{"paper_id":"62e686dc-de7e-4b5a-ad39-9f0a09b9e885","body_text":"EDITORIAL\nIrish Journal of Medical Science (1971 -) (2026) 195:223–224\nhttps://doi.org/10.1007/s11845-025-04143-8\noften have mild-moderate disease while some women with \nsevere disease have few or no symptoms. Infertility can be \nthe main manifestation of disease for some women and up \nto 50% of women with infertility have endometriosis [ 2]. \nSome of these women are asymptomatic or do not recognise \ntheir symptoms as abnormal until they receive a diagnosis \nof endometriosis during their infertility workup.\nEndometriosis may be suspected clinically based on \nsymptom history and physical examination findings. Ultra -\nsound and MRI may also support a diagnosis of disease \nwhere ovarian involvement (endometriomas) or deep nod -\nular disease are detected. Definitive diagnosis is based on \nlaparoscopic visualisation and histological confirmation \nof disease. Women should be informed that laparoscopy \nhas surgical and anaesthetic risks, and that surgery may be \navoidable with successful empiric treatment. Empiric treat-\nment can sufficiently manage endometriosis symptoms for \nmany women, and it should be initiated in primary care. \nThe choice of empiric therapy depends on the severity of \nsymptoms and the woman’s reproductive aspirations. Non-\nsteroidal anti-inflammatory drugs (NSAIDs) are frequently \nused to manage pain, but they do not address the underly -\ning disease. Hormonal treatments including combined oral \ncontraceptives, progestin-only contraceptives and gonado -\ntropin-releasing hormone (GnRH) analogues aim to reduce \nor suppress oestrogen levels, thus suppressing the disease \nprocess. Surgery is typically recommended for women with \npersistent symptoms despite medical therapy, for women \nwho cannot tolerate medical therapies due to side effects, \nor for women with infertility where endometriosis may be \na contributing factor. Laparoscopy is the gold standard for \ndiagnosis and for the removal of endometriotic lesions for \nsymptomatic relief - this may involve excising or ablating \nlesions, removing scar tissue, and, in severe cases, address-\ning organ involvement with the input of colorectal surgeons \nand urologists. Additional supportive therapies play a cru -\ncial role in addressing the multifaceted nature of endome -\ntriosis. Pain management clinics and pelvic physiotherapy \ncan help manage chronic pain, while counselling and cogni-\ntive behavioural therapy can improve the mental health of \nEndometriosis is a challenging chronic disease that deserves \nincreased recognition, not least because the diagnosis is \noften delayed, and the implications can be life altering. The \nsystematic review and meta-analysis published by Özcan et \nal. in this journal highlights the importance of support for \npeople with endometriosis to help manage the symptoms of \ntheir disease and deserves recognition for the work that con-\ntinues to advocate for high quality and holistic assessment \nand care [1].\nEndometriosis is characterised by the growth of endome-\ntrial-like tissue outside the uterus. It is a hormone-mediated \ncondition driven by oestrogen from the onset of menstrua -\ntion (menarche). The endometrial-like tissue causes a \nchronic inflammatory response that can lead to scar tissue \nformation in the pelvis and in rare cases elsewhere in the \nbody. Various causes have been postulated but none proven.\nEndometriosis symptoms are highly variable – for some \nwomen these symptoms can be debilitating and can severely \nimpact on quality of life. Classically women report lower \nabdominal/pelvic pain symptoms such as painful periods \n(dysmenorrhoea), pain during or after sexual intercourse \n(dyspareunia) and/or pain on defaecation (dyschezia). Some \nwomen may report chronic non-cyclical pelvic pain (i.e. \nnot related to their menstrual cycle) while others have no \npain symptoms. Additionally, women may present with \nnon-specific symptoms that overlap with other medical con-\nditions, such as bloating, nausea and fatigue, while others \nmay experience depression or anxiety. Various classification \nsystems have been developed to categorise disease severity \nbased on the anatomy of endometriotic lesions, however the \nanatomical severity of disease often does not correlate with \nclinical symptoms. Many women with severe symptoms \n \r David James Rooney\ndavid.rooney@hse.ie\n1 Specialist Registrar in Obstetrics and Gynaecology, National \nMaternity Hospital, Dublin, Ireland\n2 Consultant Gynaecologist, National Maternity Hospital, St \nVincents University Hospital, Dublin, Ireland\nPublished online: 11 November 2025\n© The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland 2025\nEndometriosis – a prevalent but often underestimated condition\nDavid James Rooney1 · Zara Fonseca-Kelly2\n1 3\n\nIrish Journal of Medical Science (1971 -) (2026) 195:223–224\nthose suffering from anxiety or depression related to their \ncondition.\nIt is thought that up to 10% of women and girls are \naffected by endometriosis globally, but for many a diagno -\nsis is delayed or remains elusive [ 2]. Barriers to diagnosis \nand effective treatment include: a lack of education and \nawareness of endometriosis symptoms amongst the gen -\neral public; a lack of training and guidance in endometrio -\nsis diagnosis and management among healthcare providers \nincluding general practitioners and general gynaecologists; \nchallenges for both patients and clinicians in recognising \nendometriosis due to the heterogeneity of symptom presen-\ntation – these symptoms often overlap with other medical \nconditions that may actually be causing or contributing to \nthe patients symptomatology; a lack of access to diagnostic \nimaging such as ultrasound and MRI; a lack of experience/\ntraining amongst gynaecologists in laparoscopic diagnosis \nand treatment of endometriosis; a lack of access to specialist \nendometriosis services with multidisciplinary teams to man-\nage complex disease; and a lack of access to surgery due to \noperating theatre waiting lists.\nThe National Framework for Endometriosis Care in \nIreland developed by the Health Service Executive (HSE) \nand the National Women and Infants Health Programme \n(NWIHP) aims to improve access to endometriosis care \nthrough the establishment of five regional endometriosis \nhubs and two supra-regional specialist centres in Dublin \nand Cork [3]. The continued implementation of this frame -\nwork (announced in 2023) is of paramount importance for \nIrish women suffering from endometriosis symptoms and \nfor clinicians who want to provide the highest standards of \ncare in a timely manner. Barriers to the implementation of \nthe framework remain, particularly in the areas of training, \nrecruitment and retention of specialists and in terms of wait-\ning lists for access to specialist clinics, diagnostic imaging \nand theatre. The HSE National Clinical Practice Guide -\nline on the Assessment and Management of Endometriosis \n(March 2025) will further improve standards of care for \nIrish patients as it provides a comprehensive standardised \ntemplate for the assessment and management of women \nwith endometriosis symptoms and endometriosis-associated \ninfertility [4].\nReferences\n1. Özcan H, Çuvadar A, Uzun S (2025) The effect of psychothera -\npeutic interventions on pain and quality of life in endometrio -\nsis: a systematic review and meta-analysis study. Ir J Med Sci \n194(4):1391–1400.  h t t p  s : /  / d o i  . o  r g /  1 0 . 1  0 0 7  / s 1  1 8 4 5 - 0 2 5 - 0 3 9 8 5 - 6\n2. World Health Organization (2023) Endometriosis [Fact Sheet]. \nAvailable at:  h t t p  s : /  / w w w  . w  h o .  i n t /  n e w  s - r  o o m  / f a  c t - s  h e  e t s  / d e t  a i l  / e \nn  d o m e t r i o s i s. Accessed 16 Jun 2025\n3. Department of Health (2023) Minister for Health announces \ndevelopment of the National Endometriosis Framework [Press \nRelease]. Available at:  h t t p  s : /  / w w w  . g  o v .  i e / e  n / d  e p a  r t m  e n t  - o f -  h e  a \nl t  h / p r  e s s  - r e  l e a  s e s  / m i n  i s  t e r  - f o r  - h e  a l t  h - a  n n o  u n c e  s -  d e v  e l o p  m e n  t - o  \nf - t  h e -  n a t i  o n  a l - e n d o m e t r i o s i s - f r a m e w o r k /. Accessed 16 Jun 2025\n4. DeMaio A, McTiernan A, Durand O, Connor A et al (2025) \nNational Clinical Practice Guideline: Assessment and Manage -\nment of Endometriosis. National Women and Infants Health Pro-\ngramme and The Institute of Obstetricians and Gynaecologists.  h \nt t p s :   /  / w w  w . h  s  e  .  i e  / e  n  g / a  b  o  u t /   w h o /  a  c  u t e  - h o  s p i   t a l  s - d  i v  i  s i o  n /   w o m  a \nn - i   n f a  n t  s / c  l  i n  i c a l  - g  u i  d  e l i  n e s /  a s  s  e s  s  m e  n t -  a n d  - m a  n a  g e m e n t - o f - e n \nd o  m e t r  i  o s i s - 2 0 2 5 - . p d f. Accessed 17 Jun 2025\nPublisher’s Note Springer Nature remains neutral with regard to juris-\ndictional claims in published maps and institutional affiliations.\n1 3\n224","source_license":"public-domain-us","license_restricted":false}