Endometriosis: Pathogenesis, Diagnosis and Treatment, volume II

In: Frontiers Research Topics · 2024 · doi:10.3389/978-2-8325-4894-3 · W4396929758
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This paper is a research-topic call describing the state of knowledge and research priorities for endometriosis, focusing on pathogenesis, diagnosis, and treatment. It outlines clinical approaches such as transvaginal ultrasonography as first-line imaging, MRI/virtual colonoscopy for suspected bowel or urinary tract disease, hormonal therapy as first-line pain treatment (with combined estroprogestins/progestins and second-line GnRH analogues/antagonists), and mentions aromatase inhibitors as proposed but not approved outside scientific research; it also notes that hormonal therapy is not curative and symptoms often recur after stopping. Surgical excision is described as an option for persistent pain or refusal of hormonal therapies, with the caveat that procedures are challenging and recurrence can occur, and it states that infertility is usually treated with in vitro fertilization while the role of pre-treatment hormonal therapy is unclear. This paper is centrally about endometriosis — it serves as a Frontiers in Endocrinology Research Topic overview on endometriosis pathogenesis, diagnosis, and treatment.

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Abstract

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*This Research Topic is a continuation of " Endometriosis: Pathogenesis, Diagnosis and Treatment"* Endometriosis is a benign gynecological condition that causes pain symptoms and infertility; these symptoms may significantly impair quality of life. It affects at least 4% of reproductive age women. Over the last 20 year several improvements have been made in the understanding of the molecular pathways involved in the pathogenesis of endometriosis which however remains to be fully elucidated. Transvaginal ultrasonography is the first line imaging technique used for the diagnosis of endometriosis, radiological imaging (such as magnetic resonance imaging and virtual colonoscopy) can be used for patients with suspicion of bowel or urinary tract endometriosis. Hormonal therapy is the first-line treatment of endometriosis related pain. First-line therapies are combined estroprogestins combinations and progestins. Second-line therapies include gonadotropin releasing hormone analogue and gonadotropin releasing hormone antagonist. Aromatase inhibitors have been proposed for the treatment of endometriosis but they are not approved for this use and they should be administered only in the setting of scientific research. Although, hormonal therapy decreases the intensity of pain symptoms, it is not curative, and symptoms usually recur after the discontinuation of treatment. Surgical excision of endometriosis may be offered to patients refusing hormonal therapies and to those suffering pain symptoms persisting despite the use of hormonal therapies. These surgical procedures can be challenging and require extensive experience in minimally invasive surgery. Endometriosis may recur after surgery and hormonal therapies may be used to decrease the risk of recurrence. Endometriosis-related infertility is usually treated by in vitro fertilization; the role of hormonal therapies before infertility treatment is unclear. Given the importance of this topic, Frontiers in Endocrinology is launching a Research Topic entitled “Endometriosis: Pathogenesis, Diagnosis and Treatment”, with the aim of gathering together accurate and up-to-date scientific information on all aspects of endometriosis. We are pleased to invite you and your co-workers to submit your original research articles reporting on the mechanisms involved in the pathogenesis of endometriosis. Moreover, we invite you to submit clinical studies investigating the methods used for the diagnosis of endometriosis, the role on hormonal therapies in the treatment of pain and infertility in women with endometriosis and the role of surgery in improving endometriosis-related symptoms. We would also like to invite you to submit review articles aimed at providing a comprehensive overview of the recent advances in understanding of all of the discussed aspects of endometriosis. *This Research Topic is a continuation of " Endometriosis: Pathogenesis, Diagnosis and Treatment"* Endometriosis is a benign gynecological condition that causes pain symptoms and infertility; these symptoms may significantly impair quality of life. It affects at least 4% of reproductive age women. Over the last 20 year several improvements have been made in the understanding of the molecular pathways involved in the pathogenesis of endometriosis which however remains to be fully elucidated. Transvaginal ultrasonography is the first line imaging technique used for the diagnosis of endometriosis, radiological imaging (such as magnetic resonance imaging and virtual colonoscopy) can be used for patients with suspicion of bowel or urinary tract endometriosis. Hormonal therapy is the first-line treatment of endometriosis related pain. First-line therapies are combined estroprogestins combinations and progestins. Second-line therapies include gonadotropin releasing hormone analogue and gonadotropin releasing hormone antagonist. Aromatase inhibitors have been proposed for the treatment of endometriosis but they are not approved for this use and they should be administered only in the setting of scientific research. Although, hormonal therapy decreases the intensity of pain symptoms, it is not curative, and symptoms usually recur after the discontinuation of treatment. Surgical excision of endometriosis may be offered to patients refusing hormonal therapies and to those suffering pain symptoms persisting despite the use of hormonal therapies. These surgical procedures can be challenging and require extensive experience in minimally invasive surgery. Endometriosis may recur after surgery and hormonal therapies may be used to decrease the risk of recurrence. Endometriosis-related infertility is usually treated by in vitro fertilization; the role of hormonal therapies before infertility treatment is unclear. Given the importance of this topic, Frontiers in Endocrinology is launching a Research Topic entitled “Endometriosis: Pathogenesis, Diagnosis and Treatment”, with the aim of gathering together accurate and up-to-date scientific information on all aspects of endometriosis. We are pleased to invite you and your co-workers to submit your original research articles reporting on the mechanisms involved in the pathogenesis of endometriosis. Moreover, we invite you to submit clinical studies investigating the methods used for the diagnosis of endometriosis, the role on hormonal therapies in the treatment of pain and infertility in women with endometriosis and the role of surgery in improving endometriosis-related symptoms. We would also like to invite you to submit review articles aimed at providing a comprehensive overview of the recent advances in understanding of all of the discussed aspects of endometriosis.

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