Endometriosis: advances and controversies in classification, pathogenesis, diagnosis, and treatment

Edgardo Rolla, Edgardo Rolla

Abstract

Endometriosis is an enigmatic disease that could start at birth. Its pathogenesis is supported by different theories. Accumulating facts relate it to a multigenic disorder. In this review of recent publications, the principal symptoms of the disease, pain and infertility, as well as its pathogenesis, diagnosis, and classification will be addressed. Endometriosis presents three main variants: superficial peritoneal disease, deep infiltrating endometriosis, and ovarian endometriomas. The management of the disease, surgery, and medical and alternative therapies will be discussed. Special reference will be made to the quality of surgery and how to understand patients with endometriosis and endometriosis.

Trial registration: ClinicalTrials.gov NCT01656434 NCT01728454 NCT01931670 NCT03204318.

Keywords: endometrosis deep infiltrating endometriosis pain infertility.

Conflict of interest statement

Competing interests: The author has been a principal investigator for the following clinical trials: Proellex, Elagolix, Relugolix, MVT 601 3101, and NOMAC.No competing interests were disclosed.No competing interests were disclosed.No competing interests were disclosed.No competing interests were disclosed.

Figures

Figure 1.. High-resolution magnetic resonance imaging and…
Figure 1.. High-resolution magnetic resonance imaging and laparoscopic findings.
Figure 2.. American Society for Reproductive Medicine…
Figure 2.. American Society for Reproductive Medicine revised classification.
Figure 3.. The Enzian classification for deep…
Figure 3.. The Enzian classification for deep infiltrating endometriosis – .
Figure 4.. Endometriosis fertility index.
Figure 4.. Endometriosis fertility index.
Figure 5.. A new proposal by Koninckx…
Figure 5.. A new proposal by Koninckx and Wattiez et al. .
Figure 6.. Algorithm proposed by the author…
Figure 6.. Algorithm proposed by the author for the treatment of endometriosis-associated infertility.
This algorithm is proposed in cases where laparoscopy is indicated for endometriosis-associated infertility. Many patients with suspected endometriosis benefit directly from assisted reproductive techniques without a prior laparoscopy. IVF,in vitro fertilization.
Figure 7.. Complete removal of all superficial…
Figure 7.. Complete removal of all superficial and hidden lesions at the pouch of Douglas.
Image is from surgery performed by the author.
Figure 8.. Endometrioma cystectomy.
Figure 8.. Endometrioma cystectomy.
A correct dissection plane is mandatory for a careful cystectomy of endometriomas and must be clearly identified. Whenever possible, incision should be made at a site opposite the ovarian vascular pedicles. Image is from surgery performed by the author.
Figure 9.. Colorectal image of deep infiltrating…
Figure 9.. Colorectal image of deep infiltrating endometriosis after shaving of a nodule.
Rectal shaving of endometriotic nodules has proven to be a safe and fast surgical procedure that alleviates pain and gastrointestinal symptoms even in low locations of the disease. Image is from surgery performed by the author.
Figure 10.. Poster inviting the public to…
Figure 10.. Poster inviting the public to attend a patients’ workshop with doctors and social psychologists and a photo from the workshop.
Photo by the author.
Figure 11.. Poster inviting the public to…
Figure 11.. Poster inviting the public to attend a conference on endometriosis and a photo from the conference.
Photo by the author.
Figure 12.. March for Endometriosis (2018).
Figure 12.. March for Endometriosis (2018).
Public awareness talks at a park. Photos by the author.

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