Clinical review for general practice

The global relevance of endometriosis as one of the most common gynaecological nosologies is increasing every year. Currently available evidence-based data help to uncover the most intimate pathogenetic stigmas of the disease and identify key application points for its treatment. That said, the most common forms of endometriosis are currently deep infiltrative, superficial peritoneal, and endometrioid ovarian cysts. This review presents the key pathogenetic mechanisms of different phenotypes of the disease and highlights current strategies for their combined treatment.

Keywords: superficial peritoneal endometriosis, deep infiltrative endometriosis, endometrioid ovarian cysts, dienogest.

1. Lamceva J, Uljanovs R, Strumfa I. The main theories on the pathogenesis of endometriosis. International journal of molecular sciences. 2023;24(5):4254.

2. Yilmaz BD, Bulun SE. Endometriosis and nuclear receptors. Human reproduction update. 2019;25(4):473-85.

3. Ellis K, Munro D, Clarke J. Endometriosis is undervalued: a call to action. Frontiers in Global Women’s Health. 2022;3:54.

4. Parazzini F, Esposito G, Tozzi L et al. Epidemiology of endometriosis and its comorbidities. Eur J Obstetrics Gynecology Reproductive Biology. 2017;209:3-7.

5. Yarmolinskaya M, Suslova E, Tkachenko N et al. Dopamine agonists as genital endometriosis target therapy. Gynecological Endocrinology. 2020;36(Supl 1):7-11.

6. Raja MHR, Farooqui N, Zuberi N et al. Endometriosis, infertility and MicroRNA’s: A review. J Gynecology Obstetrics Human Reproduction. 2021;50(9):102157.

7. Arnold MJ, Osgood AT, Aust A. Chronic Pelvic Pain in Women: ACOG Updates Recommendations. Am Fam Physician. 2021;103(3):186-8. PMID: 33507045.

8. Horne AW, Saunders PTK. SnapShot: Endometriosis. Cell. 2019;179:1677.

9. Imperiale L, Nisolle M, Noël JC, Fastrez M. Three types of endometriosis: pathogenesis, diagnosis and treatment. State of the art. J Clin Med.2023;12(3):994.

10. Cardoso JV, Machado DE, Silva MCD et al. Epidemiological profile of women with endometriosis: a retrospective descriptive study. Revista Brasileira de Saúde Materno Infantil. 2021;20:1057-67.

11. Quintana RL. Endometriosis infiltrativa profunda en la vejiga, resección quirúrgica por laparoscopia. Reporte de un caso y revisión de la bibliografía. Revista Mexicana de Medicina De La Reproducción. 2022;13(d).

12. Kor E et al. Relationship between the severity of endometriosis symptoms (dyspareunia, dysmenorrhea and chronic pelvic pain) and the spread of the disease on ultrasound. BMC Research Notes. 2020;13:1-8.

13. Lunde CE, Wu Z, Reinecke A, Sieberg CB. The Application of Cognitive Behavioral Therapy for Adolescent Patients With Endometriosis: A Topical Review. Cognitive and Behavioral Practice. 2024.

14. Maggiore ULR, Chiappa V, Ceccaroni M et al. Epidemiology of infertility in women with endometriosis. Best Practice & Research Clinical Obstetrics & Gynaecology. 2024: 102454.

15. Johnson NP, Hummelshoj L, World Endometriosis Society Montpellier Consortium. Consensus on current management of endometriosis. Hum Reprod. 2013;28:1552-68. 

16. Mifsud JM, Pellegrini L, Cozzolino M. Oocyte Cryopreservation in Women with Ovarian Endometriosis. Journal of Clinical Medicine. 2023;12(21):6767.

17.  E, Schiermeier S,  T. Coexistence of endometriomas with extraovarian endometriosis and adhesions. Eur J Obstet Gynecol Reprod Biol. 2021;263:20-4.

18. Leyendecker G, Kunz G, Noe M et al. Endometriosis: A dysfunction and disease of the archimetra. Hum Reprod Update. 1998;4: 752-62.

19. Habiba M, Benagiano G, Guo SW. An Appraisal of the Tissue Injury and Repair (TIAR) Theory on the Pathogenesis of Endometriosis and Adenomyosis. Biomolecules. 2023;13(6):975.

20. Leyendecker G, Wildt L, Laschke MW, Mall G. Archimetrosis: The evolution of a disease and its extant presentation: Pathogenesis and pathophysiology of archimetrosis (uterine adenomyosis and endometriosis). Archives of Gynecology and Obstetrics. 2023;307(1):93-112.

21. Anastasiu CV, Moga MA, Elena Neculau A et al. Biomarkers for the Noninvasive Diagnosis of Endometriosis: State of the Art and Future Perspectives. Int J Mol Sci 2020;21:1750. DOI: 10.3390/ijms21051750

22. Halme J, Hammond MG, Hulka JF et al. Retrograde menstruation in healthy women and in patients with endometriosis. Obstet. Gynecol. 1984;64:151-4.

23. Leyendecker G, Bilgicyildirim A, Inacker M et al. Adenomyosis and endometriosis. Revisiting their association and further insights into the mechanisms of autotraumatisation. An MRI study. Arch. Gynecol Obstet. 2015;291:917-32.

24. Leyendecker G, Herbertz M, Kunz G, Mall G Endometriosis results from the dislocation of basal endometrium. Hum Reprod. 2002;17:2725-36.

25. Goławski K et al. The Role of Cadherin 12 (CDH12) in the Peritoneal Fluid among Patients with Endometriosis and Endometriosis-Related Infertility. Int J Environmental Research and Public Health. 2022;19 (18):11586.

26. Ponandai-Srinivasan S et al. Syndecan-1 modulates the invasive potential of endometrioma via TGF-β signalling in a subgroup of women with endometriosis. Human Reproduction. 2020;35(10):2280-93.

27. Smolarz B, Szyłło K, Romanowicz H. Endometriosis: epidemiology, classification, pathogenesis, treatment and genetics (review of literature). Int J Molecular Sciences. 2021;22(19):10554.

28. Laganà AS et al. The pathogenesis of endometriosis: molecular and cell biology insights. Int J Molec Sci. 2019;20(22):5615.

29. Koninckx PR, Ussia A, Adamyan LV et al. Deep endometriosis: definition, diagnosis, and treatment. Fertil Steril. 2012;98(3):564-71.

30. Abrao M, Neme R, Carvalho F et al. Histological classification of endometriosis as a predictor of response to treatment. Int J Gynecol Obstet. 2003;82.

31. Estrogen Receptor α, Progesterone Receptor, and Progesterone Receptor B Proteins in Rectosigmoid Endometriosis: A Tissue Microarray Study. Reprod Sci. 2014;22:31-7.

32. Tosti C, Pinzauti S, Santulli P et al. Pathogenetic Mechanisms of Deep Infiltrating Endometriosis. Reprod. Sci. 2015;22:1053-9.

33. Оразов М.Р., Радзинский В.Е., Долгов Е.Д. «Всегда в моде». Неоклассика, или Излюбленные локализации эндометриоза. Клинический разбор в общей медицине. 2023;4(9):6-14. DOI: 10.47407/ kr2023.4.9.0 Orazov M.R., Radzinskii V.E., Dolgov E.D. «Always trendy». Neoclassic, or Favorite endometriosis localizations. Clinical review for general practice. 2023;4(9):6-14. DOI: 10.47407/kr2023.4.9.00323 (in Russian).

34. Оразов М.Р., Долгов Е.Д. Профилактика рецидивов эндометриоза: сказки братьев Гримм или суровая реальность в классическом бальзаковском жанре. Women’s Clinic. 2022;4:57-65.  Orazov M.R., Dolgov E.D. Prevention of relapses of endometriosis: fairy tales of the brothers Grimm or harsh reality in the classical Balzac genre. Women’s Clinic. 2022;4:57-65 (in Russian).

35. Оразов М.Р., Радзинский В.Е., Долгов Е.Д., Абрамашвили Ю.Г. Патогенез и патогенетические опции в менеджменте эндометриоза. Вопросы гинекологии, акушерства и перинатологии. 2023;22(1):92-104. DOI: 10.20953/1726-1678-2023-1-92-104 Orazov M.R., Radzinsky V.E., Dolgov E.D., Abramashvili Yu.G. Pathogenesis and pathogenetic options in endometriosis management. Issues of gynecology, obstetrics and perinatology. 2023;22(1):92-104. DOI: 10.20953/1726-1678-2023-1-92-104 (in Russian).

36. Guideline of European Society of Human Reproduction and Embryology. Endometriosis. 2022.

37. Riley KA, Benton AS, Deimling TA et al. Surgical excision versus ablation for superficial endometriosis-associated pain: a randomized controlled trial. Journal of Minimally Invasive Gynecology. 2019;26(1):71-7.

38. Burks C, Lee M, DeSarno M et al. Excision versus ablation for management of minimal to mild endometriosis: a systematic review and meta-analysis. Journal of Minimally Invasive Gynecology. 2021;28(3):587-97.

39. Попов А.А., Пучков К.В., Федоров А.А. и др. Хирургическое лечение больных с колоректальным эндометриозом: анатомические особенности, показания, техника операций, осложнения. Российский вестник акушера-гинеколога. 2020;20(2):95-104. DOI: 10.17116/ rosakush20202002195 Popov A.A., Puchkov K.V., Fedorov A.A. et al. Surgical treatment of patients with colorectal endometriosis: anatomical features, indications, surgical technique, complications. Russian bulletin of the obstetrician-gynaecologist. 2020;20(2):95-104. DOI: 10.17116/rosakush 20202002195 (in Russian).

40. La Torre F, Vannuccini S, Toscano F et al. Long-term treatment for endometriosis with dienogest: efficacy, side effects and tolerability. Gynecological Endocrinology. 2024;40(1):2336121.

41. Maiorana A et al. Evaluation of long-term efficacy and safety of dienogest in patients with chronic cyclic pelvic pain associated with endometriosis. Arch Gynecol Obstet. 2024;309:589-97.

42. Эндометриоз. Федеральные клинические рекомендации. М., 2020.  Endometriosis. Federal Clinical Guidelines. Moscow, 2020 (in Russian).

43. Оразов М.Р., Радзинский В.Е., Орехов Р.Е., Таирова М.Б. Эффективность профилактики рецидивов после хирургического лечения эндометриоза яичников. Вопросы гинекологии, акушерства и перинатологии. 2022; 21(3):53-62. DOI: 10.20953/ 1726-1678-2022-3-53-62 Orazov M.R., Radzinsky V.E., Orekhov R.E., Tairova M.B. Effectiveness of recurrence prevention after surgical treatment of ovarian endometriosis. Issues of gynecology, obstetrics and perinatology. 2022; 21(3):53-62. DOI: 10.20953/1726-1678-2022-3-53-62 (in Russian).