Abstract
Endometriosis is a disease that affects ∼10% of women. It is a chronic condition that is difficult to diagnose, very challenging to manage and, not uncommonly, difficult to treat. As a rule, manifestations of endometriosis include chronic pelvic pain, dysmenorrhea, dyspareunia, and a multitude of other symptoms. Women suffering from endometriosis can have gastrointestinal symptoms, such as nausea, vomiting, and diarrhea; very often, the condition is confused with irritable bowel syndrome or other intestinal pathology. In addition, women suffering from endometriosis may have a multitude of urologic symptoms including painful urination, painful bladder syndrome, and difficulty with urination.
Endometriosis may affect quality of life of a woman both from personal, social, and professional perspectives. The condition may also affect current and future fertility. Multiple studies that are highlighted in this issue demonstrate the effects of endometriosis—both superficial and deep retroperitoneal disease—on a women's fertility and future childbearing.
First described almost 100 years ago, we now believe that the etiology and pathophysiology of endometriosis is complex and does not follow one particular pattern. Multiple theories have been developed over the years, none of which answer all the questions and manifestations of the disease found in different patients. From the theory of retrograde menstruation to immunologic mechanisms and genetic abnormalities, researchers have been looking at ways to improve diagnostic accuracy and develop new ways of therapeutic testing. Much research is focusing on developing a blood test that can be used noninvasively to detect and predict the development of endometriosis, as well as finding the specific genetic markers that can be utilized in future diagnosis and treatment.
Several methods currently exist for the treatment of this challenging condition. From pharmacologic management to noninvasive medical options to surgery, researchers and surgeons around the world have been looking at the best possible ways to address this enigmatic condition. New medical therapies have been developed that provide relief of the symptoms associated with endometriosis, albeit with some unavoidable side-effects. As sophisticated surgical techniques are becoming more widely adopted, including better laparoscopic visualization, superior light sources and 3D and 4K high-definition monitors, the difficulties associated with treating this condition are becoming understood more clearly. We now know that endometriosis may manifest as typical “powder-burn” or cherry red–spot lesions, but also as a highly atypical small vesicular or yellow lesion, previously ignored during laparoscopy. In addition, deep infiltrating endometriosis (DIE) is a very challenging disease to treat surgically, with inherent risks to the surrounding organs. Such surgical procedures should only be performed in highly specialized centers experienced in the surgical management of advanced endometriosis.
I hope that this special section in this issue on the topic of endometriosis will help our readers and physicians around the world to understand the complexity of this condition better and become future educators and pioneers in developing new techniques and approaches to treat this relentless disease.