Management of women with endometriosis in the 21st century

Attilio Di Spiezio Sardo, Christian M Becker, Stefan P Renner, Pia A Suvitie, Pia Suvitie, Josep Estadella Tarriel, Josep Estadella, Silvia Vannuccini, Juan A Garcia Velasco, Juan A. García-Velasco, Jasper Verguts, Antonio Mercorio
Current opinion in obstetrics & gynecology · 2025 · vol. 37(3) , pp. 149–157 · doi:10.1097/gco.0000000000001027 · PMID:40237624 · W4409503942
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This review updates the 21st-century management of endometriosis from asymptomatic to complicated cases, discussing advances in imaging, medical and surgical therapies, and assisted reproduction.

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Abstract

PURPOSE OF REVIEW: Endometriosis is a chronic inflammatory condition that significantly affects women's quality of life and fertility. Despite advancements in treatment, many areas of uncertainty persist in clinical management. This review provides a symptom-focused, patient-centered update, addressing cases from asymptomatic to those complicated by pain and infertility. RECENT FINDINGS: Advancement in imaging technology has increased incidental diagnoses of asymptomatic endometriosis, raising the debate between immediate treatment and watchful waiting. Medical therapy primarily aims to suppress symptoms, with oral gonadotropin-releasing hormone antagonists and add-back therapy offering promising long-term pain control. Research into local neurogenesis and central sensitization supports complementary approaches, though high-quality evidence is still limited. For pain refractory to medical therapy, conservative surgical strategies can minimize postoperative complications without significantly increasing recurrence rates. In infertility, assisted reproductive technology (ART) provides effective options, although the optimal endometrial preparation and the necessity of pre-ART surgery remain to be fully elucidated. SUMMARY: The optimal management of endometriosis requires a personalized, multidisciplinary approach within specialized centers. Long-term suppressive medical therapy remains the cornerstone of pain management while emerging targeted agents hold promise for better symptom control with fewer side effects. Surgical intervention should be performed by experienced surgeons as a single definitive procedure when possible. Tailored ART protocols can address infertility challenges. Standardized classification systems and robust randomized trials are crucial to refining treatment pathways, optimizing fertility outcomes, and enhancing quality of life.

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Outcome instruments

EHP-30

Condition tags

mesh:D004715mesh:D017699endometriosisinfertility

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

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 (86)

Cited by (4)

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