without previous surgery for selected infertile patients.

Endometriosis management should be personalized for best fitting to the patient’s intentions and priorities; management protocols may differ in each country since pain perception and health-care systems differ across the continents. Ovarian cancer risk incidence in endometriosis should be properly evaluated, and a rational risk-reduction strategy or screening should be performed. 

"Modern endometriosis management should be individualized with a patient-centered, multi-modal and interdisciplinary integrated approach", the authors concluded.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/31488888