Parasar, P., Ozcan, P., & Terry, K. L. (2017). Endometriosis: Epidemiology, Diagnosis and Clinical Management. Current obstetrics and gynecology reports, 6(1), 34-41. https://doi.org/10.1007/s13669-017-0187-1
Parasar P, Ozcan P, Terry KL. Endometriosis: Epidemiology, Diagnosis and Clinical Management. Current obstetrics and gynecology reports. 2017;6(1):34-41. doi:10.1007/s13669-017-0187-1
Parasar, Parveen, et al. "Endometriosis: Epidemiology, Diagnosis and Clinical Management." Current obstetrics and gynecology reports, vol. 6, no. 1, 2017, pp. 34-41.
No blood or urine test reliably diagnoses endometriosis yet
No blood, urine, or period-fluid test reliably diagnoses endometriosis yet, so diagnosis still needs laparoscopy and a biopsy. This 2017 narrative review describes risk, diagnosis, and care. Patients aged 18 to 45 wait 6.7 years on average.
Study at a glance, narrative review: No blood or urine test reliably diagnoses endometriosis yet. Source: Parasar P et al., 2017, PMID 29276652.
Key Findings
The review puts endometriosis at 10–15% of women of reproductive age and 70% of women with chronic pelvic pain.
Patients aged 18–45 years wait 6.7 years on average for a diagnosis.
Early menarche and short cycles are associated with higher risk. Having given birth and current oral contraceptive use are associated with lower risk.
Transvaginal ultrasound finds ovarian endometriotic cysts. It does not rule out peritoneal disease, adhesions, or deep infiltrating endometriosis.
Endometriosis comes back in 5 to 15% of cases after hysterectomy with bilateral oophorectomy.
Interpretation
This narrative review summarizes published research on endometriosis risk, diagnosis, and care. Early menarche and short cycles are linked to higher risk. Giving birth and current birth control pill use are linked to lower risk. Most studies found lower risk in current pill users and higher risk in past users. The authors think this may reflect symptoms that pills suppress and that return once a woman stops them. Smoking, alcohol, and caffeine results were mixed across studies. The authors call for future studies with surgically confirmed cases and well-matched control groups to sharpen these risk estimates.
RRM Context
Restorative reproductive medicine puts finding the cause first. The review reports that symptoms track poorly with disease burden. Pelvic pain has many possible sources, which supports a full workup instead of one test. Conventional care often starts with birth control pills, and the authors note recurrence is not uncommon despite treatment. Excision removes the disease itself.
Our editorial summary of this paper, not the article's abstract.
Abstract
Purpose of Review
Endometriosis is a disease of adolescents and reproductive-aged women characterized by the presence of endometrial tissue outside the uterine cavity and commonly associated with chronic pelvic pain and infertility. Here we review the epidemiology of endometriosis as well as potential biomarkers for detection and with the goal of highlighting risk factors that could be used in combination with biomarkers to identify and treat women with endometriosis earlier..
Recent Findings
Early age at menarche, shorter menstrual length, and taller height are associated with a higher risk of endometriosis while parity, higher body mass index (BMI) and smoking are associated with decreased risk. Endometriosis often presents as infertility or continued pelvic pain despite treatment with analgesics and cyclic oral contraceptive pills.
Summary
Despite a range of symptoms, diagnosis of endometriosis is often delayed due to lack of non-invasive, definitive and consistent biomarkers for diagnosis of endometriosis. Hormone therapy and analgesics are used for treatment of symptomatic endometriosis. However, the efficacy of these treatments are limited as endometriosis often recurs. In this review, we describe potential diagnostic biomarkers and risk factors that may be used as early non-invasive in vitro tools for identification of endometriosis to minimize diagnostic delay and improve reproductive health of patients.
Endometriosis is a chronic inflammatory disease that drives pain, organ dysfunction, and infertility. How RRM-trained clinicians diagnose and treat it through excision surgery, cycle charting, and longitudinal care.
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