Rethinking endometriosis and pelvic pain

Kristin Patzkowsky
The Journal of clinical investigation · 2021 · vol. 131(20) · doi:10.1172/jci154876 · PMID:34651579 · W3205382069
article OA: bronze CC0 ⤵ 8 in-corpus citations
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-07 ⓘ

This viewpoint argues that the narrow, "classic" definition of endometriosis symptoms is inadequate, leading to misdiagnosis and flawed research outcomes that fail to address the condition's variability and multifactorial pain mechanisms.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

This JCI Viewpoint paper argues that endometriosis research and clinical teaching have been constrained by an overly narrow “classic” phenotype and by methodological choices that use pelvic pain as a proxy for endometriosis and often fail to require histologic confirmation. Drawing on the author’s experience and cited literature, it highlights findings such as the poor correlation between surgical stage and symptoms, the approximate 60% positive predictive value of visual inspection, and the lack of evidence that any single medical therapy is more effective for endometriosis-associated pain. The author’s caveats are that the piece is not original research and provides a broad critique based on existing studies rather than new data, with emphasis on the need to change study outcomes and recruitment/diagnostic standards. This paper is centrally about endometriosis — it focuses on rethinking how endometriosis and pelvic pain are defined, studied, and managed, including limits of pain-based research designs and diagnostic/surgical considerations.

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Reference

information: J Clin Invest. 2021;131(20):e154876. https://doi.org/10.1172/JCI154876. -

References

- Practice bulletin no . 114: management of endometriosis. Obstet Gynecol. 2010;116(1):223–236. - Benagiano G, et al. The history of endometriosis. Gynecol Obstet Invest. 2014;78(1):1–9. - Russel WW. Aberrant portins of the Mullerian duct found in an ovary. Johns Hopkins Med J. 1899;10(1):8–10. - Sampson JA. Perforating hemorrhagic (chocolate) cysts of the ovary. Arch Surg. 1921;3(2):245–323.View this article via: CrossRef Google Scholar - Till S, et al. Psychology of chronic pelvic pain: prevalence, neurobiological vulnerabilities, and treatment. Clin Obstet Gynecol. 2019;62(1):22–36. - Howard FM. Endometriosis and mechanisms of pelvic pain. J Minim Invasive Gynecol. 2009;16(5):540–550. - Ling FW. Randomized controlled trial of depo leuprolide in patients with chronic pelvic pain and clinically suspected endometriosis. Pelvic Pain Study Group. Obstet Gynecol. 1999;93(1):51–58.View this article via: PubMed Google Scholar - Winkel CA. A cost-effective approach to the management of endometriosis. Curr Opin Obstet Gynecol. 2000;12(4):317–320. - Abbot J, et al. Laparoscopic excision of endometriosis: a randomized, placebo-controlled trial. Fertil Steril. 2004;82(4):878–884. - Pundir J, et al. Laparoscopic excision versus ablation for endometriosis-associated pain: an updated systematic review and meta-analysis. J Minim Invasive Gynecol. 2017;24(5):747–756. - Walter AJ, et al. Endometriosis: correlation between histologic and visual findings at laparoscopy. Am J Obstet Gynecol. 2001;187(7):1407–1411. - Byrne D, et al. Laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres: a multicentre prospective cohort study. BMJ Open. 2018;8(4):e018924. - Version history - Version 1 (October 15, 2021): Electronic publication - View PDF - Download citation information - Send a comment - Terms of use - Standard abbreviations - Need help? Email the journal - Endometriosis patients deserve access to quality care Heather Guidone Advertisement Advertisement Copyright © 2026 American Society for Clinical Investigation ISSN: 0021-9738 (print), 1558-8238 (online)

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Condition tags

mesh:D004715mesh:D017699endometriosis

MeSH descriptors

Endometriosis Pelvic Pain Endometriosis Endometriosis Endometriosis Female Humans Pelvic Pain

Citation neighborhood (2-hop)

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

References (10)

Cited by (8)

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