Carey, E. T., Wong, J. M. K., & Khan, Z. (2025). Comprehensive Review of Endometriosis Care. Obstetrics & Gynecology. https://doi.org/10.1097/AOG.0000000000006004
Carey ET, Wong JMK, Khan Z. Comprehensive Review of Endometriosis Care. Obstetrics & Gynecology. 2025. doi:10.1097/AOG.0000000000006004
Carey, Erin T., et al. "Comprehensive Review of Endometriosis Care." Obstetrics & Gynecology, 2025.
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RRM Academy Synopsis
Endometriosis drugs and surgery often give limited benefit
A 2025 expert review in Obstetrics & Gynecology finds that endometriosis treatments often give limited benefit, and recurrence after surgery is significant. The authors sum up past research on causes, tests, drugs, surgery and pregnancy. The review adds no new patient data.
Key Findings
About 10% of reproductive-aged individuals with a uterus have endometriosis. Pain severity has not been found to match how severe the disease is.
In couples with endometriosis, natural fecundity can fall to 2–10%. Spontaneous pregnancy rates can reach 22% following full removal of the disease.
After ovarian endometrioma surgery, only 3–16% of patients needed more surgery when the cyst was excised, versus 32% after drainage and ablation.
When surgery spares the ovaries, reoperation rates run up to 58%.
Approximately 30% of patients report no better pelvic pain on combined hormonal contraceptives, a suppressive medication.
Interpretation
The paper is a clinical review of earlier studies, so each figure is only as strong as the study behind it. The authors say the cause of endometriosis-associated infertility is still uncertain, and the link between the three disease forms is unclear. They call for larger studies of ablation versus excision for superficial disease. The fertility benefit of surgery for deep disease is unclear. The authors state that hormonal medical therapy cannot be used by patients actively seeking fertility. A Cochrane review found no imaging method able to replace surgery for diagnosis. The authors add that no blood, saliva or endometrial marker reliably meets the diagnostic criteria.
RRM Context
Restorative reproductive medicine looks for the cause of pain and infertility in each couple and treats it. The review says a response to drugs does not settle whether a patient has endometriosis. That supports evaluation before treatment. The cyst figures favor excision: 3–16% needed more surgery after excision, against 32% after drainage and ablation.
Our editorial summary of this paper, not the article's abstract.
Abstract
Endometriosis is an estrogen-dependent, chronic inflammatory disorder characterized by the presence of endometrium-like tissue outside the uterus, affecting approximately 10% of individuals of reproductive age. It contributes to chronic pelvic pain, dysmenorrhea, and subfertility, resulting in substantial societal economic burdens. Genetic and environmental risk factors have been identified, and recent research suggests that endometriosis functions as a systemic disease affecting nonreproductive systems and increasing susceptibility to other health conditions. Various phenotypes-superficial peritoneal endometriosis, ovarian endometriomas, and deep endometriosis-may develop under different mechanisms, yet the relationship between these presentations remains unclear. Diagnosis relies on clinical evaluation, imaging, and surgical staging, and the advent of advanced ultrasonography and magnetic resonance imaging has helped to enhance accuracy. Although medical management focuses on hormonal modulation to alleviate symptoms, surgical intervention remains a critical tool for refractory symptoms. Postoperative care and patient education are essential to manage recurrence and to improve quality of life. Current research emphasizes the need for comprehensive, interdisciplinary approaches to endometriosis management, incorporating novel diagnostic tools, diverse therapeutic avenues, and patient-centered care models. Addressing disparities in treatment access is essential to improving outcomes. To achieve this, recruiting and analyzing data from racially, socioeconomically, and geographically diverse cohorts will reveal how disease presentation and treatment efficacy vary across populations. Continued efforts in research and health care policy are necessary to develop effective and personalized strategies in managing endometriosis.