Diagnosis and treatment of endometriosis

Heeyon Kim; SiHyun Cho

doi:10.5124/jkma.2019.62.10.513

J Korean Med Assoc > Volume 62(10); 2019 > Article

Kim and Cho: Diagnosis and treatment of endometriosis

Focused Issue of this Month

J Korean Med Assoc 2019; 62(10): 513-518.

Published online: October 17, 2019

DOI: http://dx.doi.org/10.5124/jkma.2019.62.10.513

Diagnosis and treatment of endometriosis

Heeyon Kim, MD, SiHyun Cho, MD

Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

Corresponding author: SiHyun Cho E-mail: sihyuncho@yuhs.ac

Received August 28, 2019 Accepted September 04, 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Endometriosis is a common gynecological condition characterized by chronic pelvic pain, dysmenorrhea and subfertility. However, the pathophysiology of the disease remains unclear and accurate non-invasive diagnostic methods are unavailable. Although clinical symptoms, serum biomarkers, and imaging studies, such as transvaginal ultrasonography and magnetic resonance imaging are useful diagnostic aids, laparoscopy remains the gold standard for the diagnosis of endometriosis. The treatment of endometriosis should be individualized and a multi-disciplinary approach is recommended based on degree of disease-associated symptoms, patient characteristics and preferences, reproductive plans, and desired quality of life. Surgical management is effective for subfertility, chronic pain, and ovarian endometriomas. The principle of surgery is removal of all ectopic endometrial lesions while ensuring that no lesions are missed. Currently, numerous medical treatment options are available to manage endometriosis-associated symptoms; however, all modalities are suppressive rather than curative. Further studies are needed to clarify the exact pathophysiology of endometriosis to enable the development of non-invasive diagnostic tools for early detection and to indicate potential therapeutic targets for this chronic and frustrating disease.

Key words: Endometriosis; Pelvic pain; Dysmenorrhea; Subferfility

REFERENCES

1. Hadfield R, Mardon H, Barlow D, Kennedy S. Delay in the diagnosis of endometriosis: a survey of women from the USA and the UK. Hum Reprod 1996;11:878-880.

2. Porpora MG, Koninckx PR, Piazze J, Natili M, Colagrande S, Cosmi EV. Correlation between endometriosis and pelvic pain. J Am Assoc Gynecol Laparosc 1999;6:429-434.

3. Damario MA, Rock JA. Classification of endometriosis. Semin Reprod Endocrinol 1997;15:235-244.

4. Tuttlies F, Keckstein J, Ulrich U, Possover M, Schweppe KW, Wustlich M, Buchweitz O, Greb R, Kandolf O, Mangold R, Masetti W, Neis K, Rauter G, Reeka N, Richter O, Schindler AE, Sillem M, Terruhn V, Tinneberg HR. [ENZIAN-score, a classification of deep infiltrating endometriosis]. Zentralbl Gynakol 2005;127:275-281.

5. Adamson GD, Pasta DJ. Endometriosis fertility index: the new, validated endometriosis staging system. Fertil Steril 2010;94:1609-1615.

6. May KE, Conduit-Hulbert SA, Villar J, Kirtley S, Kennedy SH, Becker CM. Peripheral biomarkers of endometriosis: a systematic review. Hum Reprod Update 2010;16:651-674.

7. Abrao MS, Podgaec S, Pinotti JA, de Oliveira RM. Tumor markers in endometriosis. Int J Gynaecol Obstet 1999;66:19-22.

8. Mol BW, Bayram N, Lijmer JG, Wiegerinck MA, Bongers MY, van der Veen F, Bossuyt PM. The performance of CA-125 measurement in the detection of endometriosis: a metaanalysis. Fertil Steril 1998;70:1101-1108.

9. Hirsch M, Duffy J, Davis CJ, Nieves Plana M, Khan KS. International Collaboration to Harmonise O. Diagnostic accuracy of cancer antigen 125 for endometriosis: a systematic review and metaanalysis. BJOG 2016;123:1761-1768.

10. Guerriero S, Mais V, Ajossa S, Paoletti AM, Angiolucci M, Labate F, Melis GB. The role of endovaginal ultrasound in differentiating endometriomas from other ovarian cysts. Clin Exp Obstet Gynecol 1995;22:20-22.

11. Mais V, Guerriero S, Ajossa S, Angiolucci M, Paoletti AM, Melis GB. The efficiency of transvaginal ultrasonography in the diagnosis of endometrioma. Fertil Steril 1993;60:776-780.

12. Kinkel K, Frei KA, Balleyguier C, Chapron C. Diagnosis of endometriosis with imaging: a review. Eur Radiol 2006;16:285-298.

13. Medeiros LR, Rosa MI, Silva BR, Reis ME, Simon CS, Dondo-ssola ER, da Cunha Filho JS. Accuracy of magnetic resonance in deeply infiltrating endometriosis: a systematic review and metaanalysis. Arch Gynecol Obstet 2015;291:611-621.

14. Kim M, Kim SH, Shin JH, Lee SR, Lee JR, Cho SH, Choi YS, Lee BS. Guidelines for management of endometriosis. Korean J Obstet Gynecol 2011;54:399-405.

15. Farquhar C, Sutton C. The evidence for the management of endometriosis. Curr Opin Obstet Gynecol 1998;10:321-332.

16. Hart R, Hickey M, Maouris P, Buckett W, Garry R. Excisional surgery versus ablative surgery for ovarian endometriomata: a Cochrane Review. Hum Reprod 2005;20:3000-3007.

17. Lefebvre G, Allaire C, Jeffrey J, Vilos G, Arneja J, Birch C, Fortier M. Clinical Practice Gynaecology Committee and Executive Committeee and Council, Society of Obstetricians and Gynaecologists of Canada. SOGC clinical guidelines. Hysterectomy. J Obstet Gynaecol Can 2002;24:37-61.

18. Chalermchockchareonkit A, Tekasakul P, Chaisilwattana P, Sirimai K, Wahab N. Laparoscopic hysterectomy versus abdominal hysterectomy for severe pelvic endometriosis. Int J Gynaecol Obstet 2012;116:109-111.

19. Gambone JC, Mittman BS, Munro MG, Scialli AR, Winkel CA. Chronic Pelvic Pain/Endometriosis Working G. Consensus statement for the management of chronic pelvic pain and endometriosis: proceedings of an expert-panel consensus process. Fertil Steril 2002;78:961-972.

20. Prentice A, Deary AJ, Goldbeck-Wood S, Farquhar C, Smith SK. Gonadotrophin-releasing hormone analogues for pain associated with endometriosis. Cochrane Database Syst Rev 2000;(2):CD000346.

21. Wheeler JM, Knittle JD, Miller JD. Depot leuprolide versus danazol in treatment of women with symptomatic endometriosis. I. Efficacy results. Am J Obstet Gynecol 1992;167:1367-1371.

22. Brown J, Pan A, Hart RJ. Gonadotrophin-releasing hormone analogues for pain associated with endometriosis. Cochrane Database Syst Rev 2010;(12):CD008475.

23. Surrey ES. Gonadotropin-releasing hormone agonist and add-back therapy: what do the data show? Curr Opin Obstet Gynecol 2010;22:283-288.

24. Davis L, Kennedy SS, Moore J, Prentice A. Oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev 2007;(3):CD001019.

25. Mabrouk M, Solfrini S, Frasca C, Del Forno S, Montanari G, Ferrini G, Paradisi R, Seracchioli R. A new oral contraceptive regimen for endometriosis management: preliminary experience with 24/4-day drospirenone/ethinylestradiol 3 mg/20 mcg. Gynecol Endocrinol 2012;28:451-454.

26. Harada T, Momoeda M, Taketani Y, Hoshiai H, Terakawa N. Low-dose oral contraceptive pill for dysmenorrhea associated with endometriosis: a placebo-controlled, double-blind, randomized trial. Fertil Steril 2008;90:1583-1588.

27. Muzii L, Di Tucci C, Achilli C, Di Donato V, Musella A, Palaia I, Panici PB. Continuous versus cyclic oral contraceptives after laparoscopic excision of ovarian endometriomas: a systematic review and metaanalysis. Am J Obstet Gynecol 2016;214:203-211.

28. McKinnon B, Mueller M, Montgomery G. Progesterone resistance in endometriosis: an acquired property? Trends Endocrinol Metab 2018;29:535-548.

29. Schlaff WD, Carson SA, Luciano A, Ross D, Bergqvist A. Subcutaneous injection of depot medroxyprogesterone acetate compared with leuprolide acetate in the treatment of endometriosis-associated pain. Fertil Steril 2006;85:314-325.

30. Crosignani PG, Luciano A, Ray A, Bergqvist A. Subcutaneous depot medroxyprogesterone acetate versus leuprolide acetate in the treatment of endometriosis-associated pain. Hum Reprod 2006;21:248-256.

31. Strowitzki T, Marr J, Gerlinger C, Faustmann T, Seitz C. Dienogest is as effective as leuprolide acetate in treating the painful symptoms of endometriosis: a 24-week, randomized, multicentre, open-label trial. Hum Reprod 2010;25:633-641.

32. Petraglia F, Hornung D, Seitz C, Faustmann T, Gerlinger C, Luisi S, Lazzeri L, Strowitzki T. Reduced pelvic pain in women with endometriosis: efficacy of longterm dienogest treatment. Arch Gynecol Obstet 2012;285:167-173.

33. Lockhat FB, Emembolu JO, Konje JC. The evaluation of the effectiveness of an intrauterine-administered progestogen (levonorgestrel) in the symptomatic treatment of endometriosis and in the staging of the disease. Hum Reprod 2004;19:179-184.

34. Lockhat FB, Emembolu JO, Konje JC. The efficacy, side-effects and continuation rates in women with symptomatic endometriosis undergoing treatment with an intra-uterine administered progestogen (levonorgestrel): a 3 year followup. Hum Reprod 2005;20:789-793.

35. Kim SA, Um MJ, Kim HK, Kim SJ, Moon SJ, Jung H. Study of dienogest for dysmenorrhea and pelvic pain associated with endometriosis. Obstet Gynecol Sci 2016;59:506-511.

36. Practice Committee of American Society for Reproductive M. Treatment of pelvic pain associated with endometriosis. Fertil Steril 2008;90((5 Suppl):S260-S269.

37. Selak V, Farquhar C, Prentice A, Singla A. Danazol for pelvic pain associated with endometriosis. Cochrane Database Syst Rev 2007;(4):CD000068.

38. Ferrero S, Gillott DJ, Venturini PL, Remorgida V. Use of aromatase inhibitors to treat endometriosis-related pain symptoms: a systematic review. Reprod Biol Endocrinol 2011;9:89.

39. Zeitoun KM, Bulun SE. Aromatase: a key molecule in the pathophysiology of endometriosis and a therapeutic target. Fertil Steril 1999;72:961-969.