Endometriosis: A Narrative Review

Andrew Zakhari, Dong Bach Nguyen
In: Canadian Women's Health Today · 2024 · doi:10.58931/cwht.2024.1213 · W4400040441
review OA: hybrid CC0 ⤵ 1 in-corpus citation
🔓 Open OA copy Full text JSON View on OpenAlex View at publisher
⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This review explores the complex pathogenesis, diverse clinical presentations, significant societal impact, and substantial economic burden of endometriosis, a chronic inflammatory condition.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

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

This narrative review describes current concepts in endometriosis pathogenesis, phenotypes, clinical impacts, and areas of active research, including theories such as Samson’s retrograde menstruation and the roles of immune, genetic, and local environmental factors. It outlines that endometriosis can be asymptomatic or cause chronic pelvic pain, infertility, endometriomas, and invasion into organs like the bowel or bladder, and it distinguishes superficial lesions, deeply infiltrating endometriosis, and ovarian endometriomas. The review acknowledges key shortcomings in the retrograde menstruation theory, noting that retrograde menstruation occurs far more commonly than the reported prevalence of endometriosis, and it emphasizes that lesions can occur outside the pelvis (e.g., in the thoracic cavity). It also states that endometriosis is associated with work/school absenteeism, reduced quality of life, chronic pelvic pain, and mental health diagnoses, alongside substantial economic burden, though no explicit limitations of the narrative-review approach are detailed. This paper is centrally about endometriosis — it is a narrative review summarizing theories, phenotypes, and burden of endometriosis.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works

Abstract

Although much progress has been made since endometriosis was first scientifically described centuries ago, numerous unanswered questions still surround this chronic, inflammatory condition. For instance, one theory on the pathogenesis of endometriosis suggests that the condition begins from retrograde menstrual flow implanting on surfaces in the abdomen and pelvis (Samson’s theory), which is a logical mechanism given the high rates of endometriosis in patients with obstructive anomalies of the lower genital tract and significant retrograde flow. This explanation has many shortcomings however, as retrograde menstruation occurs more commonly than the reported 10% prevalence of endometriosis. Additionally, endometriosis lesions can be found in areas quite remote from the pelvis, such as the thoracic cavity. As such, research has been increasingly focused on identifying immune, genetic, and local environmental factors that likely play critical roles in the development of endometriosis. This growth of benign endometrial-like tissue outside of the uterus can sometimes be asymptomatic, but it can also cause debilitating pain, infertility, ovarian cysts (endometriomas), and can invade surrounding organs such as the bowel or bladder. There are three main phenotypes of endometriosis: superficial lesions, deeply infiltrating endometriosis (including nodules), and ovarian endometriomas. While the exact etiology may be obscure, the societal and economic impacts of this condition are undeniable. Patients diagnosed with endometriosis are at a significantly higher risk of absenteeism from work or school, lower quality of life, chronic pelvic pain, and are more likely to receive a mental health diagnosis such as depression or anxiety. Apart from direct and indirect incurred costs to patients (estimated at approximately $5000 per patient annually), at a national level the economic burden of endometriosis exceeds $2 billion annually in Canada, and approaches $80 billion in the USA.
Full text 9,350 characters · extracted from oa-doi-fallback · 2 sections · click to expand

Abstract

Although much progress has been made since endometriosis was first scientifically described centuries ago, numerous unanswered questions still surround this chronic, inflammatory condition. For instance, one theory on the pathogenesis of endometriosis suggests that the condition begins from retrograde menstrual flow implanting on surfaces in the abdomen and pelvis (Samson’s theory), which is a logical mechanism given the high rates of endometriosis in patients with obstructive anomalies of the lower genital tract and significant retrograde flow. This explanation has many shortcomings however, as retrograde menstruation occurs more commonly than the reported 10% prevalence of endometriosis. Additionally, endometriosis lesions can be found in areas quite remote from the pelvis, such as the thoracic cavity. As such, research has been increasingly focused on identifying immune, genetic, and local environmental factors that likely play critical roles in the development of endometriosis. This growth of benign endometrial-like tissue outside of the uterus can sometimes be asymptomatic, but it can also cause debilitating pain, infertility, ovarian cysts (endometriomas), and can invade surrounding organs such as the bowel or bladder. There are three main phenotypes of endometriosis: superficial lesions, deeply infiltrating endometriosis (including nodules), and ovarian endometriomas. While the exact etiology may be obscure, the societal and economic impacts of this condition are undeniable. Patients diagnosed with endometriosis are at a significantly higher risk of absenteeism from work or school, lower quality of life, chronic pelvic pain, and are more likely to receive a mental health diagnosis such as depression or anxiety. Apart from direct and indirect incurred costs to patients (estimated at approximately $5000 per patient annually), at a national level the economic burden of endometriosis exceeds $2 billion annually in Canada, and approaches $80 billion in the USA.

References

Acién P, Velasco I. Endometriosis: a disease that remains enigmatic. ISRN Obstet Gynecol. 2013;2013:242149. doi:10.1155/2013/242149 Thiel PS, Bougie O, Pudwell J, Shellenberger J, Velez MP, Murji A. Endometriosis and mental health: a population-based cohort study. Am J Obstet Gynecol. 2024. doi:10.1016/j.ajog.2024.01.023 Soliman AM, Rahal Y, Robert C, Defoy I, Nisbet P, Leyland N, et al. Impact of endometriosis on fatigue and productivity impairment in a cross-sectional survey of Canadian women. J Obstet Gynaecol Can. 2021;43(1):10-18. doi:10.1016/j.jogc.2020.06.022 Soliman AM, Yang H, Du EX, Kelley C, Winkel C. The direct and indirect costs associated with endometriosis: a systematic literature review. Hum Reprod. 2016;31(4):712-722. doi:10.1093/humrep/dev335 Levy AR, Osenenko KM, Lozano-Ortega G, Sambrook R, Jeddi M, Bélisle S, et al. Economic burden of surgically confirmed endometriosis in Canada. J Obstet Gynaecol Can. 2011;33(8):830-837. doi:10.1016/s1701-2163(16)34986-6 Agarwal SK, Chapron C, Giudice LC, Laufer MR, Leyland N, Missmer SA, et al. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol. 2019;220(4):354.e351-354.e312. doi:10.1016/j.ajog.2018.12.039 Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009. doi:10.1093/hropen/hoac009 Leyland N, Casper R, Laberge P, Singh SS, Allen L, Arendas K, et al. Endometriosis: diagnosis and management. Journal of Endometriosis. 2010;2(3):107-134. doi:10.1177/228402651000200303 Guerriero S, Ajossa S, Orozco R, Perniciano M, Jurado M, Melis GB, et al. Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in the rectosigmoid: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2016;47(3):281-289. doi:10.1002/uog.15662 Chen-Dixon K, Uzuner C, Mak J, Condous G. Effectiveness of ultrasound for endometriosis diagnosis. Curr Opin Obstet Gynecol. 2022;34(5):324-331. doi:10.1097/gco.0000000000000812 Goncalves MO, Siufi Neto J, Andres MP, Siufi D, de Mattos LA, Abrao MS. Systematic evaluation of endometriosis by transvaginal ultrasound can accurately replace diagnostic laparoscopy, mainly for deep and ovarian endometriosis. Hum Reprod. 2021;36(6):1492-1500. doi:10.1093/humrep/deab085 Bendifallah S, Dabi Y, Suisse S, Delbos L, Spiers A, Poilblanc M, et al. Validation of a salivary miRNA signature of endometriosis - interim data. NEJMEvid. 2023;2(7):EVIDoa2200282. doi:10.1056/EVIDoa2200282 Bendifallah S, Suisse S, Puchar A, Delbos L, Poilblanc M, Descamps P, et al. Salivary MicroRNA signature for diagnosis of endometriosis. J Clin Med. 2022;11(3).doi:10.3390/jcm11030612 Abril-Coello R, Correyero-León M, Ceballos-Laita L, Jiménez-Barrio S. Benefits of physical therapy in improving quality of life and pain associated with endometriosis: a systematic review and metaanalysis. Int J Gynaecol Obstet. 2023;162(1):233-243.doi:10.1002/ijgo.14645 Mitchell JB, Chetty S, Kathrada F. Progestins in the symptomatic management of endometriosis: a metaanalysis on their effectiveness and safety. BMC Womens Health. 2022;22(1):526. doi:10.1186/s12905-022-02122-0 Brown J, Kives S, Akhtar M. Progestagens and anti-progestagens for pain associated with endometriosis. Cochrane Database Syst Rev.2012;2012(3):Cd002122. doi:10.1002/14651858.CD002122.pub2 Regidor PA, Schindler AE. Antiandrogenic and antimineralocorticoid health benefits of COC containing newer progestogens: dienogest and drospirenone. Oncotarget. 2017;8(47):83334-83342.doi:10.18632/oncotarget.19833 McCormack PL. Dienogest: a review of its use in the treatment of endometriosis. Drugs. 2010;70(16):2073- 2088. doi:10.2165/11206320-000000000-00000 Bedaiwy MA, Mousa NA, Casper RF. Aromatase inhibitors prevent the estrogen rise associated with the flare effect of gonadotropins in patients treated with GnRH agonists. Fertil Steril. 2009;91(4 Suppl):1574-1577. doi:10.1016/j.fertnstert.2008.09.077 Eberle A, Nguyen DB, Smith JP, Mansour FW, Krishnamurthy S, Zakhari A. Medical management of ovarian endometriomas: a systematic review and meta-analysis. Obstet Gynecol. 2024;143(1):53-66.doi:10.1097/aog.0000000000005444 Thiel P, Donders F, Kobylianskii A, Maheux-Lacroix S, Matelski J, Walsh C, et al. The effect of medical management on ovarian endometriomas: a systematic review and meta-analysis. Journal of Minimally Invasive Gynecology. 2023;30(11, Supplement):S9-S10. doi:https://doi.org/10.1016/j.jmig.2023.08.029 Zakhari A, Delpero E, McKeown S, Tomlinson G, Bougie O, Murji A. 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 Falcone T, Wilson JR. Surgical treatment of endometriosis: excision versus ablation of peritoneal disease. J Minim Invasive Gynecol. 2019;26(1):1-2. doi:10.1016/j.jmig.2018.10.008 Burks C, Lee M, DeSarno M, Findley J, Flyckt R. Excision versus ablation for management of minimal to mild endometriosis: a systematic review and metaanalysis. J Minim Invasive Gynecol. 2021;28(3):587- 597. doi:10.1016/j.jmig.2020.11.028 Healey M, Cheng C, Kaur H. To excise or ablate endometriosis? A prospective randomized doubleblinded trial after 5-year follow-up. J Minim Invasive Gynecol. 2014;21(6):999-1004. doi:10.1016/j.jmig.2014.04.002 Pundir J, Omanwa K, Kovoor E, Pundir V, Lancaster G, Barton-Smith P. Laparoscopic excision versus ablation for endometriosis-associated pain: an updated systematic review and meta-analysis. J Minim Invasive Gynecol. 2017;24(5):747-756. doi:10.1016/j.jmig.2017.04.008 Banerjee SK, Ballard KD, Wright JT. Endometriomas as a marker of disease severity. J Minim Invasive Gynecol. 2008;15(5):538-540. doi:10.1016/j.jmig.2008.05.004 Bougie O, McClintock C, Pudwell J, Brogly SB, Velez MP. Long-term follow-up of endometriosis surgery in Ontario: a population-based cohort study. Am J Obstet Gynecol. 2021;225(3):270.e271-270.e219. doi:10.1016/j.ajog.2021.04.237 Sandström A, Bixo M, Johansson M, Bäckström T, Turkmen S. Effect of hysterectomy on pain in women with endometriosis: a population-based registry study. Bjog. 2020;127(13):1628-1635. doi:10.1111/1471-0528.16328 Rizk B, Fischer AS, Lotfy HA, Turki R, Zahed HA, Malik R, et al. Recurrence of endometriosis after hysterectomy. Facts Views Vis Obgyn. 2014;6(4):219-227. Grigoriadis G, Daniilidis A, Merlot B, Stratakis K, Dennis T, Crestani A, et al. Surgical treatment of deep endometriosis: impact on spontaneous conception. Best Pract Res Clin Obstet Gynaecol. 2024;93:102455. doi:10.1016/j.bpobgyn.2024.102455 Brown J, Farquhar C. Endometriosis: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2014;2014(3):Cd009590. doi:10.1002/14651858. CD009590.pub2 Casals G, Carrera M, Domínguez JA, Abrão MS, Carmona F. Impact of surgery for deep infiltrative endometriosis before in vitro fertilization: a systematic review and meta-analysis. J Minim Invasive Gynecol. 2021;28(7):1303-1312.e1305. doi:10.1016/j.jmig.2021.02.007 Melo P, Georgiou EX, Johnson N, van Voorst SF, Strandell A, Mol BWJ, et al. Surgical treatment for tubal disease in women due to undergo in vitro fertilisation. Cochrane Database Syst Rev. 2020;10(10):Cd002125. doi:10.1002/14651858. CD002125.pub4

Text is read by the "Ask this paper" AI Q&A widget below. Extraction quality varies by source — PMC NXML preserves structure cleanly, OA-HTML may include some navigation residue, and OA-PDF can have broken hyphenation. The publisher copy (via DOI) is the canonical version.

My notes (saved in your browser only)

⚙ Ask this paper AI returns verbatim quotes from the full text · source: oa-doi-fallback ⓘ

Answers must be backed by verbatim quotes from this paper's full text. Hallucinated quotes are dropped automatically; if no verbatim passage answers the question, we say so. How this works

Condition tags

endometriosischronic_pelvic_paininfertility

Citation neighborhood

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. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (34)

Cited by (1)

Source provenance

openalex
last seen: 2026-06-10T17:14:06.276822+00:00
License: CC0 · commercial use OK