Summary

An Evidence-Based Approach to Assessing Surgical Versus Clinical

Diagnosis of Symptomatic Endometriosis

Endometriosis is usually described by the presence of lesions that vary in form,

size, and location and are validated histologically by the presence of endometrial
glands, endometrial stroma, and/or hemosiderin-laden macrophages. It is a prevalent
gynecologic illness that affects around 6%–10% of reproductive-aged women.
Discomfort, which manifests as dysmenorrhea, persistent pelvic pain, dyspareunia,
and/or dyschezia, is a debilitating symptom of endometriosis. Endometriosis is seen in
between 20%–50% of women who are treated for infertility but do not have symptoms
like pain or irregular periods. In the context of endometriosis, the term "asymptomatic"
refers to the existence of endometrial lesions without pain, infertility, ovarian masses, or
bladder or bowel trouble.

Pelvic pain is a common occurrence in the general population. While pain is a

key symptom of endometriosis, determining whether it is due to endometriosis can be
difficult. Pelvic pain in women can come from a variety of origins and appear in a variety
of ways, making its use as a marker for endometriosis more difficult. Overall,
dysmenorrhea is the most common pain symptom, with the majority of women with
endometriosis reporting it.

Infertility is much more common in women with endometriosis than in women

who do not have the disease. Given this association, endometriosis should be
examined as a possible cause of infertility or comorbidity among women with infertility,
especially those who exhibit additional endometriosis-like symptoms.

Despite limitations in our understanding and evidence base regarding

endometriosis—from the most basic understanding of disease pathogenesis to
diagnosis and management—the current clinical need requires that we consider how to
optimize the information and approaches available to us in order to provide patients with
cost-effective interventions.
 The current study of endometriosis diagnostic methods has yielded some
significant findings. First, there is a significant possibility to minimize the time to
diagnosis for a condition that has a significant impact on many people's quality of life.
Second, a clinical diagnosis may have distinct value because it is noninvasive and
based on common techniques; it is accessible to both primary care and specialist
practitioners; and it may be widely adopted without causing significant changes to
normal practices and patient flow. The possibility of a clinical diagnosis of symptomatic
endometriosis does not invalidate the importance of laparoscopy, nor does it rule out
the possibility that laparoscopy will be required for a fraction of patients diagnosed
clinically. When medical therapy fails to offer adequate symptom alleviation or scarring
is present, surgical intervention remains an important management option. Ultimately,
regardless of different viewpoints or preferences about clinical versus surgical
diagnosis, our common goal is to provide access to suitable and effective therapeutic
choices for symptomatic endometriosis and minimize the disease burden.