Literature review - diagnostic and treatment challenges of endometriosis in premenopausal women

Abstract

Dominyka Grinciūtė1, Ernestas Frolovas2 1Vilnius University, Faculty of Medicine, Vilnius, Lithuania 2Vilnius University Hospital Santaros Klinikos, Obstetrics and Gynecology department, Vilnius, Lithuania Abstract Background and aim. Endometriosis is an inflammatory disease that highly decreases the quality of life. The gold standard of diagnosis is considered laparoscopy with tissue biopsy, which can often lead to excess surgical interventions. To this day there is an ongoing discussion about the best treatment for endometriosis, which has led to multiple different guidelines and no clear conclusion. The aim of this review is to discuss whether diagnostic laparoscopy can be safely replaced by non-surgical imaging techniques and to compare different treatment guidelines for endometriosis. Materials and methods. To evaluate whether transvaginal ultrasound and magnetic resonance imaging can take the role of diagnostic laparoscopy with tissue biopsy, the literature research using PubMed and Google Scholar databases was performed. We also reviewed different endometriosis treatment algorithms to try and depict the best treatment method of today. Results. Radiological endometriosis diagnosis although highly sensitive and specific does depend on the disease location. Nevertheless, it should be the primary choice for diagnosis as it carries less risk for the patient. Most of the treatment algorithms are based on the main symptoms: pain and infertility. The guidelines agree that medical therapy should be the primary choice of treatment. However, surgery is still irreplaceable while removing already existing endometriotic lesions. Conclusion. Non-surgical diagnosis can safely replace diagnostic laparoscopy with tissue biopsy in diagnosing endometriosis. Pharmaceutical therapy is the first choice for treatment when the primary symptom is pain. If the main complaint is infertility treatment should depend on the size of the endometrioma and fertility. Keywords: peritoneal endometriosis, endometriomas, transvaginal sonography, magnetic resonance imaging, firstline therapy. Full article https://doi.org/10.53453/ms.2023.5.2