Endometriosis Diagnosis

Comprehensive Review of Endometriosis Care

Carey ET, Wong JMK, Khan Z

Published July 17, 2025 Obstetrics & Gynecology
DOI 10.1097/AOG.0000000000006004 PMID 40674745

RRM Academy Synopsis

Endometriosis drugs and surgery often give limited benefit

A 2025 review in Obstetrics & Gynecology covers endometriosis care. It finds that endometriosis treatments often give limited benefit, and recurrence after surgery is common. The authors sum up past research on causes, tests, drugs, surgery and pregnancy.

About 1 in 10 women of reproductive age have endometriosis
About 1 in 10 women of reproductive age have endometriosis. Source: Carey ET et al., 2025, PMID 40674745.
Study at a glance: Endometriosis treatments often give limited benefit, and recurrence is common
Study at a glance, review in Obstetrics & Gynecology: Endometriosis treatments often give limited benefit, and recurrence is common. Source: Carey ET et al., 2025, PMID 40674745.

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

This review pulls together past research on endometriosis causes, tests, treatment and fertility. The authors say the cause of infertility linked to endometriosis is still unclear. They say how the three disease forms connect is also unclear. Patients trying to get pregnant cannot use hormonal medical therapy. A Cochrane review found no imaging test that can replace surgery for diagnosis. No blood, saliva or tissue marker reliably meets the diagnostic standard. The authors note that larger studies are needed to compare ablation and excision for mild disease.

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. Only 3 to 16% needed more surgery after excision. 32% needed more surgery after drainage and ablation.

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.

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Topics

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Endometriosis › Diagnosis › Staging and Classification · General Gynecology › Pelvic Pain › Chronic Pelvic Pain · Diagnostics › Ultrasound › Transvaginal Ultrasound
Erin T Carey, Jacqueline M K Wong, Zaraq Khan
E Carey, J Wong, Z Khan
PMID 40674745 40674745 DOI 10.1097/AOG.0000000000006004 10.1097/AOG.0000000000006004 Carey et al. 2025, Carey 2025