Endometriosis

[author photo]Endometriosis is among the most common gynecologic disorders associated with infertility and pelvic pain. Endometriosis is one of the leading causes of disability among reproductive aged women in the United States and represents a major personal and public health concern. The pathogenesis of endometriosis has puzzled researchers for most of the century, and it still remains one of the most enigmatic disorders in gynecology. In the last decade alone more than 4000 articles on endometriosis appeared in the world scientific literature, many of them contradictory, reflecting our difficulties in deciphering this disorder.

More recently, the application of cellular and molecular biology techniques to the study of endometriosis allowed us to better understand the pathogenesis and pathophysiology of endometriosis and helped us to develop new therapeutic approaches. This special issue of Seminars in Reproductive Medicine is designed to present both cellular and molecular aspects and clinical management of endometriosis. A diverse group of internationally recognized experts have come together to provide a detailed discussion of various aspects of endometriosis. I would like to express my gratitude to all authors, who, despite their other responsibilities, took the time to contribute to this issue.

The opening article of this issue is devoted to the genetics of endometriosis by Dr. Stephen Kennedy, who reviewed the positional cloning approach. That article is followed by Dr. Linda Giudice's overview of the role of genomics in understanding the pathogenesis of endometriosis.

Endometriosis is clearly an estrogen-dependent disease, yet circulating levels of estrogen are not different in women with and without endometriosis. Drs. Gurates and Bulun discuss the relevance of locally produced estrogen in the pathogenesis of endometriosis. Dr. Seli and I review the interaction of immune and endocrine systems in the pathogenesis of endometriosis.

Drs. Rier and Foster review the role of environmental dioxins in endometriosis. Drs. Osteen, Yeaman, and Bruner-Tran discuss the role of matrix metalloproteins in endometriosis. Dr. Garcia-Velasco and I review the relevance of apoptosis, the programmed cell death, believed to play a role in the pathogenesis of endometriosis. Dr. Witz reviews cell adhesion molecules in endometriosis.

In the second part of this issue, the focus becomes more clinical. Changes in uterine and ovarian function in endometriosis are outlined by Drs. Garrido, Pellicer, Remohí, and Simón. In clinical practice, the diagnosis of endometriosis remains a major challenge. Drs. Spaczynski and Duleba review challenges in the diagnosis of endometriosis. Equally difficult is the establishment of guidelines of therapy for endometriosis. Dr. Olive summarizes medical therapies available for endometriosis. Following this chapter, Dr. Adamson overviews surgical management of endometriosis. The relative place of combination therapy in the treatment of endometriosis also remains controversial. Drs. Donnez, Pirard, Smets, Jadoul, and Squifflet discuss pre- and postsurgical management of endometriosis. The relationship between endometriosis and subfertility is discussed by Drs. D'Hooghe, Debrock, Hill, and Meuleman. Finally, an overview on where we should be heading in endometriosis research is given by Drs. Hastings and Fazleabas.

I thank my colleagues who contributed their time, effort, and expertise to this issue. I also thank Dr. Bruce Carr for inviting me to guest edit this issue. I do hope that this issue will serve women, their physicians, and investigators well in the ongoing battle against this enigmatic disease.