35. Endometriosis

Endometriosis is a benign gynaecological disorder, characterised by endometrial-like tissue growing outside the uterine cavity under the influence of oestrogens. It affects 2–10 % of women of reproductive age. The exact pathogenesis is not entirely clear, but a complex multifactorial process of immunologic, inflammatory and hormonal factors seems to be involved. Endometriosis can be suspected based on clinical symptoms and findings by physical examination and/or imaging modalities. Surgical identification, including histological verification, is no longer the gold standard for the diagnosis. Currently, laparoscopy is recommended only in patients with negative imaging and/or where empirical treatment has failed. Since curative treatment options for endometriosis are not available, treatment is challenging. Symptomatic treatment of this chronic disease consists of analgesia, hormonal suppression therapy and surgical intervention. In infertile women, assisted reproductive techniques may be considered. A multidisciplinary and life course approach is advocated.