Endometriosis: how to diagnose and manage this complex condition

Endometriosis is a painful, complex condition affecting about 1 in 10 women of reproductive age, but it is poorly understood. A new clinical review published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.220637 provides an overview of the causes, diagnosis and management of endometriosis based on the latest evidence, to help clinicians and patients.

The review is timely, as March is Endometriosis Awareness Month.

Endometriosis, defined as the presence of endometrial-like tissue outside the uterus, is one of the most common gynecologic conditions. It is estimated to affect approximately 1 million women in Canada and an unknown number of gender-diverse people. It can cause chronic pelvic pain and organ damage, affect fertility and negatively impact quality of life.

“Endometriosis can involve multiple organ systems and its symptoms are often chronic, which can affect work productivity, social life, intimate relationships and mental health considerably, and lead to substantial societal costs,” writes Dr. Catherine Allaire, Department of Obstetrics and Gynaecology, University of British Columbia, and BC Women’s Centre for Pelvic Pain and Endometriosis, Vancouver, BC, with coauthors.

Although laparoscopy with histopathologic confirmation has been considered the gold standard for diagnosis, to address the unacceptably long interval between symptom onset and diagnosis, recent guidelines note that a diagnosis can be made based on symptoms, physical examination and imaging.

“Early recognition and diagnosis are key to providing timely treatment. Primary care providers can make a clinical diagnosis of endometriosis and start first-line medical management. Referral to a gynecologist for second-line hormonal therapy or surgery is important, when indicated,” the authors conclude.

“Reducing the delay to diagnosis and initiating treatment will help improve quality of life for the 1 million individuals affected by endometriosis in Canada,” say the authors.

In a related article https://www.cmaj.ca/lookup/doi/10.1503/cmaj.230215, a patient describes her own painful experience with endometriosis in an “In their own words” first-person article.