Endometriosis: pathogenesis and treatment

Endometriosis is defined as the presence of endometrial-type mucosa outside the uterine cavity. Of the proposed pathogenic theories (retrograde menstruation, coelomic metaplasia and Müllerian remnants), none explain all the different types of endometriosis. According to the most convincing model, the retrograde menstruation hypothesis, endometrial fragments reaching the pelvis via transtubal retrograde flow, implant onto the peritoneum and abdominal organs, proliferate and cause chronic inflammation with formation of adhesions. The number and amount of menstrual flows together with genetic and environmental factors determines the degree of phenotypic expression of the disease. Endometriosis is estrogen-dependent, manifests during reproductive years and is associated with pain and infertility. Dysmenorrhoea, deep dyspareunia, dyschezia and dysuria are the most frequently reported symptoms. Standard diagnosis is carried out by direct visualization and histologic examination of lesions. Pain can be treated by excising peritoneal implants, deep nodules and ovarian cysts, or inducing lesion suppression by abolishing ovulation and menstruation through hormonal manipulation with progestins, oral contraceptives and gonadotropin-releasing hormone agonists. Medical therapy is symptomatic, not cytoreductive; surgery is associated with high recurrence rates. Although lesion eradication is considered a fertility-enhancing procedure, the benefit on reproductive performance is moderate. Assisted reproductive technologies constitute a valid alternative. Endometriosis is associated with a 50% increase in the risk of epithelial ovarian cancer, but preventive interventions are feasible. This is a preview of subscription content, access via your institution Access options Subscribe to this journal Receive 12 print issues and online access 176,64 € per year only 14,72 € per issue Buy this article - Purchase on SpringerLink - Instant access to the full article PDF. 39,95 € Prices may be subject to local taxes which are calculated during checkout Similar content being viewed by others

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D. Alberico, D. Dridi, A. M. Sanchez and C. Vercellini are greatly acknowledged for their support. Author information Authors and Affiliations Contributions P. Vercellini, P. Viganò and E. Somigliana researched data for the article, provided a substantial contribution to discussion of the content, wrote the article and reviewed/edited the manuscript before submission. L. Fedele provided a substantial contribution to discussion of the content and reviewed/edited the manuscript before submission. Corresponding author Ethics declarations Competing interests The authors declare no competing financial interests. Rights and permissions About this article Cite this article Vercellini, P., Viganò, P., Somigliana, E. et al. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol 10, 261–275 (2014). https://doi.org/10.1038/nrendo.2013.255 Published: Issue date: DOI: https://doi.org/10.1038/nrendo.2013.255 This article is cited by - Neutrophil to lymphocytes ratio in deep infiltrating endometriosis as a new toll for clinical management Scientific Reports (2024) - Disrupted Tuzzerella abundance and impaired l-glutamine levels induce Treg accumulation in ovarian endometriosis: a comprehensive multi-omics analysis Metabolomics (2024) - Identification of diagnostic markers related to inflammatory response and cellular senescence in endometriosis using machine learning and in vitro experiment Inflammation Research (2024) - Exploring the Effects of Endocrine-Disrupting Chemicals and miRNA Expression in the Pathogenesis of Endometriosis by Unveiling the Pathways: a Systematic Review Reproductive Sciences (2024) - Endometriosis, a common but enigmatic disease with many faces: current concept of pathophysiology, and diagnostic strategy Japanese Journal of Radiology (2024)