DIAGNOSTIC AND THERAPEUTIC CHALLENGES IN ENDOMETRIOSIS: A NARRATIVE REVIEW

DIAGNOSTIC AND THERAPEUTIC CHALLENGES IN ENDOMETRIOSIS: A NARRATIVE REVIEW DOI: https://doi.org/10.31435/ijitss.3(51).2026.5926Keywords: Endometriosis, Chronic Pelvic Pain, Non-Invasive Diagnostics, FertilityAbstract Endometriosis is a multifactorial inflammatory disease associated with altered estrogen signaling, immune dysregulation, and the presence of endometrial-like tissue outside the uterine cavity. It affects nearly 10% of women of reproductive age and can substantially reduce quality of life through chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility. Despite its prevalence, diagnosis and treatment remain difficult because symptoms are heterogeneous and frequently nonspecific, contributing to an average diagnostic delay of seven to ten years. This review summarizes the shift from invasive diagnostic laparoscopy toward non-invasive multimodal imaging, particularly transvaginal sonography (TVS) and magnetic resonance imaging (MRI), for disease assessment. It also discusses current medical, surgical, and fertility-preservation strategies aimed at improving symptom control and treatment outcomes in affected patients. Early diagnosis and a multidisciplinary approach may help reduce delays in treatment and improve long-term clinical outcomes. References Becker, C. M., Bokor, A., Heikinheimo, O., Horne, A., Jansen, F., Kiesel, L., King, K., Kvaskoff, M., Nap, A., Petersen, K., Saridogan, E., Tomassetti, C., van Hanegem, N., Vulliemoz, N., Vermeulen, N., Altmäe, S., Ata, B., Ball, E., Barra, F., ... ESHRE Guideline Group. (2022). ESHRE guideline: endometriosis. Human Reproduction Open, 2022(2), hoac009. https://doi.org/10.1093/hropen/hoac009 Bulun, S. E., Yilmaz, B. D., Sison, C., Miyazaki, K., Bernardi, L., Liu, S., Kohlmeier, A., Yin, P., Milad, M., & Wei, J. (2019). Endometriosis. Endocrine Reviews, 40(4), 1048–1079. https://doi.org/10.1210/er.2018-00242 Bazot, M., & Daraï, E. (2017). Diagnosis of deep endometriosis: Clinical examination, ultrasonography, magnetic resonance imaging, and other techniques. Fertility and Sterility, 108(6), 886–894. https://doi.org/10.1016/j.fertnstert.2017.10.026 Culley, L., Law, C., Hudson, N., Denny, E., Mitchell, H., Baumgarten, M., & Raine-Fenning, N. (2013). The social and psychological impact of endometriosis on women's lives: A critical narrative review. Human Reproduction Update, 19(6), 625–639. https://doi.org/10.1093/humupd/dmt027 Bafort, C., Beebeejaun, Y., Tomassetti, C., Bosteels, J., & Duffy, J. M. N. (2020). Laparoscopic surgery for endometriosis. Cochrane Database of Systematic Reviews, 2020(10), CD011031. https://doi.org/10.1002/14651858.CD011031.pub3 Guerriero, S., Condous, G., van den Bosch, T., Valentin, L., Leone, F. P. G., Van Schoubroeck, D., Exacoustos, C., Installé, A. J. F., Martins, W. P., Abrao, M. S., Hudelist, G., Bazot, M., Alcazar, J. L., Gonçalves, M. O., Pascual, M. A., Ajossa, S., Savelli, L., Dunham, R., Reid, S., ... Bourne, T. (2016). Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: A consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound in Obstetrics & Gynecology, 48(3), 318–332. https://doi.org/10.1002/uog.15955 Nisenblat, V., Bossuyt, P. M., Shaikh, R., Farquhar, C., Jordan, V., Scheffers, C. S., Crawford, R., & Hull, M. L. (2016). Blood biomarkers for the non-invasive diagnosis of endometriosis. Cochrane Database of Systematic Reviews, 2016(5), CD012179. https://doi.org/10.1002/14651858.CD012179 Taylor, H. S., Giudice, L. C., Lessey, B. A., Abrao, M. S., Kotarski, J., Archer, D. F., Diamond, M. P., Surrey, E., Johnson, N. P., Watts, N. B., Gallagher, J. C., Simon, J. A., Carr, B. R., Dmowski, W. P., Leyland, N., Rowan, J. P., Duan, W. R., Ng, J., Schwefel, B., ... Jain, R. I. (2017). Treatment of endometriosis-associated pain with elagolix, an oral GnRH antagonist. New England Journal of Medicine, 377(1), 28–40. https://doi.org/10.1056/NEJMoa1700089 Zondervan, K. T., Becker, C. M., & Missmer, S. A. (2018). Endometriosis. Nature Reviews Disease Primers, 4(1), 9. https://doi.org/10.1038/s41572-018-0008-5 Downloads Published Issue Section License Copyright (c) 2026 Adrianna Krupska, Karina Kinga Brzózka, Katarzyna Ledwożyw, Alicja Piełuć, Zuzanna Pyrka, Weronika Elżbieta Cionżyńska This work is licensed under a Creative Commons Attribution 4.0 International License. All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles. CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.