Endometriosis

Endometriosis is a gynaecological disorder characterised by the growth of endometrial tissue outside the uterine cavity. It significantly impacts the quality of life of women and can cause chronic pelvic pain and reduced fertility. Globally, about 176 million women are affected. This chapter provides an overview of the clinical symptoms associated with endometriosis, highlights the emerging role of ultrasound imaging in the preoperative diagnosis of severity of the disease and describes strategies for early diagnosis and triage of symptomatic women to medical or surgical management. The chapter also identifies gaps in the current management of endometriosis in resource restricted countries and suggests opportunities for targeted interventions that will develop the capacity of health care professionals in these countries to manage endometriosis. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

Kennedy S, Bergqvist A, Chapron C, d’Hooghe T, Dunselman G, Greb R, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005;20:2698–704. Giudice LC. Clinical practice. Endometriosis. N Engl J Med. 2010;362:2389–98. American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. Fertil Steril. 2012;98(3):591–8. Kennedy S, Mardon H, Barlow D. Familial endometriosis. J Assist Reprod Genet. 1995;12(1):3234. Kennedy S, Hadfield R, Mardon H, Barlow D. Age of onset of pain symptoms in non-twin sisters concordant for endometriosis. Hum Reprod. 1996;11(2):403–5. Sampson JA. The development of the implantation theory for the origin of peritoneal endometriosis. Am J Obstet Gynaecol. 1940;40:549–57. Gruenwald P. Origin of endometriosis from the mesenchyme of the coelomic walls. Am J Obstet Gynaecol. 1942;44(3):470–4. Koninckx PR, Kennedy SH, Barlow DH. Endometriotic disease the role of peritoneal fluid. Human Reprod Update. 1998;4(5):741–51. Johnson NP, Hummelshoj L, World Endometriosis Society Montpellier Consortium. Consensus on current management of endometriosis. Hum Reprod. 2013;28:1552–68. Laufer MR. Premenarcheal endometriosis without an associated obstructive anomaly: presentation, diagnosis, and treatment. Fertil Steril. 2000;74:S15. Nezhat F, Datta MS, Hanson V, Pejovic T, Nezhat C. The relationship of endometriosis and ovarian malignancy: a review. Fertil Steril. 2008;90(5):1559. Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gynecol Clin North Am. 1997;13:235–58. Zondervan KT, Yudkin PL, Vessey MP, Jenkinson CP, Dawes MG, Barlow DH, et al. The community prevalence of chronic pelvic pain in women and associated illness behaviour. Br J Gen Pract. 2001;51(468):541–7. Zondervan KT, Cardon LR, Kennedy SH. What makes a good case-control study? Design issues for complex traits such as endometriosis. Hum Reprod. 2002;17:1415–23. Rogers PAW, d’Hooghe TM, Fazleabas A, Gargett CE, Giudice LC, Montgomery GW, et al. Priorities for endometriosis research: recommendations from an international consensus workshop. Reprod Sci Reprod Sci. 2009;16:335–46. Adamson GD, Kennedy SH, Hummelshoj L. Creating solutions in endometriosis: global collaboration through the World Endometriosis Research Foundation. J Endometriosis. 2010;2:3–6. Kyama CM, Mwenda JM, Machoki J, Mihalyi A, Simsa P, Chai DC, D’Hooghe TM. Endometriosis in African women. A review. Women’s Health. 2007;3(5):629–35. Fawole AO, Bello FA, Ogunbode O, Odukogbe AT, Nkwocha GC, Nnoaham KE, Zondervan KT, Akintan A, Abdus-Salam RA, Okunlola MA. Endometriosis and associated symptoms among Nigerian women. Int J Gynaecol Obstet. 2015;130(2):190–4. Brawn J, Morotti M, Zondervan KT, et al. Central changes associated with chronic pelvic pain and endometriosis. Hum Reprod Update. 2014;20:737. Bajaj P, Bajaj P, Madsen H, Arendt-Nielsen L. Endometriosis is associated with central sensitization: a psychophysical controlled study. J Pain. 2003;4:372. Givens V, Mitchell GE, Harraway-Smith C, et al. Diagnosis and management of adnexal masses. Am Fam Physician. 2009;80:815. Vercellini P, Viganò P, Somigliana E, Fedele L. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol. 2014;10:261. Sinaii N, Plumb K, Cotton L, et al. Differences in characteristics among 1,000 women with endometriosis based on extent of disease. Fertil Steril. 2008;89:538. Engemise S, Gordon C, Konje JC. Endometriosis. BMJ. 2010;340:c2168. Dunselman GA, Vermeulen N, Becker C, et al. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29:400. Ballard KD, Seaman HE, de Vries CS, Wright JT. Can symptomatology help in the diagnosis of endometriosis? Findings from a national case-control study—part 1. BJOG. 2008;115:1382. Hansen KE, Kesmodel US, Baldursson EB, et al. Visceral syndrome in endometriosis patients. Eur J Obstet Gynecol Reprod Biol. 2014;179:198. The Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility. Fertil Steril. 2004;81:1441–6. D’Hooghe T, Debrock S, Hill J, Meuleman C. Endometriosis and subfertility: is the relationship resolved? Semin Reprod Med. 2003;21:243–54. Koch J, Rowan K, Rombauts L, Yazdani A, Chapman M, Johnson N. Endometriosis and Infertility – A Consensus Statement From ACCEPT (Australasian CREI Consensus Expert Panel On Trial Evidence). ANZJOG. 2012;52:513–22. Lessey DA. Assessment of endometrial receptivity. Fertil Steril. 2011;96:522–9. Barnhart K, Dunsmoor-Su R, Coutifaris C. Effect of endometriosis on in vitro fertilization. Fertil Steril. 2002;77:1148–55. Maubon A, Faury A, Kapella M, Pouquet M, Piver P. Uterine junctional zone at magnetic resonance imaging: a predictor of in vitro fertilization implantation failure. J Obstet Gynaecol Res. 2010;36:611–8. Adamson GD. Endometriosis classification: an update. Curr Opin Obstet Gynecol. 2011;23:213–20. Hickey M, Ballard K, Farquhar C. Endometriosis. BMJ. 2014;348:1752. Bazot M, Lafont C, Rouzier R, Roseau G, Thomassin-Naggara I, Darai E. Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis. Fertil Steril. 2009;92:1825–33. Eskenazi B, Warner M, Bonsignore L, Olive D, Samuels S, Vercellini P. Validation study of nonsurgical diagnosis of endometriosis. Fertil Steril. 2001;76:929–35. Condous G, Van Calster B, Van Huffel S, Lam A. What is the value of preoperative bimanual pelvic examination in women undergoing laparoscopic total hysterectomy? J Minim Invasive Gynecol. 2007;14:334–8. Chapron C, Dubuisson JB, Pansini V, Vieira M, Fauconnier A, Barakat H, Dousset B. Routine clinical examination is not sufficient for diagnosing and locating deeply infiltrating endometriosis. J Am Assoc Gynecol Laparosc. 2002;9:115–9. May KE, Conduit-Hulbert SA, Villar J, Kirtley S, Kennedy SH, Becker CM. Peripheral biomarkers of endometriosis: a systematic review. Hum Reprod Update. 2010;16:651–74. Al-Jefout M, Dezarnaulds G, Cooper M, Tokushige N, Luscombe GM, Markham R, Fraser IS. Diagnosis of endometriosis by detection of nerve fibres in an endometrial biopsy: a double blind study. Hum Reprod. 2009;24:3019–24. Bokor A, Kyama CM, Vercruysse L, Fassbender A, Gevaert O, Vodolazkaia A, De Moor B, Fulop V, D’Hooghe T. Density of small diameter sensory nerve fibres in endometrium: a semi–invasive diagnostic test for minimal to mild endometriosis. Hum Reprod. 2009;24:3025–32. Royal College of Obstetricians and Gynaecologists. Management of acute pelvic inflammatory disease. In: Green-top Guideline No. 32. London: RCOG; 2008. www.rcog.org.uk/womens-health/clinical-guidance/management-acute-pelvicinflammatory-disease-32. Nisenblat V, Bossuyt PMM, Farquhar C, Johnson N, Hull ML. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev. 2016;2(2):CD009591. Hudelist G, English J, Thomas AE, Tinelli A, Singer CF, Keckstein J. Diagnostic accuracy of transvaginal ultrasound for non-invasive diagnosis of bowel endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2011;37:257–63. Holland TK, Yazbek J, Cutner A, Saridogan E, Hoo LW, Jurkovic D. Value of transvaginal ultrasound in assessing severity of pelvic endometriosis. Ultrasound Obstet Gynecol. 2010;36:241–8. Hsu AL, Khachikyan I, Stratton P. Invasive and non-invasive methods for the diagnosis of endometriosis. Clin Obstet Gynecol. 2010;53(2):413–9. Van Der Wat J, Kaplan MD. Modified virtual colonoscopy in the diagnosis and quantification of bowel and disseminated endometriosis. Surg Technol Int. 2015;26:19–24. Menakaya UA, Reid S, Infante F, Condous G. The systematic evaluation of women with suspected endometriosis using a five domain ultrasound based approach. J Ultrasound Med. 2015;34:937–47. Dessole S, Farina M, Rubattu G, Cosmi E, Ambrosini G, Nardelli GB. Sonovaginography is a new technique for assessing rectovaginal endometriosis. Fertil Steril. 2003;79(4):1023–7. Menakaya UA, Rombauts L, Johnson NP. Diagnostic laparoscopy in pre-surgical planning for higher stage endometriosis: Is it still relevant? Aust N Z J Obstet Gynaecol. 2016;56(5):518–22. Benacerraf BR, Groszmann Y. Sonography should be the first imaging examination done to evaluate patients with suspected endometriosis. J Ultrasound Med. 2012;31:651–3. Savelli L. Transvaginal sonography for the assessment of ovarian and pelvic endometriosis: how deep is our understanding? Ultrasound Obstet Gynecol. 2009;33:497–501. Reid S, Lu C, Hardy N, Casikar I, Reid G, Cario G, Chou D, Almashat D, Condous G. Office gel sonovaginography for the prediction of posterior deep infiltrating endometriosis: a multicentre prospective observational study. Ultrasound Obstet Gynecol. 2014;44:710–8. Bazot M, Thomassin I, Hourani R, Cortez A, Darai E. Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis. Ultrasound Obstet Gynecol. 2004;24:180–5. Menakaya UA, Reid S, Infante F, Condous G. The “sliding sign” in conjunction with Sonovaginography: Is this the optimal approach for the Diagnosis of Pouch of Douglas Obliteration and Posterior Compartment deep infiltrating endometriosis? AJUM. 2013;16(3):118–23. Guerriero S, Ajossa S, Angel Minguez J, Jurado M, Mais V, Melis GB, Alcazar JL. Diagnostic accuracy of transvaginal ultrasound for diagnosis of deep endometriosis regarding locations other than recto-sigmoid: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2015. https://doi.org/10.1002/uog.15667. Epub ahead of print. Guerriero S, Ajossa S, Orozco R, Perniciano M, Jurado M, Melis GB and Alcazar JL. Diagnostic accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in the recto-sigmoid: a meta-analysis. Ultrasound Obstet Gynecol. 2015. https://doi.org/10.1002/uog.15662. Epub ahead of print. Tammaa A, Fritzer N, Lozano P, Krell A, Salzer H, Aslama M, et al. Interobserver agreement and accuaracy of non invasive diagnosis of endometirosis by TVS. Ultrasound Obstet Gynecol. 2015;46(6):737–40. Guerriero S, Condous G, van den Bosch T, Valentin L, Menakaya U, et al. 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 Obstet Gynecol. 2016;48(3):318–32. Menakaya UA. Managing endometriosis in sub-Saharan Africa: emerging concepts and new techniques. Afr J Reprod Health. 2015;19(2):13–6. Menakaya UA. Capacity building in endometriosis ultrasound: are we there yet? Aust J Ultrasound Med. 2015;18(4):129–31. Menakaya U, Reid S, Lu C, Bassem G, Infante F, Condous G. Performance of an ultrasound based endometriosis staging system (UBESS) for predicting the level of complexity of laparoscopic surgery for endometriosis. Ultrasound Obstet Gynecol. 2016;48(6):786–95. Menakaya UA, Adno A, Lanzarone V, Johnson NP, Condous G. Integrating the concept of advanced gynaecological imaging for endometriosis. ANZJOG. 2015;55:409–12. Royal College of Obstetricians and Gynaecologists (RCOG). Classification of laparoscopic procedures per level of difficulty. Report of the RCOG working party on training in gynaecological endoscopic surgery. 2001. Roman H, Carilho J, Da Costa C, De Vecchi C, et al. Computed tomography-based virtual colonoscopy in the assessment of bowel endometriosis: the surgeon’ point of view. Gynecol Obstet Fertil. 2016;44(1):3–10. Ballard K, Lowton K, Wright J. What’s the delay? A qualitative study of women’s experiences of reaching a diagnosis of endometriosis. Fertil Steril. 2006;86:1296–301. Nnoaham KE, Hummelshoj L, Webster P, d’Hooghe T, de Cicco NF, de Cicco NC, Jenkinson C, Kennedy SH, Zondervan KT, World Endometriosis Research Foundation Global Study of Women’s Health Consortium. Impact of endometriosis on quality of life and work productivity: a multicentre study across ten countries. Fertil Steril. 2011;96:366–73. e368 Hudelist G, Fritzer N, Thomas A, Niehues C, Oppelt P, Haas D, Tammaa A, Salzer H. Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences. Hum Reprod. 2012;27:3412–6. Seear K. The etiquette of endometriosis: stigmatisation, menstrual concealment and the diagnostic delay. Soc Sci Med. 2009;69:1220–7. Harvey J, Warwick I. Endometriosis. BMJ. 2010;340:c2661. Nnoaham KE, Hummelshoj L, Kennedy SH, Jenkinson C, Zondervan KT, World Endometriosis Research Foundation Women’s Health Symptom Survey Consortium. Developing symptom-based predictive models of endometriosis as a clinical screening tool: results from a multi Centre study. Fertil Steril. 2012;98:692–701. Nnoaham KE, Webster P, Kumbang J, Kennedy SH, Zondervan KT. Is early age at menarche a risk factor for endometriosis? A systematic review and meta-analysis of case-control studies. Fertil Steril. 2012;98:702–12. Jones G, Kennedy S, Barnard A, Wong J, Jenkinson C. Development of an endometriosis quality of life instrument: the endometrioisis health profile- 30. Obstet Gynecol. 2001;98(2):258–64. Revised American Society for Reproductive Medicine. Classification of endometriosis. Fertil Steril. 1997;67(5):817–21. Jacobson TZ, Duffy JM, Barlow D, Koninckx PR, Garry R. Laparoscopic surgery for pelvic pain associated with endometriosis. Cochrane Database Syst Rev. 2009;4:CD001300. Jacobson TZ, Duffy JM, Barlow D, Farquhar C, Koninckx PR, Olive D. Laparoscopic surgery for subfertility associated with endometriosis. Cochrane Database Syst Rev. 2010;20:CD001398. Adamson GD, Pasta DJ. Endometriosis fertility index: the new, validated endometriosis staging system. Fertil Steril. 2010;94:1609–15. Pellicano M, Bramante S, Guida M, Bifulco G, Di Spiezio SA, Cirillo D, Nappi C. Ovarian endometrioma: postoperative adhesions following bipolar coagulation and suture. Fertil Steril. 2008;89:796–9. Author information Authors and Affiliations Corresponding author Editor information Editors and Affiliations Rights and permissions Copyright information © 2021 The Author(s), under exclusive license to Springer Nature Switzerland AG About this chapter Cite this chapter Menakaya, U.A. (2021). Endometriosis. In: Okonofua, F., Balogun, J.A., Odunsi, K., Chilaka, V.N. (eds) Contemporary Obstetrics and Gynecology for Developing Countries . Springer, Cham. https://doi.org/10.1007/978-3-030-75385-6_43 Download citation DOI: https://doi.org/10.1007/978-3-030-75385-6_43 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-030-75384-9 Online ISBN: 978-3-030-75385-6 eBook Packages: MedicineMedicine (R0)