Endometriosis: symptoms, diagnosis, and treatment

https://doi.org/10.53730/ijhs.v1nS1.15299

Authors

  • Omar Hussain Alsomali KSA, National Guard Health Affairs
  • Abdulrhman Awadh Alharbi KSA, National Guard Health Affairs
  • Ali Suliman Aloula KSA, National Guard Health Affairs
  • Barakat Shumailan Alazmiy KSA, National Guard Health Affairs
  • Ahmad Alhelo Alanazi KSA, National Guard Health Affairs
  • Saud Dakhel Alanazi KSA, National Guard Health Affairs
  • Ibrahim Muhammad Al-Arej KSA, National Guard Health Affairs
  • Abdullatif Suliman Alsayegh KSA, National Guard Health Affairs
  • Abdulaziz Radi Alanazi KSA, National Guard Health Affairs
  • Mohammed Abdullah Alduaybi KSA, National Guard Health Affairs
  • Meshal Ibrahim Zaid Al Owias KSA, National Guard Health Affairs

Keywords:

Endometriosis, pain management, infertility, surgical treatment, hormonal therapy, multidisciplinary approach

Abstract

Background: Endometriosis is a complex gynecological condition characterized by the presence of endometrial-like tissue outside the uterus, often leading to chronic pain and infertility. Its management requires a multidisciplinary approach that includes surgical and medical interventions. Aim: This article aims to review current clinical management practices for pain and infertility associated with endometriosis, focusing on surgical and hormonal treatments as well as pain management strategies. Methods: A comprehensive analysis of existing literature on endometriosis management was conducted, highlighting various therapeutic options, their efficacy, and considerations regarding surgical interventions. Results: Surgical techniques, such as excision of endometrial implants and nerve ablation, demonstrate success rates of 50% to 80% in alleviating symptoms. Hormonal treatments, including non-steroidal anti-inflammatory drugs (NSAIDs), combined oral contraceptive pills (COCPs), progestins, and gonadotropin-releasing hormone agonists (GnRH), are first-line therapies for managing pain. In cases of infertility, surgical interventions can enhance the likelihood of natural conception. However, the recurrence of endometriosis remains a significant concern, occurring in 5% to 15% of patients even after comprehensive surgeries. Conclusion: Effective management of endometriosis-related pain and infertility necessitates a tailored approach, considering patient preferences, side effects, and the specific clinical scenario. 

Downloads

Download data is not yet available.

References

Giudice, L. C., & Kao, L. C. (2004). Endometriosis. Lancet, 364(9447), 1789–1799. DOI: https://doi.org/10.1016/S0140-6736(04)17403-5

Nisolle, M., & Donnez, J. (1997). Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertility and Sterility, 68(4), 585–596. DOI: https://doi.org/10.1016/S0015-0282(97)00191-X

Farland, L. V., Shah, D. K., Kvaskoff, M., Zondervan, K., & Missmer, S. A. (2015). Epidemiological and clinical risk factors for endometriosis. In T. D’Hooghe (Ed.), Biomarkers for endometriosis (pp. 1–12). New York: Springer Science.

Anaf, V., Simon, P., El Nakadi, I., Fayt, I., Simonart, T., Buxant, F., et al. (2002). Hyperalgesia, nerve infiltration and nerve growth factor expression in deep adenomyotic nodules, peritoneal and ovarian endometriosis. Human Reproduction, 17, 1895–1900. DOI: https://doi.org/10.1093/humrep/17.7.1895

Wang, G., Tokushige, N., Markham, R., & Fraser, I. S. (2009). Rich innervation of deep infiltrating endometriosis. Human Reproduction, 24, 827–834. DOI: https://doi.org/10.1093/humrep/den464

Berkley, K. J., Rapkin, A. J., & Papka, R. E. (2005). The pains of endometriosis. Science, 308, 1587–1589. DOI: https://doi.org/10.1126/science.1111445

Bulun, S. E. (2009). Endometriosis. New England Journal of Medicine, 360(3), 268–279. doi:10.1056/NEJMra0804690. DOI: https://doi.org/10.1056/NEJMra0804690

Ferguson, B. R., Bennington, J. L., & Haber, S. L. (1969). Histochemistry of mucosubstances and histology of mixed Mullerian pelvic lymph node glandular inclusions: Evidence for histogenesis by Mullerian metaplasia of coelomic epithelium. Obstetrics and Gynecology, 33, 617–625.

Sampson, J. A. (1927). Metastatic or embolic endometriosis due to menstrual dissemination of endometrial tissue into the venous circulation. American Journal of Pathology, 3, 93–109.

Carter, J. E. (1994). Combined hysteroscopic and laparoscopic findings in patients with chronic pelvic pain. Journal of the American Association of Gynecologic Laparoscopists, 2, 43–47. DOI: https://doi.org/10.1016/S1074-3804(05)80830-8

Nnoaham, K. E., Hummelshoj, L., Webster, P., d'Hooghe, T., de Cicco Nardone, F., de Cicco Nardone, C., Jenkinson, C., Kennedy, S. H., & Zondervan, K. T. (2011). Impact of endometriosis on quality of life and work productivity: A multicenter study across ten countries. Fertility and Sterility, 96(2), 366–373.e8. doi:10.1016/j.fertnstert.2011.05.090. DOI: https://doi.org/10.1016/j.fertnstert.2011.05.090

Greene, R., Stratton, P., Cleary, S. D., Ballweg, M. L., & Sinaii, N. (2009). Diagnostic experience among 4,334 women reporting surgically diagnosed endometriosis. Fertility and Sterility, 91, 32–39. DOI: https://doi.org/10.1016/j.fertnstert.2007.11.020

Dun, E. C., Kho, K. A., Morozov, V. V., Kearney, S., Zurawin, J. L., & Nezhat, C. H. (2015). Endometriosis in adolescents. JSLS, 19(2). doi:10.4293/JSLS.2015.00019. DOI: https://doi.org/10.4293/JSLS.2015.00019

Laufer, M. R. (2008). Current approaches to optimizing the treatment of endometriosis in adolescents. Gynecologic and Obstetric Investigation, 66(Suppl 1), 19–27. DOI: https://doi.org/10.1159/000148027

Sinaii, N., Plumb, K., Cotton, L., Lambert, A., Kennedy, S., Zondervan, K., & Stratton, P. (2008). Differences in characteristics among 1,000 women with endometriosis based on extent of disease. Fertility and Sterility, 89(3), 538–545. DOI: https://doi.org/10.1016/j.fertnstert.2007.03.069

American Society for Reproductive Medicine. (1997). Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertility and Sterility, 67, 817–821. DOI: https://doi.org/10.1016/S0015-0282(97)81391-X

Missmer, S. A., Hankinson, S. E., Spiegelman, D., Barbieri, R. L., Marshall, L. M., & Hunter, D. J. (2004). Incidence of laparoscopically confirmed endometriosis by demographic, anthropometric, and lifestyle factors. American Journal of Epidemiology, 160(8), 784–796. DOI: https://doi.org/10.1093/aje/kwh275

Darrow, S. L., Vena, J. E., Batt, R. E., Zielezny, M. A., Michalek, A. M., & Sharon, S. (1993). Menstrual cycle characteristics and the risk of endometriosis. Epidemiology, 4(2), 135–142. DOI: https://doi.org/10.1097/00001648-199303000-00009

Matalliotakis, I., Cakmak, H., Fragouli, Y., Goumenou, A., Mahutte, N., & Arici, A. (2008). Epidemiological characteristics in women with and without endometriosis in the Yale series. Archives of Gynecology and Obstetrics, 277(5), 389–393. DOI: https://doi.org/10.1007/s00404-007-0479-1

Missmer, S., Hankinson, S., Spiegelman, D., Barbieri, R., Malspeis, S., Willett, W., & Hunter, D. (2004). Reproductive history and endometriosis among premenopausal women. Obstetrics and Gynecology, 104(5 Pt 1), 965–974. DOI: https://doi.org/10.1097/01.AOG.0000142714.54857.f8

Signorello, L. B., Harlow, B. L., Cramer, D. W., Spiegelman, D., & Hill, J. A. (1997). Epidemiologic determinants of endometriosis: A hospital-based case-control study. Annals of Epidemiology, 7(4), 267–274. DOI: https://doi.org/10.1016/S1047-2797(97)00017-3

Candiani, G., Danesino, V., Gastaldi, A., Parazzini, F., & Ferraroni, M. (1991). Reproductive and menstrual factors and risk of peritoneal and ovarian endometriosis. Fertility and Sterility, 56(2), 230–234. DOI: https://doi.org/10.1016/S0015-0282(16)54477-X

Parazzini, F. (1999). Risk factors for pelvic endometriosis in women with pelvic pain or infertility: Gruppo Italiano per lo Studio dell’endometriosi. European Journal of Obstetrics & Gynecology and Reproductive Biology, 83(2), 195–199. DOI: https://doi.org/10.1016/S0301-2115(98)00332-7

Peterson, C. M., Johnstone, E. B., Hammoud, A. O., Stanford, J. B., Varner, M. W., Kennedy, A., Chen, Z., Sun, L., Fujimoto, V. Y., Hediger, M. L., & Buck Louis, G. M. (2013). Risk factors associated with endometriosis: Importance of study population for characterizing disease in the ENDO Study. American Journal of Obstetrics and Gynecology, 208(6), 451.e1–451.e11. DOI: https://doi.org/10.1016/j.ajog.2013.02.040

Moen, M. H., & Schei, B. (1997). Epidemiology of endometriosis in a Norwegian county. Acta Obstetricia et Gynecologica Scandinavica, 76(6), 559–562. DOI: https://doi.org/10.3109/00016349709024584

Cramer, D. W., Wilson, E., Stillman, R. J., et al. (1986). The relation of endometriosis to menstrual characteristics, smoking, and exercise. JAMA, 255(14), 1904–1908. DOI: https://doi.org/10.1001/jama.255.14.1904

Sangi-Haghpeykar, H., & Poindexter, A. N. (1995). Epidemiology of endometriosis among parous women. Obstetrics & Gynecology, 85(6), 983–992. DOI: https://doi.org/10.1016/0029-7844(95)00074-2

Vercellini, P., Eskenazi, B., Consonni, D., Somigliana, E., Parazzini, F., Abbiati, A., et al. (2011). Oral contraceptives and risk of endometriosis: A systematic review and meta-analysis. Human Reproduction Update, 17(2), 159–170. DOI: https://doi.org/10.1093/humupd/dmq042

Chiaffarino, F., Parazzini, F., La Vecchia, C., Ricci, E., & Crosignani, P. G. (1998). Oral contraceptive use and benign gynecologic conditions: A review. Contraception, 57(1), 11–18. DOI: https://doi.org/10.1016/S0010-7824(97)00201-1

Hediger, M. L., Hartnett, H. J., & Buck Louis, G. M. (2005). Association of endometriosis with body size and figure. Fertility and Sterility, 84(5), 1366–1374. DOI: https://doi.org/10.1016/j.fertnstert.2005.05.029

Vitonis, A. F., Baer, H. J., Hankinson, S. E., Laufer, M. R., & Missmer, S. A. (2010). A prospective study of body size during childhood and early adulthood and the incidence of endometriosis. Human Reproduction, 25(5), 1325–1334. DOI: https://doi.org/10.1093/humrep/deq039

Vaughan, S., Coward, J. I., Bast, R. C. Jr, Berchuck, A., Berek, J. S., Brenton, J. D., Coukos, G., Crum, C. C., Drapkin, R., Etemadmoghadam, D., Friedlander, M., Gabra, H., Kaye, S. B., Lord, C. J., Lengyel, E., Levine, D. A., McNeish, I. A., Menon, U., Mills, G. B., Nephew, K. P., Oza, A. M., Sood, A. K., Stronach, E. A., Walczak, H., Bowtell, D. D., & Balkwill, F. R. (2011). Rethinking ovarian cancer: Recommendations for improving outcomes. Nature Reviews Cancer, 11(10), 719–725. DOI: https://doi.org/10.1038/nrc3144

Bonocher, C. M., Montenegro, M. L., Rosa, E. S. J. C., Ferriani, R. A., & Meola, J. (2014). Endometriosis and physical exercises: A systematic review. Reproductive Biology and Endocrinology, 12, 4. DOI: https://doi.org/10.1186/1477-7827-12-4

Kvaskoff, M., Bijon, A., Clavel-Chapelon, F., Mesrine, S., & Boutron-Ruault, M. C. (2013). Childhood and adolescent exposures and the risk of endometriosis. Epidemiology, 24(2), 261–269. DOI: https://doi.org/10.1097/EDE.0b013e3182806445

Wolff, E. F., Sun, L., Hediger, M. L., Sundaram, R., Peterson, C. M., Chen, Z., et al. (2013). In utero exposures and endometriosis: The endometriosis, natural history, disease, outcome (ENDO) study. Fertility and Sterility, 99(3), 790–795. DOI: https://doi.org/10.1016/j.fertnstert.2012.11.013

Buck Louis, G. M., Hediger, M. L., & Pena, J. B. (2007). Intrauterine exposures and risk of endometriosis. Human Reproduction, 22(12), 3232–3236. DOI: https://doi.org/10.1093/humrep/dem338

Baron, J. A., La Vecchia, C., & Levi, F. (1990). The antiestrogenic effect of cigarette smoking in women. American Journal of Obstetrics and Gynecology, 162(2), 502–514. DOI: https://doi.org/10.1016/0002-9378(90)90420-C

Parazzini, F., Chiaffarino, F., Surace, M., Chatenoud, L., Cipriani, S., Chiantera, V., Benzi, G., & Fedele, L. (2004). Selected food intake and risk of endometriosis. Human Reproduction, 19(8), 1755–1759. DOI: https://doi.org/10.1093/humrep/deh395

Grodstein, F., Goldman, M. B., & Cramer, D. W. (1994). Infertility in women and moderate alcohol use. American Journal of Public Health, 84(9), 1429–1432. DOI: https://doi.org/10.2105/AJPH.84.9.1429

Heilier, J. F., Donnez, J., Nackers, F., Rousseau, R., Verougstraete, V., Rosenkranz, K., et al. (2007). Environmental and host-associated risk factors in endometriosis and deep endometriotic nodules: A matched case-control study. Environmental Research, 103(1), 121–129. DOI: https://doi.org/10.1016/j.envres.2006.04.004

Berlanda, N., Somigliana, E., Viganò, P., & Vercellini, P. (2016). Safety of medical treatments for endometriosis. Expert opinion on drug safety, 15(1), 21-30. DOI: https://doi.org/10.1517/14740338.2016.1121991

Published

15-01-2017

How to Cite

Alsomali, O. H., Alharbi, A. A., Aloula, A. S., Alazmiy, B. S., Alanazi, A. A., Alanazi, S. D., Al-Arej, I. M., Alsayegh, A. S., Alanazi, A. R., Alduaybi, M. A., & Al Owias, M. I. Z. (2017). Endometriosis: symptoms, diagnosis, and treatment. International Journal of Health Sciences, 1(S1), 228–238. https://doi.org/10.53730/ijhs.v1nS1.15299

Issue

Section

Peer Review Articles

Most read articles by the same author(s)

1 2 > >>