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Endometriosis: Epidemiology, Diagnosis and Clinical Management

  • Reproductive Endocrinology and Infertility (REI) (R Anchan, Section Editor)
  • Published:
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Abstract

Purpose of Review

Endometriosis is a disease of adolescents and reproductive-aged women characterized by the presence of endometrial tissue outside the uterine cavity and commonly associated with chronic pelvic pain and infertility. Here we review the epidemiology of endometriosis as well as potential biomarkers for detection and with the goal of highlighting risk factors that could be used in combination with biomarkers to identify and treat women with endometriosis earlier.

Recent Findings

Early age at menarche, shorter menstrual length, and taller height are associated with a higher risk of endometriosis while parity, higher body mass index (BMI), and smoking are associated with decreased risk. Endometriosis often presents as infertility or continued pelvic pain despite treatment with analgesics and cyclic oral contraceptive pills.

Summary

Despite a range of symptoms, diagnosis of endometriosis is often delayed due to lack of non-invasive, definitive, and consistent biomarkers for the diagnosis of endometriosis. Hormone therapy and analgesics are used for treatment of symptomatic endometriosis. However, the efficacy of these treatments is limited as endometriosis often recurs. In this review, we describe potential diagnostic biomarkers and risk factors that may be used as early non-invasive in vitro tools for identification of endometriosis to minimize diagnostic delay and improve reproductive health of patients.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance, •• Of major importance

  1. Giudice LC, Kao LC. Endometriosis. Lancet. 2004;364(9447):1789–99.

    Article  PubMed  Google Scholar 

  2. Nisolle M, Donnez J. Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril. 1997;68(4):585–96.

    Article  CAS  PubMed  Google Scholar 

  3. Farland LV, Shah DK, Kvaskoff M, Zondervan K, Missmer SA. Epidemiological and clinical risk factors for endometriosis. In: D’Hooghe T, editor. Biomarkers for endometriosis. New York: Springer Science; 2015.

    Google Scholar 

  4. Anaf V, Simon P, El Nakadi I, Fayt I, Simonart T, Buxant F, et al. Hyperalgesia, nerve infiltration and nerve growth factor expression in deep adenomyotic nodules, peritoneal and ovarian endometriosis. Hum Reprod. 2002;17:1895–900.

    Article  PubMed  Google Scholar 

  5. Wang G, Tokushige N, Markham R, Fraser IS. Rich innervation of deep infiltrating endometriosis. Hum Reprod. 2009;24:827–34.

    Article  PubMed  Google Scholar 

  6. Berkley KJ, Rapkin AJ, Papka RE. The pains of endometriosis. Science. 2005;308:1587–9.

    Article  CAS  PubMed  Google Scholar 

  7. Bulun SE. Endometriosis. N Engl J Med. 2009 Jan 15;360(3):268–79. doi:10.1056/NEJMra0804690.

    Article  CAS  PubMed  Google Scholar 

  8. Ferguson BR, Bennington JL, Haber SL. Histochemistry of mucosubstances and histology of mixed mullerian pelvic lymph node glandular inclusions: evidence for histogenesis by mullerian metaplasia of coelomic epithelium. Obstet Gynecol. 1969;33:617–25.

    CAS  PubMed  Google Scholar 

  9. Sampson JA. Metastatic or embolic endometriosis due to menstrual dissemination of endometrial tissue into the venous circulation. Am J Pathol. 1927;3:93–109.

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Carter JE. Combined hysteroscopic and laparoscopic findings in patients with chronic pelvic pain. J Am Assoc Gynecol Laparosc. 1994;2:43–7.

    Article  CAS  PubMed  Google Scholar 

  11. • Nnoaham KE, Hummelshoj L, Webster P, d'Hooghe T, de Cicco Nardone F, de Cicco Nardone C, 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 multicenter study across ten countries. Fertil Steril. 2011;96(2):366–373.e8. doi:10.1016/j.fertnstert.2011.05.090. This multi-site study reported that endometriosis is highly debilitating disease which affects socioeconomic quality and work life of patients. This is one of the articles which identified the diagnostic delay in women with endometriosis.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Greene R, Stratton P, Cleary SD, Ballweg ML, Sinaii N. Diagnostic experience among 4,334 women reporting surgically diagnosed endometriosis. Fertil Steril. 2009;91:32–9.

    Article  PubMed  Google Scholar 

  13. Dun EC, Kho KA, Morozov VV, Kearney S, Zurawin JL, Nezhat CH. Endometriosis in adolescents. JSLS. 2015; 19(2). doi: 10.4293/JSLS.2015.00019.

  14. Laufer MR. Current approaches to optimizing the treatment of endometriosis in adolescents. Gynecol Obstet Investig. 2008;66(Suppl 1):19–27.

    Article  Google Scholar 

  15. Sinaii N, Plumb K, Cotton L, Lambert A, Kennedy S, Zondervan K, Stratton P. Differences in characteristics among 1,000 women with endometriosis based on extent of disease. Fertil Steril. 2008;89(3):538–45.

    Article  PubMed  Google Scholar 

  16. American Society for Reproductive Medicine. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril. 1997;67:817–21.

    Article  Google Scholar 

  17. • Missmer SA, Hankinson SE, Spiegelman D, Barbieri RL, Marshall LM, Hunter DJ. Incidence of laparoscopically confirmed endometriosis by demographic, anthropometric, and lifestyle factors. Am J Epidemiol. 2004;160(8):784–96. This study provides incidence measures of laproscopically-confirmed endometriosis in a large cohort of women which avoids biases inherent in hospital based studies or the misclassification of self-report.

    Article  PubMed  Google Scholar 

  18. Darrow SL, Vena JE, Batt RE, Zielezny MA, Michalek AM, Sharon S. Menstrual cycle characteristics and the risk of endometriosis. Epidemiology. 1993;4(2):135–42.

    Article  CAS  PubMed  Google Scholar 

  19. Matalliotakis I, Cakmak H, Fragouli Y, Goumenou A, Mahutte N, Arici A. Epidemiological characteristics in women with and without endometriosis in the Yale series. Arch Gynecol Obstet. 2008;277(5):389–93.

    Article  PubMed  Google Scholar 

  20. Missmer S, Hankinson S, Spiegelman D, Barbieri R, Malspeis S, Willett W, Hunter D. Reproductive history and endometriosis among premenopausal women. Obstet Gynecol. 2004;104(5 Pt 1):965–74.

    Article  PubMed  Google Scholar 

  21. Signorello LB, Harlow BL, Cramer DW, Spiegelman D, Hill JA. Epidemiologic determinants of endometriosis: a hospital-based case-control study. Ann Epidemiol. 1997;7(4):267–74.

    Article  CAS  PubMed  Google Scholar 

  22. Candiani G, Danesino V, Gastaldi A, Parazzini F, Ferraroni M. Reproductive and menstrual factors and risk of peritoneal and ovarian endometriosis. Fertil Steril. 1991;56(2):230–4.

    Article  CAS  PubMed  Google Scholar 

  23. Parazzini F. Risk factors for pelvic endometriosis in women with pelvic pain or infertility: Gruppo Italiano per lo Studio dell’ endometriosi. European Journal of Obstetrics & Gynecology and Reproductive Biology. 1999;83(2):195–9.

    Article  Google Scholar 

  24. Peterson CM, Johnstone EB, Hammoud AO, Stanford JB, Varner MW, Kennedy A, Chen Z, Sun L, Fujimoto VY, Hediger ML, Buck Louis GM. Risk factors associated with endometriosis: importance of study population for characterizing disease in the ENDO Study. Am J Obstet Gynecol. 2013;208(6):451.e451–11.

    Article  Google Scholar 

  25. Moen MH, Schei B. Epidemiology of endometriosis in a Norwegian county. Acta Obstet Gynecol Scand. 1997;76(6):559–62.

    Article  CAS  PubMed  Google Scholar 

  26. Cramer DW, Wilson E, Stillman RJ, et al. The relation of endometriosis to menstrual characteristics, smoking, and exercise. JAMA. 1986;255(14):1904–8.

    Article  CAS  PubMed  Google Scholar 

  27. Sangi-Haghpeykar H, Poindexter AN. Epidemiology of endometriosis among parous women. Obstet Gynecol 1995;85(6):983–992.

  28. Vercellini P, Eskenazi B, Consonni D, Somigliana E, Parazzini F, Abbiati A, et al. Oral contraceptives and risk of endometriosis: a systematic review and meta-analysis. Hum Reprod Update. 2011;17(2):159–70.

    Article  CAS  PubMed  Google Scholar 

  29. Chiaffarino F, Parazzini F, La Vecchia C, Ricci E, Crosignani PG. Oral contraceptive use and benign gynecologic conditions. A review Contraception. 1998;57(1):11–8.

    Article  CAS  PubMed  Google Scholar 

  30. Hediger ML, Hartnett HJ, Buck Louis GM. Association of endometriosis with body size and figure. Fertil Steril. 2005;84(5):1366–74.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Vitonis AF, Baer HJ, Hankinson SE, Laufer MR, Missmer SA. A prospective study of body size during childhood and early adulthood and the incidence of endometriosis. Hum Reprod. 2010;25(5):1325–34.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Vaughan S, Coward JI, Bast Jr RC, Berchuck A, Berek JS, Brenton JD, Coukos G, Crum CC, Drapkin R, Etemadmoghadam D, Friedlander M, Gabra H, Kaye SB, Lord CJ, Lengyel E, Levine DA, McNeish IA, Menon U, Mills GB, Nephew KP, Oza AM, Sood AK, Stronach EA, Walczak H, Bowtell DD, Balkwill FR. Rethinking ovarian cancer: recommendations for improving outcomes. Nat Rev Cancer. 2011;11(10):719–25. PMC3380637

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Bonocher CM, Montenegro ML, Rosa ESJC, Ferriani RA, Meola J. Endometriosis and physical exercises: a systematic review. Reprod Biol Endocrinol. 2014;12:4. PMC3895811

    Article  PubMed  PubMed Central  Google Scholar 

  34. Kvaskoff M, Bijon A, Clavel-Chapelon F, Mesrine S, Boutron-Ruault MC. Childhood and adolescent exposures and the risk of endometriosis. Epidemiology. 2013;24(2):261–9.

    Article  PubMed  Google Scholar 

  35. Wolff EF, Sun L, Hediger ML, Sundaram R, Peterson CM, Chen Z, et al. In utero exposures and endometriosis: the endometriosis, natural history, disease, outcome (ENDO) study. Fertil Steril. 2013;99(3):790–5.

    Article  CAS  PubMed  Google Scholar 

  36. Buck Louis GM, Hediger ML, Pena JB. Intrauterine exposures and risk of endometriosis. Hum Reprod. 2007;22(12):3232–6.

    Article  PubMed  Google Scholar 

  37. Baron JA, La Vecchia C, Levi F. The antiestrogenic effect of cigarette smoking in women. Am J Obstet Gynecol. 1990;162(2):502–14.

    Article  CAS  PubMed  Google Scholar 

  38. Parazzini F, Chiaffarino F, Surace M, Chatenoud L, Cipriani S, Chiantera V, Benzi G, Fedele L. Selected food intake and risk of endometriosis. Hum Reprod. 2004;19(8):1755–9.

    Article  CAS  PubMed  Google Scholar 

  39. Grodstein F, Goldman MB, Cramer DW. Infertility in women and moderate alcohol use. Am J Public Health. 1994;84(9):1429–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Heilier JF, Donnez J, Nackers F, Rousseau R, Verougstraete V, Rosenkranz K, et al. Environmental and host-associated risk factors in endometriosis and deep endometriotic nodules: a matched case-control study. Environ Res. 2007;103(1):121–9.

    Article  CAS  PubMed  Google Scholar 

  41. Ferrero S, Anserini P, Remorgida V, Ragni N. Body mass index in endometriosis. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2005;121(1):94–8.

    Article  Google Scholar 

  42. Shah DK, Correia KF, Vitonis AF, Missmer SA. Body size and endometriosis: results from 20 years of follow-up within the Nurses' Health Study II prospective cohort. Hum Reprod. 2013;28(7):1783–92. PMC3685336

    Article  PubMed  PubMed Central  Google Scholar 

  43. Grodstein F, Goldman MB, Ryan L, Cramer DW. Relation of female infertility to consumption of caffeinated beverages. Am J Epidemiol. 1993;137(12):1353–60.

    Article  CAS  PubMed  Google Scholar 

  44. Missmer SA, Chavarro JE, Malspeis S, Bertone-Johnson ER, Hornstein MD, Spiegelman D, Barbieri RL, Willett WC, Hankinson SE. A prospective study of dietary fat consumption and endometriosis risk. Hum Reprod. 2010;25(6):1528–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Apter D, Reinilä M, Vihko R. Some endocrine characteristics of early menarche, a risk factor for breast cancer, are preserved into adulthood. Int J Cancer. 1989;44(5):783–7.

    Article  CAS  PubMed  Google Scholar 

  46. Macmahon B, Trichopoulos D, Brown J, Andersen AP, Cole P, Dewaard F, Kauraniemi T, Polychronopoulou A, Ravnihar B, Stormby N, Westlund K. Age at menarche, urine estrogens and breast cancer risk. Int J Cancer. 1982;30(4):427–31.

    Article  CAS  PubMed  Google Scholar 

  47. Moore JW, Key TJA, Wang DY, Bulbrook RD, Hayward JL, Takatani O. Blood concentrations of estradiol and sex hormone-binding globulin in relation to age at menarche in premenopausal British and Japanese women. Breast Cancer Res Treat. 1991;18(1):S47–50.

    Article  PubMed  Google Scholar 

  48. Bernstein L, Pike M, Ross R, Judd H, Brown J, Henderson B. Estrogen and sex hormone-binding globulin levels in nulliparous and parous women. J Natl Cancer Inst. 1985;74(4):741–5.

    CAS  PubMed  Google Scholar 

  49. Dorgan JF, Reichman ME, Judd JT, Brown C, Longcope C, Schatzkin A, Campbell WS, Franz C, Kahle L, Taylor PR. Relationships of age and reproductive characteristics with plasma estrogens and androgens in premenopausal women. Cancer Epidemiol Biomark Prev. 1995;4(4):381–6.

    CAS  Google Scholar 

  50. Zondervan KT, Cardon LR, Kennedy SH. What makes a good case-control study? Design issues for complex traits such as endometriosis. Hum Reprod. 2002 Jun;17(6):1415–23.

    Article  PubMed  Google Scholar 

  51. Cramer DW, Missmer SA. The epidemiology of endometriosis. Ann N Y Acad Sci. 2002;955:11–22. discussion 34-6, 396-406

    Article  PubMed  Google Scholar 

  52. Berube S, Marcoux S, Maheux R. Characteristics related to the prevalence of minimal or mild endometriosis in infertile women. Canadian Collaborative Group on Endometriosis. Epidemiology. 1998;9(5):504–10.

    Article  CAS  PubMed  Google Scholar 

  53. Matalliotakis IM, Arici A, Cakmak H, Goumenou AG, Koumantakis G, Mahutte NG. Familial aggregation of endometriosis in the Yale Series. Arch Gynecol Obstet. 2008;278(6):507–11.

    Article  PubMed  Google Scholar 

  54. Parazzini F, Chiaffarino F, Surace M, Chatenoud L, Cipriani S, Chiantera V, et al. Selected food intake and risk of endometriosis. Hum Reprod. 2004;19(8):1755–9.

    Article  CAS  PubMed  Google Scholar 

  55. Hemmings R, Rivard M, Olive DL, Poliquin-Fleury J, Gagne D, Hugo P, et al. Evaluation of risk factors associated with endometriosis. Fertil Steril. 2004;81(6):1513–21.

    Article  PubMed  Google Scholar 

  56. Kern PA, Ranganathan S, Li C, Wood L, Ranganathan G. Adipose tissue tumor necrosis factor and interleukin-6 expression in human obesity and insulin resistance. Am J Physiol Endocrinol Metab. 2001;280(5):E745–51.

    CAS  PubMed  Google Scholar 

  57. Shephard RJ. Cytokine responses to physical activity, with particular reference to IL-6: sources, actions, and clinical implications. Crit Rev Immunol. 2002;22(3):165–82.

    CAS  PubMed  Google Scholar 

  58. Weisberg SP, McCann D, Desai M, Rosenbaum M, Leibel RL, Ferrante Jr AW. Obesity is associated with macrophage accumulation in adipose tissue. J Clin Invest. 2003;112(12):1796–808.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Hotamisligil GS, Arner P, Caro JF, Atkinson RL, Spiegelman BM. Increased adipose tissue expression of tumor necrosis factor-alpha in human obesity and insulin resistance. J Clin Invest. 1995;95(5):2409–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Baer DJ, Judd JT, Clevidence BA, Tracy RP. Dietary fatty acids affect plasma markers of inflammation in healthy men fed controlled diets: a randomized crossover study. Am J Clin Nutr. 2004;79(6):969–73.

    CAS  PubMed  Google Scholar 

  61. Kennedy S, Bergqvist A, Chapron C, D'Hooghe T, Dunselman G, Greb R, Hummelshoj L, Prentice A, Saridogan E. ESHRE Special Interest Group for Endometriosis and Endometrium Guideline Development Group. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005;20(10):2698–704.

    Article  PubMed  Google Scholar 

  62. Moore J, Copley S, Morris J, Lindsell D, Golding S, Kennedy S. A systematic review of the accuracy of ultrasound in the diagnosis of endometriosis. Ultrasound Obstet Gynecol. 2002;20:630–4.

    Article  CAS  PubMed  Google Scholar 

  63. 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.

    Article  CAS  PubMed  Google Scholar 

  64. 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.

    Article  PubMed  Google Scholar 

  65. Dessole S, Farina M, Rubattu G, Cosmi E, Ambrosini G, Nardelli GB. Sonovaginography is a new technique for assessing rectovaginal endometriosis. Fertil Steril. 2003;79:1023–7.

    Article  PubMed  Google Scholar 

  66. Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D'Hooghe T, De Bie B, Heikinheimo O, Horne AW, Kiesel L, Nap A, Prentice A, Saridogan E, Soriano D, Nelen W. European Society of Human Reproduction and Embryology ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29(3):400–12.

    Article  CAS  PubMed  Google Scholar 

  67. May KE, Villar J, Kirtley S, Kennedy SH, Becker CM. Endometrial alterations in endometriosis: a systematic review of putative biomarkers. Hum Reprod Update. 2011;17(5):637–53.

    Article  CAS  PubMed  Google Scholar 

  68. Pan Q, Luo X, Toloubeydokhti T, Chegini N. The expression profile of micro-RNA in endometrium and endometriosis and the influence of ovarian steroids on their expression. Mol Hum Reprod. 2007;13:797–806.

    Article  CAS  PubMed  Google Scholar 

  69. Othman Eel D, Hornung D, Al-Hendy A. Biomarkers of endometriosis. Expert Opin Med Diagn. 2008;2:741–52.

    Article  Google Scholar 

  70. Lessey BA, Young SL. Integrins and other cell adhesion molecules in endometrium and endometriosis. Semin Reprod Endocrinol. 1997;15(3):291–9.

    Article  CAS  PubMed  Google Scholar 

  71. Witz CA. Cell adhesion molecules and endometriosis. Semin Reprod Med. 2003;21(2):173–82.

    Article  CAS  PubMed  Google Scholar 

  72. Umezawa M, Saito Y, Tanaka-Hattori N, Takeda K, Ihara T, Sugamata M. Expression profile of extracellular matrix and adhesion molecules in the development of endometriosis in a mouse model. Reprod Sci. 2012;19(12):1365–72. doi:10.1177/1933719112450340.

    Article  PubMed  Google Scholar 

  73. Taylor RN, Lebovic DI, Mueller MD. Angiogenic factors in endometriosis. Ann N Y Acad Sci. 2002;955:89–100.

    Article  CAS  PubMed  Google Scholar 

  74. Becker CM, D'Amato RJ. Angiogenesis and antiangiogenic therapy in endometriosis. Microvasc Res. 2007;74:121–30.

    Article  CAS  PubMed  Google Scholar 

  75. Kyama CM, Mihalyi A, Gevaert O, Waelkens E, Simsa P, Van de Plas R, et al. Evaluation of endometrial biomarkers for semi-invasive diagnosis of endometriosis. Fertil Steril. 2011;95:1338–43.

    Article  CAS  PubMed  Google Scholar 

  76. Chan RWS, et al. Clonogenicity of human endometrial epithelial and stromal cells. Biol Reprod. 2004;70:1738–50.

    Article  CAS  PubMed  Google Scholar 

  77. Du H, Taylor HS. Contribution of bone marrow-derived stem cells to endometrium and endometriosis. Stem Cells. 2007;25:2082–6.

    Article  CAS  PubMed  Google Scholar 

  78. Tai MH, Chang CC, Kiupel M, Webster JD, Olson LK, Trosko JE. Oct4 expression in adult human stem cells: evidence in support of the stem cell theory of carcinogenesis. Carcinogenesis. 2005;26:495–502.

    Article  CAS  PubMed  Google Scholar 

  79. Painter JN, Anderson CA, Nyholt DR, Macgregor S, Lin J, Lee SH, Lambert A, Zhao ZZ, Roseman F, Guo Q, et al. Genome-wide association study identifies a locus at 7p15.2 associated with endometriosis. Nat Genet. 2011;43:51–4.

    Article  CAS  PubMed  Google Scholar 

  80. Browne AS, Yu J, Huang RP, Francisco AM, Sidell N, Taylor RN. Proteomic identification of neurotrophins in the eutopic endometrium of women with endometriosis. Fertil Steril. 2012;98:713–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  81. Liu H, Wang J, Wang H, Tang N, Li Y, Zhang Y, Hao T. Correlation between matrix metalloproteinase-9 and endometriosis. Int J Clin Exp Pathol. 2015;8(10):13399–404. eCollection 2015

    PubMed  PubMed Central  Google Scholar 

  82. Yang H, Liu J, Fan Y, Guo Q, Ge L, Yu N, Zheng X, Dou Y, Zheng S. Associations between various possible promoter polymorphisms of MMPs genes and endometriosis risk: a meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2016;205:174–88. doi:10.1016/j.ejogrb.2016.08.015.

    Article  PubMed  Google Scholar 

  83. •• Nisenblat V, Bossuyt PM, Shaikh R, Farquhar C, Jordan V, Scheffers CS, Mol BW, Johnson N, Hull ML. Blood biomarkers for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev. 2016;1(5):CD012179. doi:10.1002/14651858.CD012179. This is a comprehensive review of potential non-invasive tests (primarily blood biomarkers) for endometriosis.

    Google Scholar 

  84. •• Fassbender A, Vodolazkaia A, Saunders P, Lebovic D, Waelkens E, De Moor B, D'Hooghe T. Biomarkers of endometriosis. Fertil Steril. 2013;99(4):1135–45. This review discusses the diagnostic performance of peripheral blood biomarkers and endometrial nerve density in identifying women with endometriosis.

    Article  CAS  PubMed  Google Scholar 

  85. Vodolazkaia A, El-Aalamat Y, Popovic D, Mihalyi A, Bossuyt X, Kyama CM, Fassbender A, Bokor A, Schols D, Huskens D, Meuleman C, Peeraer K, Tomassetti C, Gevaert O, Waelkens E, Kasran A, De Moor B, D'Hooghe TM. Evaluation of a panel of 28 biomarkers for the non-invasive diagnosis of endometriosis. Hum Reprod. 2012;27(9):2698–711.

    Article  CAS  PubMed  Google Scholar 

  86. Zito G, Luppi S, Giolo E, Martinelli M, Venturin I, Di Lorenzo G, Ricci G. Medical treatments for endometriosis-associated pelvic pain. Biomed Res Int. 014; 2014:191967. doi: 10.1155/2014/191967.

  87. Angioni S, Cofelice V, Pontis A, Tinelli R, Socolov R. New trends of progestins treatment of endometriosis. Gynecol Endocrinol. 2014;30(11):769–73. doi:10.3109/09513590.2014.950646.

    Article  CAS  PubMed  Google Scholar 

  88. Andres Mde P, Lopes LA, Baracat EC, Podgaec S. Dienogest in the treatment of endometriosis: systematic review. Arch Gynecol Obstet. 2015;292(3):523–9.

    Article  PubMed  Google Scholar 

  89. Granese R, Perino A, Calagna G, Saitta S, De Franciscis P, Colacurci N, Triolo O, Cucinella G. Gonadotrophin-releasing hormone analogue or dienogest plus estradiol valerate to prevent pain recurrence after laparoscopic surgery for endometriosis: a multi-center randomized trial. Acta Obstet Gynecol Scand. 2015;94(6):637–45.

    Article  CAS  PubMed  Google Scholar 

  90. Champaneria R, Abedin P, Daniels J, Balogun M, Khan KS. Ultrasound scan and magnetic resonance imaging for the diagnosis of adenomyosis: systematic review comparing test accuracy. Acta Obstet Gynecol Scand. 2010;89(11):1374–84.

    Article  PubMed  Google Scholar 

  91. Posadzka E, Jach R, Pityński K, Jablonski MJ. Treatment efficacy for pain complaints in women with endometriosis of the lesser pelvis after laparoscopic electroablation vs. CO2 laser ablation. Lasers Med Sci. 2015;30(1):147–52.

    Article  PubMed  Google Scholar 

  92. de Dominique Z, Bruno B, Charles C. Endometriosis and infertility: pathophysiology and management. Lancet. 2010;376:730–8.

    Article  Google Scholar 

  93. Jacobson TZ, Duffy JM, Barlow D, Farquhar C, Koninckx PR, Olive D. Laparoscopic surgery for subfertility associated with endometriosis. Cochrane Database SystRev. 2010:CD001398.

  94. D'Hooghe TM, Nugent NP, Cuneo S, Chai DC, Deer F, Debrock S, Kyama CM, Mihalyi A, Mwenda JM. Recombinant human TNFRSF1A (r-hTBP1) inhibits the development of endometriosis in baboons: a prospective, randomized, placebo- and drug-controlled study. Biol Reprod. 2006;74(1):131–6.

    Article  PubMed  Google Scholar 

  95. Issa B, Onon TS, Agrawal A, Shekhar C, Morris J, Hamdy S, Whorwell PJ. Visceral hypersensitivity in endometriosis: a new target for treatment? Gut. 2012;61(3):367–72.

    Article  CAS  PubMed  Google Scholar 

  96. •• McKinnon BD, Kocbek V, Nirgianakis K, Bersinger NA, Mueller MD. Kinase signaling pathways in endometriosis: potential targets for non-hormonal therapeutics. Hum Reprod Update. 2016;22(3) doi:10.1093/humupd/dmv060. A recent report describing the role of kinase signaling pathways in endometriosis and their use as a potential therapeutic targets for endometriosis.

  97. Santulli P, Marcellin L, Tosti C, Chouzenoux S, Cerles O, Borghese B, Batteux F, Chapron C. MAP kinases and the inflammatory signaling cascade as targets for the treatment of endometriosis? Expert Opin Ther Targets. 2015;19(11):1465–83.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Kathryn L. Terry.

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Parveen Parasar, Pinar Ozcan, and Kathryn L. Terry declare that they have no conflicts of interest.

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Parasar, P., Ozcan, P. & Terry, K.L. Endometriosis: Epidemiology, Diagnosis and Clinical Management. Curr Obstet Gynecol Rep 6, 34–41 (2017). https://doi.org/10.1007/s13669-017-0187-1

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