Recurrent genital endometriosis: risk factors and possible prevention strategy

In: Journal of obstetrics and women's diseases · 2023 · vol. 72(2) , pp. 95–103 · doi:10.17816/jowd125109 · W4377029451
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AI-generated summary by claude@2026-06, 2026-06-08

This review analyzes literature on endometriosis recurrence, its risk factors, and prevention strategies, highlighting the need for personalized approaches due to a persistent high recurrence rate.

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This narrative review examines how recurrent genital endometriosis is defined and what factors are associated with recurrence, drawing on literature across symptoms, diagnostic laboratory testing, hormonal therapies, and surgical features that may influence relapse risk. The authors report that, despite advances in understanding endometriosis mechanisms and using combined treatment approaches, recurrence remains a major unresolved problem, with reported recurrence rates varying widely across sources. A key limitation explicitly noted is that the recurrence issue is not solved and the evidence base is heterogeneous, prompting the need for improved early diagnosis and risk-stratified, personalized approaches. This paper is centrally about endometriosis — it specifically reviews risk factors and potential prevention strategies for recurrent genital endometriosis.

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Abstract

Endometriosis is one of the most common gynecological diseases in women of reproductive age, which is characterized by a relapsing course. The recurrence rate varies greatly among literary sources. This review covers symptoms and types of endometriosis, laboratory tests, options for hormonal therapy, as well as features of surgical approaches that may be associated with the disease recurrence risk. The aim of this article was to analyze and summarize current literature on the definition of endometriosis recurrence, risk factors and prevention strategy. Despite advances in the study of various mechanisms for the development of endometriosis and the use of combined treatment, a high recurrence rate remains an unsolved problem for this disease. All of this underscores the need to develop new methods for early diagnosis and treatment, taking into account the risk group and a personalized approach.
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Abstract

Endometriosis is one of the most common gynecological diseases in women of reproductive age, which is characterized by a relapsing course. The recurrence rate varies greatly among literary sources. This review covers symptoms and types of endometriosis, laboratory tests, options for hormonal therapy, as well as features of surgical approaches that may be associated with the disease recurrence risk. The aim of this article was to analyze and summarize current literature on the definition of endometriosis recurrence, risk factors and prevention strategy. Despite advances in the study of various mechanisms for the development of endometriosis and the use of combined treatment, a high recurrence rate remains an unsolved problem for this disease. All of this underscores the need to develop new methods for early diagnosis and treatment, taking into account the risk group and a personalized approach.

Keywords

Full Text About the authors Valeriia O. Semenova The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott Author for correspondence. Email: [email protected] ORCID iD: 0000-0002-9101-1981 SPIN-code: 1422-8060 Scopus Author ID: 57863306500 ResearcherId: HKF-5961-2023 MD, PhD student Russian Federation, Saint PetersburgMaria I. Yarmolinskaya The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott; North-Western State Medical University named after I.I. Mechnikov Email: [email protected] ORCID iD: 0000-0002-6551-4147 SPIN-code: 3686-3605 Scopus Author ID: 7801562649 ResearcherId: 2183-2014 MD, Dr. Sci. (Med.), Professor, Professor of the Russian Academy of Sciences Russian Federation, Saint Petersburg; Saint PetersburgReferences - Rossiyskoe obshchestvo akusherov ginekologov (ROAG). Endometrioz. Klinicheskie rekomendatsii. 2020. (In Russ.) [cited 2023 Jan 16]. Available from: https://roag-portal.ru/recommendations_gynecology - Medikamentoznaya terapiya genital’nogo endometrioza: realii i perspektivy: rukovodstvo dlya vrachey. Ed. by M.I. Yarmolinskaya. Moscow: GEOTAR-Media; 2021. (In Russ.) doi: 10.33029/9704-6034-4-MET-2021-1-384 - Horne A, Missmer S. Pathophysiology, diagnosis, and management of endometriosis. BMJ. 2022;379. doi: 10.1136/bmj-2022-070750 - Chen I, Veth VB, Choudhry AJ, et al. Pre- and postsurgical medical therapy for endometriosis surgery. Cochrane Database Syst Rev. 2020;11(11). doi: 10.1002/14651858.CD003678.pub3 - Sasamoto N, Ngo L, Vitonis AF, et al. Circulating proteomic profiles associated with endometriosis in adolescents and young adults. Hum Reprod. 2022;37(9):2042–2053. doi: 10.1093/humrep/deac146 - Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020;382:1244–1256. doi: 10.1056/nejmra1810764 - Marchandot B, Curtiaud A, Matsushita K, et al. Endometriosis and cardiovascular disease. Eur Heart J Open. 2022;2(1). doi: 10.1093/ehjopen/oeac001 - Ceccaroni M, Bounous VE, Clarizia R, et al. Recurrent endometriosis: a battle against an unknown enemy. Eur J Contracept Reprod Health Care. 2019;24(6):464–474. doi: 10.1080/13625187.2019.1662391 - Aylamazyan EK, Yarmolinskaya MI. Molotkov AS, et al. Classifications of endometriosis. Journal of Obstetrics and Women’s Diseases. 2017;66(2):77–92. (In Russ.) doi: 10.1016/10.17816/JOWD66277-92 - Nirgianakis K, Ma L, McKinnon B, et al. Recurrence patterns after surgery in patients with different endometriosis subtypes: a long-term hospital-based cohort study. J Clin Med. 2020;9(2):496. doi: 10.3390/jcm9020496 - Selçuk I., Bozdağ G. Recurrence of endometriosis; risk factors, mechanisms and biomarkers; review of the literature. J Turk Ger Gynecol Assoc. 2013;14(2):98–103. doi: 10.5152/jtgga.2013.52385 - Dückelmann AM, Taube E, Abesadze E, et al. When and how should peritoneal endometriosis be operated on in order to improve fertility rates and symptoms? The experience and outcomes of nearly 100 cases. Arch Gynecol Obstet. 2021;304(1):143–155. doi: 10.1007/s00404-021-05971-6 - Gubbels AL, Li R, Kreher D, et al. Prevalence of occult microscopic endometriosis in clinically negative peritoneum during laparoscopy for chronic pelvic pain. Int J Gynaecol Obstet. 2020;151(2):260–266. doi: 10.1002/ijgo.13303 - Li XY, Chao XP, Leng JH, et al. Risk factors for postoperative recurrence of ovarian endometriosis: long-term follow-up of 358 women. J Ovarian Res. 2019;12(1):79. doi: 10.1186/s13048-019-0552-y - Lee SY, Kim ML, Seong SJ, et al. Recurrence of ovarian endometrioma in adolescents after conservative, laparoscopic cyst enucleation. J Pediatr Adolesc Gynecol. 2017;30(2):228–233. doi: 10.1016/j.jpag.2015.11.001 - Somigliana E, Viganò P, Benaglia L, et al. Ovarian stimulation and endometriosis progression or recurrence: a systematic review. Reprod Biomed Online. 2019;38(2):185–194. doi: 10.1016/j.rbmo.2018.11.021 - ESHRE Endometriosis Guideline Development Group. Endometriosis. Guideline of European Society of Human Reproduction and Embryology. 2022 [cited 2023 Jan 16]. Available from: https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Endometriosis-guideline - Selcuk S, Cam C, Koc N, et al. Evaluation of risk factors for the recurrence of ovarian endometriomas. Eur J Obstet Gynecol Reprod Biol. 2016;203:56–60. doi: 10.1016/j.ejogrb.2016.05.008 - Nezhat C, Hajhosseini B, King LP. Laparoscopic management of bowel endometriosis: predictors of severe disease and recurrence. JSLS. 2011;15(4):431–438. doi: 10.4293/108680811x13176785203752 - Aarestrup J, Jensen BW, Ulrich LG, et al. Birth weight, childhood body mass index and height and risks of endometriosis and adenomyosis. Ann Hum Biol. 2020;47(2):173–180. doi: 10.1080/03014460.2020.1727011 - Shah DK, Correia KF, Vitonis AF, et al. Body size and endometriosis: results from 20 years of follow-up within the Nurses’ Health Study II prospective cohort. Hum Reprodn. 2013;28(7):1783–1792. doi: 10.1093/humrep/det120 - Tobiume T, Kotani Y, Takaya H, et al. Determinant factors of postoperative recurrence of endometriosis: difference between endometrioma and pain. Eur J Obstet Gynecol Reprod Biol. 2016;205:54–59. doi: 10.1016/j.ejogrb.2016.07.516 - Gu Z, Li X, Shi J, et al. The development of predictive nomogram of recurrence for patients with endometrioma after cystectomy who were younger than 45 years old and received postoperative therapy. Front Med (Lausanne). 2022;9:872481. doi: 10.3389/fmed.2022.872481 - Yarmolinskaya MI, Semenova VO, Beganova AK. Molecular biological profile of the endometrium in patients with endometriosis (literature review). Russian Journal of Human Reproduction. 2022;28(3):54–65. (In Russ.) doi: 10.17116/repro20222803154 - Xu X, Chen Y, Yu Q, et al. The presence of living endometrial cells in ovarian endometriotic cyst fluid may contribute to the recurrence of endometriosis after surgical excision of endometriomas. J Ovarian Res. 2022;15(1):89. doi: 10.1186/s13048-022-01018-9 - Yarmolinskaya MI, Adamyan LV. Hormonal contraceptives and endometriosis: modern view on the problem. Russian Journal of Human Reproduction. 2020;26(3):39–45. (In Russ.) doi: 10.17116/repro20202603139 - Zakhari A, Delpero E, McKeown S, et al. Endometriosis recurrence following post-operative hormonal suppression: a systematic review and meta-analysis. Hum Reprod Update. 2021:27(1):96–107. doi: 10.1093/humupd/dmaa033 - Wattanayingcharoenchai R, Rattanasiri S, Charakorn C, et al. Postoperative hormonal treatment for prevention of endometrioma recurrence after ovarian cystectomy: a systematic review and network meta-analysis. BJOG. 2021;128(1):25–35. doi: 10.1111/1471-0528.16366

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