The Past, Present, and Future of Diagnosing Endometriosis

Biomarkers and risk factors that could change the way endometriosis diagnosis in the future

Key Points

Highlights:

• This review analyzes the epidemiology of endometriosis, which in layman’s terms is the "determinants and distribution of the disease".
• The review also identifies risk factors and biomarkers that can be used to combat the disease in the future.

Importance:

• Endometriosis diagnosis is often delayed, and this delay can adversely affect the patient’s quality of life and fertility. Identifying risk factors and biomarkers associated with endometriosis will allow for earlier diagnosis, which will help improve quality of life and fertility in patients with endometriosis.
• Early diagnosis may also decrease the surgical costs associated with the illness.

What’s done here?

• This review by Parasar, Ozcan, and Terry is written based on the author’s knowledge and supplemented with previously published works.

Key points:

• Presentation and Clinical Course of Endometriosis
  • Endometriosis presents itself differently in different women.
  • Sometimes the disease shows no symptoms and its presence is only determined when the health care provider analyzes the patient’s fertility.
  • The American Society for Reproductive Medicine (ASRM) has developed a classification system for the pain symptoms that focuses on the implants and locations.
• Epidemiology and Risk Factors
  • Hormonal variation may play a role in endometriosis development as several reproductive factors have been found to play a role in endometriosis development: Early age at menarche and short menstrual cycles increase one’s risk for endometriosis; while oral contraceptive use decreases one’s risk for endometriosis.
  • Lower body-mass indexes are also associated with increased risk of endometriosis.
  • Researchers are yet to determine the effect of tubal ligation on endometriosis development.
  • Smoking impacts endometriosis risk in different ways. Some studies show that smoking decreases endometriosis risk because of lower circulating estrogen, whereas others show that smoking with children around can increase the child’s risk of endometriosis if the child is female.
  • Alcohol and caffeine consumption in infertile women has increased their risk of endometriosis; however, studies including women that are fertile have proven inconclusive with regards to Alcohol and caffeine consumption and endometriosis.
  • Increased physical activity and omega-3 dietary fatty acids intake can reduce inflammation.
  • Endometriosis is diagnosed surgically, which limits the field.
• Diagnosis of Endometriosis
  • Clinical history is usually used for preliminary diagnosis.
  • There are many tentative tests, like pelvic ultrasound scans and transvaginal ultrasound, that can be used to diagnose endometriosis; however, laparoscopy followed by histologic confirmation is the gold standard for diagnosis.
  • CA-125, cytokine, angiogenic factor, and growth factor levels are raised in women with endometriosis, but they have not been used as biomarkers for the diagnosis of endometriosis.
• Biomarkers for the Diagnosis of Endometriosis
  • Research has yet to find a reliable biomarker that can be used to diagnose endometriosis. There is a potential list of biomarkers that are delineated within the article. Further testing is required before the biomarkers can be utilized as a diagnostic tool.
  • Stem cell, proteomic and genomic studies may prove useful for the biomarker search.
• Clinical Management Practices for Associated Pain and Infertility
  • Endometriosis management is multi-disciplinary and consists of surgical diagnosis, reduction of the disease load, hormone treatments, and pain management.
  • Medical treatment begins with non-steroidal anti-inflammatory drugs (NSAIDs) and low-dose combined oral contraceptive pills. If no change in condition is detected after a period, then progestins, androgens, and gonadotropin-releasing hormone agonists (GnRH) are used.
  • Surgical treatment has high success rates, but recurrence can still occur. Surgery for infertility can increase the patient’s chances of natural conception. Surgery for endometriomas can adversely affect ovarian function and can lead to a loss of an ovary.
• Future Perspectives
  • Research has elucidated novel markers that can potentially be used to diagnose and treat endometriosis.

Lay Summary

This review titled “Endometriosis: Epidemiology, Diagnosis and Clinical Management” published in Current Obstetrics and Gynecology Reports examines the distribution and factors associated with endometriosis. The analysis by Parasar, Ozcan, and Terry also delineates potential biomarkers and risk factors that could be used to diagnose and treat the disease effectively.

The authors begin the review by discussing the presentation and clinical course of endometriosis. Endometriosis presents itself differently in different patients, and that can make it difficult to diagnose and classify. The American Society for Reproductive Medicine (ASRM) has developed a classification system for the pain symptoms associated with the illness. This system uses the disease implants and location. The next section of the paper looks at the epidemiology and risk factors related to the disease. These factors could include reproductive factors, body-mass index, smoking, alcohol and coffee consumption, physical activity, and diet. The next section of the paper examines the current state of an endometriosis diagnosis. While some tests can be used to diagnose endometriosis, the gold standard remains laparoscopy followed by histologic confirmation. Scientists have found some biomarkers that could potentially be used to diagnose endometriosis, but further research is required before they can be used as an actual diagnostic tool. The second to last section discusses the management and treatment of endometriosis. Endometriosis must be approached as a multidisciplinary disease. Treatment of the disease can be medical and or surgical. The last section analyzes future perspectives. Modern research and technologies have elucidated numerous markers that could be used for diagnosis and treatment of endometriosis. Indubitably, further research is needed in this field that has the potential to change endometriosis care radically.

Endometriosis can present itself in a myriad of ways, which makes it difficult to diagnose using current methodology; however, scientists have found biomarkers and risk factors that could change the way endometriosis is diagnosed in the future.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/29276652