Journal ArticleDOI
Endometriosis: pathogenesis and treatment
TLDR
Endometriosis is estrogen-dependent, manifests during reproductive years and is associated with pain and infertility, while lesion eradication is considered a fertility-enhancing procedure, the benefit on reproductive performance is moderate.Abstract:
Endometriosis is defined as the presence of endometrial-type mucosa outside the uterine cavity. Of the proposed pathogenic theories (retrograde menstruation, coelomic metaplasia and Mullerian remnants), none explain all the different types of endometriosis. According to the most convincing model, the retrograde menstruation hypothesis, endometrial fragments reaching the pelvis via transtubal retrograde flow, implant onto the peritoneum and abdominal organs, proliferate and cause chronic inflammation with formation of adhesions. The number and amount of menstrual flows together with genetic and environmental factors determines the degree of phenotypic expression of the disease. Endometriosis is estrogen-dependent, manifests during reproductive years and is associated with pain and infertility. Dysmenorrhoea, deep dyspareunia, dyschezia and dysuria are the most frequently reported symptoms. Standard diagnosis is carried out by direct visualization and histologic examination of lesions. Pain can be treated by excising peritoneal implants, deep nodules and ovarian cysts, or inducing lesion suppression by abolishing ovulation and menstruation through hormonal manipulation with progestins, oral contraceptives and gonadotropin-releasing hormone agonists. Medical therapy is symptomatic, not cytoreductive; surgery is associated with high recurrence rates. Although lesion eradication is considered a fertility-enhancing procedure, the benefit on reproductive performance is moderate. Assisted reproductive technologies constitute a valid alternative. Endometriosis is associated with a 50% increase in the risk of epithelial ovarian cancer, but preventive interventions are feasible.read more
Citations
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Journal ArticleDOI
Fertility Preservation in Women
TL;DR: There has been a sharp increase in the demand for fertility preservation, and this review summarizes the indications and current options and describes new techniques and strategies, including those for women with newly diagnosed malignant disease.
Journal ArticleDOI
Rethinking mechanisms, diagnosis and management of endometriosis
TL;DR: A patient-centred, individualized, multi-modal and interdisciplinary integrated approach should be taken to maximize the quality of the patient’s ‘endometriosis life’ and how health-care professionals could rethink endometRIosis diagnosis and management is highlighted.
Journal ArticleDOI
Clonal Expansion and Diversification of Cancer-Associated Mutations in Endometriosis and Normal Endometrium
Kazuaki Suda,Hirofumi Nakaoka,Kosuke Yoshihara,Tatsuya Ishiguro,Ryo Tamura,Yutaro Mori,Kaoru Yamawaki,Sosuke Adachi,Tomoko Takahashi,Hiroaki Kase,Kenichi Tanaka,Tadashi Yamamoto,Teiichi Motoyama,Ituro Inoue,Takayuki Enomoto +14 more
TL;DR: Remarkable increases in MAF of mutations in cancer-associated genes in endometriotic epithelium suggest retrograde flow of endometrial cells already harboring cancer- associated mutations, with selective advantages at ectopic sites, leading to the development ofendometriosis.
Journal ArticleDOI
The pathogenesis of endometriosis: Molecular and cell biology insights
Antonio Simone Laganà,Simone Garzon,Martin Götte,Paola Viganò,Massimo Franchi,Fabio Ghezzi,Dan C. Martin +6 more
TL;DR: A narrative review synthesizing the findings of the English literature retrieved from computerized databases from inception to June 2019 suggests that a single etiopathogenetic model is not sufficient to explain its complex pathobiology.
References
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Journal ArticleDOI
Revised American Society for Reproductive Medicine classification of endometriosis: 1996
Michel Canis,J. G. Donnez,D. S. Guzick,J. K. Halme,John A. Rock,Robert S. Schenken,Michael Vernon +6 more
Journal ArticleDOI
Clinical practice. endometriosis
TL;DR: A healthy 25-year-old woman presents with worsening dysmenorrhea, pain of recent onset in the left lower quadrant, and dyspareunia.
Journal ArticleDOI
ARID1A mutations in endometriosis-associated ovarian carcinomas.
Kimberly C. Wiegand,Sohrab P. Shah,Osama M. Al-Agha,Yongjun Zhao,Kane Tse,Thomas Zeng,Janine Senz,Melissa K. McConechy,Michael S. Anglesio,Steve E. Kalloger,Winnie Yang,Alireza Heravi-Moussavi,Ryan Giuliany,Christine Chow,John Fee,Abdalnasser Zayed,Leah M Prentice,Nataliya Melnyk,Gulisa Turashvili,Allen Delaney,Jason Madore,Stephen Yip,Andrew McPherson,Gavin Ha,Lynda Bell,Sian Fereday,Angela Tam,Laura Galletta,Patricia N. Tonin,Diane Provencher,Dianne Miller,Steven J.M. Jones,Richard A. Moore,Gregg B. Morin,Gregg B. Morin,Arusha Oloumi,Niki Boyd,Samuel Aparicio,Ie Ming Shih,Anne Marie Mes-Masson,David D.L. Bowtell,David D.L. Bowtell,Martin Hirst,Blake Gilks,Marco A. Marra,Marco A. Marra,David G. Huntsman +46 more
TL;DR: These data implicate ARID1A as a tumor-suppressor gene frequently disrupted in ovarian clear-cell and endometrioid carcinomas.
Journal ArticleDOI
ESHRE guideline for the diagnosis and treatment of endometriosis
Stephen Kennedy,Agneta Bergqvist,Charles Chapron,Thomas D'Hooghe,Gerard A.J. Dunselman,Robert R. Greb,Lone Hummelshoj,Andrew M. Prentice,Ertan Saridogan +8 more
TL;DR: A working group was convened comprised of practising gynaecologists and experts in evidence-based medicine from Europe, as well as an endometriosis self-help group representative, and the guideline was developed and refined.