Obstetrics

Surgery

Pathology

Nursing

Intensive care medicine

Infertility

Disease

Adenomyosis

Pregnancy

Endometriosis

Quality of life (healthcare)

Laparoscopy

Pelvic pain

Gynecology

Genetics

General surgery

Medicine

Biology

Nature Reviews Endocrinology

Endometriosis is a chronic inflammatory disease defined as the presence of endometrial tissue outside the uterus, which causes pelvic pain and infertility. This disease should be viewed as a public health problem with a major effect on the quality of life of women as well as being a substantial economic burden. In light of the considerable progress with diagnostic imaging (for example, transvaginal ultrasound and MRI), exploratory laparoscopy should no longer be used to diagnose endometriotic lesions. Instead, diagnosis of endometriosis should be based on a structured process involving the combination of patient interviews, clinical examination and imaging. Notably, a diagnosis of endometriosis often leads to immediate surgery. Therefore, rethinking the diagnosis and management of endometriosis is warranted. Instead of assessing endometriosis on the day of the diagnosis, gynaecologists should consider the patient’s ‘endometriosis life’. Medical treatment is the first-line therapeutic option for patients with pelvic pain and no desire for immediate pregnancy. In women with infertility, careful consideration should be made regarding whether to provide assisted reproductive technologies prior to performing endometriosis surgery. Modern endometriosis management should be individualized with a patient-centred, multi-modal and interdisciplinary integrated approach. This Review summarizes the mechanisms of endometriosis and highlights how health-care professionals could rethink endometriosis diagnosis and management. A patient-centred, individualized, multi-modal and interdisciplinary integrated approach should be taken to maximize the quality of the patient’s ‘endometriosis life’.

Rethinking mechanisms, diagnosis and management of endometriosis