Endometriosis

Endometriosis is defined as the presence of endometrial-like tissue, glands and stroma, outside the uterine cavity. It is a benign estrogen-dependent chronic inflammatory disease that affects at least 10% of reproductive-age women. Endometriosis is often associated with a range of painful symptoms including chronic pelvic pain and dysmenorrhea. In common with other chronic pain conditions, women with endometriosis often report fatigue and depression. Infertility is significantly more common in patients with endometriosis, with a doubling of risk compared with women without endometriosis. Women with endometriosis also have a high risk of co-occurring or evolving multisite pain and of presenting with other non-malignant gynecologic and non-gynecologic diseases. There is often a long diagnostic delay after onset of symptoms. The availability of robust non-invasive biomarkers for diagnosis, prediction of response to treatment and monitoring of disease progression remain major unmet needs. The diagnosis of endometriosis should be based on patient interview, examination and imaging. As with other chronic inflammatory conditions, treatment should be viewed as a long-term process. The available medical treatments for symptomatic endometriosis work by inhibiting ovulation, lowering serum estradiol levels and suppressing uterine blood flow. The currently available first-line treatments are hormonal, such as progestins and low-dose oral contraceptives. Nowadays, surgery is considered a second-line treatment in most endometriosis patients.