Endometriosis Basics

Current Guidance Update

ESHRE 2022

Updated Endometriosis Guidelines

The first major evidence-based guideline update since 2014 confirms that the average diagnostic delay of 7–10 years remains unacceptably common.

RCOG GTG 24 2023

Empirical Hormonal Therapy

Empirical hormonal treatment is considered appropriate for women with suspected endometriosis while awaiting laparoscopic confirmation and specialist assessment.

ACOG 2022

Prevalence & Infertility

Endometriosis affects approximately 10% of reproductive-age women and is present in up to 50% of women experiencing infertility.

WHO 2023

Global Health Priority

Endometriosis is recognized as a major public health concern, with improved awareness, earlier diagnosis, and shorter referral pathways identified as global priorities.

Introduction

Endometriosis is a chronic, inflammatory condition in which endometrial-like tissue grows outside the uterine cavity, most commonly on the ovaries, fallopian tubes, peritoneum, and bowel. It affects approximately 190 million women worldwide and is associated with debilitating pain, infertility, and significantly impaired quality of life, with diagnostic delays averaging 7–10 years.

Endometriosis: Symptoms, Diagnosis & Treatment

Disease Process

How Endometriosis Causes Symptoms

Ectopic endometrial tissue responds to hormonal changes like the uterine lining, causing repeated bleeding, inflammation, fibrosis, and adhesions. Ovarian endometriomas contain collected old blood and contribute to chronic pelvic pain and infertility.

Clinical Features

Common Symptoms

Progressive dysmenorrhoea
Deep dyspareunia
Dyschezia during menstruation
Chronic pelvic pain
Infertility affecting 30–50% of women
Persistent fatigue

Diagnosis

Clinical Assessment

Laparoscopy with histological confirmation remains the definitive diagnostic test. However, ESHRE 2022 supports empirical hormonal treatment based on clinical findings, while MRI provides valuable staging information for deep infiltrating disease.

Medical Treatment

Evidence-Based Management

Continuous combined oral contraceptive pill
Progestins including dienogest
GnRH analogues with add-back HRT
Aromatase inhibitors for resistant disease

Surgical Treatment

Laparoscopic Excision

Laparoscopic excision is superior to ablation for improving both pain relief and fertility outcomes. Complete excision performed by experienced laparoscopic surgeons offers the best long-term symptom control and reduces disease recurrence.

Frequently Asked Questions

Does endometriosis always cause infertility?

No — approximately 30–50% of women with endometriosis have difficulty conceiving, but many conceive naturally.

Can endometriosis be cured?

Currently there is no cure. Surgical excision significantly reduces disease burden but recurrence rates are 20–50% at 5 years without ongoing hormonal suppression.

Conclusion

Endometriosis deserves growing clinical and public attention. Earlier diagnosis, evidence-based management, and genuine recognition of its impact on quality of life are the priorities.

Sources & References

This article draws on guidance current at the time of writing from the following bodies and publications:

ESHRE (2022 Endometriosis Guidelines)
RCOG GTG 24 (2023)
ACOG (2022)
WHO (2023)

General reference bodies for women's health guidance:

RCOG

rcog.org.uk

ACOG

acog.org

FIGO

figo.org

WHO

who.int

NICE

nice.org.uk

⚠ IMPORTANT DISCLAIMER

This article is provided for general knowledge and reference purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. No medication, treatment, or change to your healthcare should be undertaken based on this content without first consulting a qualified doctor. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

Consult Dr. Ruby Rashmi

Specialist Obstetrician & Gynecologist, Dubai