Download PDF
Semin intervent Radiol 2023; 40(06): 544-548
DOI: 10.1055/s-0043-1777748
Clinical Corner

Endometriosis: An Overview

Tanvir Agnihotri
1   Department of Radiology, New York University School of Medicine, New York, New York
,
Abheek Ghosh
2   University of Maryland School of Medicine, Baltimore, Maryland
,
Ashley Lamba
3   Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
,
Charles E. Ray Jr.
4   Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Endometriosis is a chronic, inflammatory gynecological condition defined by the presence of endometrial-like epithelium and/or stroma outside of the uterus ([Fig. 1]). Endometriosis exists on a spectrum of presentations and can be further classified by location into superficial peritoneal (lesions involving the peritoneal surface), ovarian (formation of endometriomas or “chocolate cysts” on the ovaries typically containing ectopic tissue and bloody fluid), deep (nodular implantation of tissue into the peritoneal surface with associate fibrosis), extra-abdominal (outside the abdomen), and iatrogenic (dissemination of endometrium following surgery).[1] The clinical presentation of endometriosis is variable, and depends on the subtype of endometriosis and location(s) of involvement. While up to 20 to 25% of patients are asymptomatic, common clinical features include chronic pelvic pain which worsens prior to the onset of menses, dysmenorrhea, dyspareunia, and infertility.[2] [3] Despite its strong link to infertility in women, the pathophysiology of endometriosis remains poorly understood. Postulated to be a combination of the development of a pro-invasive inflammatory milieu by endometrial cells and retrograde flux of endometrial tissue through the fallopian tubes into and beyond the endometrial cavity, there remains a lack of consensus regarding the etiology of endometriosis.[1] Furthermore, this explanation does not account for the disparity between women with retrograde flow, seen in up to 90% of women, and the eventual development of endometriosis.[4] With studies approximating the prevalence of endometriosis between 25 and 50% in infertile women, optimization of obstetric outcomes is a priority among patients seeking treatment.[3] While surgical outcomes typically improve symptoms and increase the pregnancy rate, they come with appreciable risk of damage to the ovaries and diminished ovarian reserve.[5] Given the significant morbidity and impairment in fertility associated with endometriosis, its examination as a clinical entity, as well as the limitations and advantages in its treatment, is warranted.

Zoom Image
Fig. 1 Endometriosis is a chronic, inflammatory gynecological condition marked by the growth of endometrial-like epithelium and/or stroma outside of the uterus. Endometriotic lesions located within the ovary are referred to as endometriomas.


Publication History

Article published online:
24 January 2024

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Horne AW, Missmer SA. Pathophysiology, diagnosis, and management of endometriosis. BMJ 2022; 379: e070750
    CrossrefPubMedGoogle Scholar
  • 2 Agarwal SK, Chapron C, Giudice LC. et al. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol 2019; 220 (04) 354.e1-354.e12
    CrossrefPubMedGoogle Scholar
  • 3 Bulletti C, Coccia ME, Battistoni S, Borini A. Endometriosis and infertility. J Assist Reprod Genet 2010; 27 (08) 441-447
    CrossrefPubMedGoogle Scholar
  • 4 Nisenblat V, Bossuyt PMM, Farquhar C, Johnson N, Hull ML. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev 2016; 2 (02) CD009591
    PubMedGoogle Scholar
  • 5 Jee BC. Efficacy of ablation and sclerotherapy for the management of ovarian endometroma: a narrative review. Clin Exp Reprod Med 2022; 49 (02) 76-86
    PubMedGoogle Scholar
  • 6 Parasar P, Ozcan P, Terry KL. Endometriosis: epidemiology, diagnosis and clinical management. Curr Obstet Gynecol Rep 2017; 6 (01) 34-41
    CrossrefPubMedGoogle Scholar
  • 7 Ghiasi M, Kulkarni MT, Missmer SA. Is endometriosis more common and more severe than it was 30 years ago?. J Minim Invasive Gynecol 2020; 27 (02) 452-461
    CrossrefPubMedGoogle Scholar
  • 8 Saavalainen L, Tikka T, But A. et al. Trends in the incidence rate, type and treatment of surgically verified endometriosis - a nationwide cohort study. Acta Obstet Gynecol Scand 2018; 97 (01) 59-67
    CrossrefPubMedGoogle Scholar
  • 9 Gylfason JT, Kristjansson KA, Sverrisdottir G, Jonsdottir K, Rafnsson V, Geirsson RT. Pelvic endometriosis diagnosed in an entire nation over 20 years. Am J Epidemiol 2010; 172 (03) 237-243
    CrossrefPubMedGoogle Scholar
  • 10 Gao M, Allebeck P, Mishra GD, Koupil I. Developmental origins of endometriosis: a Swedish cohort study. J Epidemiol Community Health 2019; 73 (04) 353-359
    CrossrefPubMedGoogle Scholar
  • 11 Missmer SA, Hankinson SE, Spiegelman D, Barbieri RL, Marshall LM, Hunter DJ. Incidence of laparoscopically confirmed endometriosis by demographic, anthropometric, and lifestyle factors. Am J Epidemiol 2004; 160 (08) 784-796
    CrossrefPubMedGoogle Scholar
  • 12 Leibson CL, Good AE, Hass SL. et al. Incidence and characterization of diagnosed endometriosis in a geographically defined population. Fertil Steril 2004; 82 (02) 314-321
    CrossrefPubMedGoogle Scholar
  • 13 Eisenberg VH, Weil C, Chodick G, Shalev V. Epidemiology of endometriosis: a large population-based database study from a healthcare provider with 2 million members. BJOG 2018; 125 (01) 55-62
    CrossrefPubMedGoogle Scholar
  • 14 ACOG Committee Opinion No. 760 Summary: dysmenorrhea and endometriosis in the adolescent. Obstet Gynecol 2018; 132 (06) 1517-1518
    CrossrefPubMedGoogle Scholar
  • 15 Riazi H, Tehranian N, Ziaei S, Mohammadi E, Hajizadeh E, Montazeri A. Clinical diagnosis of pelvic endometriosis: a scoping review. BMC Womens Health 2015; 15: 39
    CrossrefPubMedGoogle Scholar
  • 16 Testini V, Eusebi L, Grechi G, Bartelli F, Guglielmi G. Imaging of endometriosis: the role of ultrasound and magnetic resonance. Global Radiol 2022; 10: 21-39
    PubMedGoogle Scholar
  • 17 Exacoustos C, Zupi E, Piccione E. Ultrasound imaging for ovarian and deep infiltrating endometriosis. Semin Reprod Med 2017; 35 (01) 5-24
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Collins BG, Ankola A, Gola S, McGillen KL. Transvaginal US of endometriosis: looking beyond the endometrioma with a dedicated protocol. Radiographics 2019; 39 (05) 1549-1568
    CrossrefPubMedGoogle Scholar
  • 19 Theodoridis TD, Zepiridis L, Mikos T. et al. Comparison of diagnostic accuracy of transvaginal ultrasound with laparoscopy in the management of patients with adnexal masses. Arch Gynecol Obstet 2009; 280 (05) 767-773
    CrossrefPubMedGoogle Scholar
  • 20 Lee SY, Koo YJ, Lee DH. Classification of endometriosis. Yeungnam Univ J Med 2021; 38 (01) 10-18
    CrossrefPubMedGoogle Scholar
  • 21 Schippert C, Witte Y, Bartels J. et al. Reproductive capacity and recurrence of disease after surgery for moderate and severe endometriosis - a retrospective single center analysis. BMC Womens Health 2020; 20 (01) 1-11
    CrossrefPubMedGoogle Scholar
  • 22 Practice Committee of the American Society for Reproductive Medicine. Treatment of pelvic pain associated with endometriosis: a committee opinion. Fertil Steril 2014; 101 (04) 927-935
    CrossrefPubMedGoogle Scholar
  • 23 Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. Fertil Steril 2012; 98 (03) 591-598
    CrossrefPubMedGoogle Scholar
  • 24 Practice bulletin no. 114: management of endometriosis. Obstet Gynecol 2010; 116 (01) 223-236
    CrossrefPubMedGoogle Scholar
  • 25 Kalaitzopoulos DR, Samartzis N, Kolovos GN. et al. Treatment of endometriosis: a review with comparison of 8 guidelines. BMC Womens Health 2021; 21 (01) 397
    CrossrefPubMedGoogle Scholar
  • 26 Allaire C, Bedaiwy MA, Yong PJ. Diagnosis and management of endometriosis. CMAJ 2023; 195 (10) E363-E371
    CrossrefPubMedGoogle Scholar
  • 27 Daraï E, Lesieur B, Dubernard G, Rouzier R, Bazot M, Ballester M. Fertility after colorectal resection for endometriosis: results of a prospective study comparing laparoscopy with open surgery. Fertil Steril 2011; 95 (06) 1903-1908
    CrossrefPubMedGoogle Scholar
  • 28 Quevedo A, Pasic R, Connor A, Chamseddine P. Fertility sparing endometriosis surgery: a review. Gynecol Obstet Clin Med 2021; 1 (03) 112-118
    CrossrefPubMedGoogle Scholar
  • 29 Vercellini P, Somigliana E, Viganò P, Abbiati A, Barbara G, Crosignani PG. Surgery for endometriosis-associated infertility: a pragmatic approach. Hum Reprod 2009; 24 (02) 254-269
    CrossrefPubMedGoogle Scholar
  • 30 Mavrelos D, Saridogan E. Treatment of endometriosis in women desiring fertility. J Obstet Gynecol India 2015; 65 (01) 11-16
    CrossrefPubMedGoogle Scholar
  • 31 Dunselman GAJ, Vermeulen N, Becker C. et al; European Society of Human Reproduction and Embryology. ESHRE guideline: management of women with endometriosis. Hum Reprod 2014; 29 (03) 400-412
    CrossrefPubMedGoogle Scholar
  • 32 Somigliana E, Berlanda N, Benaglia L, Viganò P, Vercellini P, Fedele L. Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antimüllerian hormone level modifications. Fertil Steril 2012; 98 (06) 1531-1538
    CrossrefPubMedGoogle Scholar
  • 33 Ghasemi Tehrani H, Tavakoli R, Hashemi M, Haghighat S. Ethanol sclerotherapy versus laparoscopic surgery in management of ovarian endometrioma; a randomized clinical trial. Arch Acad Emerg Med 2022; 10 (01) e55
    PubMedGoogle Scholar
  • 34 Koo JH, Lee I, Han K. et al. Comparison of the therapeutic efficacy and ovarian reserve between catheter-directed sclerotherapy and surgical excision for ovarian endometrioma. Eur Radiol 2021; 31 (01) 543-548
    CrossrefPubMedGoogle Scholar
  • 35 Cohen A, Almog B, Tulandi T. Sclerotherapy in the management of ovarian endometrioma: systematic review and meta-analysis. Fertil Steril 2017; 108 (01) 117-124.e5
    CrossrefPubMedGoogle Scholar
  • 36 Noma J, Yoshida N. Efficacy of ethanol sclerotherapy for ovarian endometriomas. Int J Gynaecol Obstet 2001; 72 (01) 35-39
    CrossrefPubMedGoogle Scholar
  • 37 Wang LL, Dong XQ, Shao XH, Wang SM. Ultrasound-guided interventional therapy for recurrent ovarian chocolate cysts. Ultrasound Med Biol 2011; 37 (10) 1596-1602
    CrossrefPubMedGoogle Scholar
  • 38 Jee BC. Efficacy of ablation and sclerotherapy for the management of ovarian endometrioma: a narrative review. Clin Exp Reprod Med 2022; 49 (02) 76-86
    CrossrefPubMedGoogle Scholar
  • 39 Yazbeck C, Madelenat P, Ayel JP. et al. Ethanol sclerotherapy: a treatment option for ovarian endometriomas before ovarian stimulation. Reprod Biomed Online 2009; 19 (01) 121-125
    CrossrefPubMedGoogle Scholar
  • 40 Alborzi S, Askary E, Keramati P. et al. Assisted reproductive technique outcomes in patients with endometrioma undergoing sclerotherapy vs laparoscopic cystectomy: prospective cross-sectional study. Reprod Med Biol 2021; 20 (03) 313-320
    CrossrefPubMedGoogle Scholar
  • 41 Lee KH, Kim CH, Lee YJ, Kim SH, Chae HD, Kang BM. Surgical resection or aspiration with ethanol sclerotherapy of endometrioma before in vitro fertilization in infertile women with endometrioma. Obstet Gynecol Sci 2014; 57 (04) 297-303
    CrossrefPubMedGoogle Scholar
  • 42 Aflatoonian A, Rahmani E, Rahsepar M. Assessing the efficacy of aspiration and ethanol injection in recurrent endometrioma before IVF cycle: a randomized clinical trial. Iran J Reprod Med 2013; 11 (03) 179-184
    PubMedGoogle Scholar