Seminars in reproductive medicine最新文献

Endometriosis affects millions of women around the world, yet it remains a complex and often misunderstood condition, with limited funding available for research. Although much about this enigmatic disease is still unknown, emerging data continue to shed light on its mechanisms, leading to improved understanding and better management options for patients. While advances have been made in understanding the symptoms and pathophysiology of endometriosis, one critical area remains underexplored: its impact on fertility. It is now well established that endometriosis can significantly impair fertility, posing additional challenges for women trying to conceive. This study explores current theories on how endometriosis affects reproductive function and highlights the latest research on both medical and surgical approaches to managing infertility in these patients. It will also examine the implications of endometriosis on natural conception as well as outcomes related to assisted reproductive technologies.

Endometriosis is a complex, chronic disorder that has the potential to produce long-term negative impact on the life and function of patients who carry this diagnosis. Endometriosis is thought to impact up to 10 to 15% of women across the globe and up to 90% of patients with pelvic pain. Yet, many questions remain regarding the true pathogenesis of this disease, as well as the best approach to surveillance and treatment. What we do know is that, as there remains no cure for endometriosis, management of this disease is best achieved with a longitudinal approach, with consideration of immediate disease features and other potential sequelae. The ideal treatment approach typically involves more conservative lifestyle changes, including dietary modifications, and incorporation of medication therapy, typically at the very least involving some form of hormone suppression therapy. The role of surgery remains dependent on both the patient's clinical course and the provider. Here, we explore both the known and the unknown in endometriosis management, with key updates on the potential implications of hysterectomy.

Endometriosis-the growth of uterine-like tissue outside the uterus-is a devastating disease that severely reduces the quality of life of those affected, resulting in missed days from school and work due to intractable pelvic pain. While endometriosis was first recognized over 100 years ago, we still do not fully understand the mechanisms of the disease, and most treatments address the symptoms of pain and discomfort but do not prevent lesion growth or disease progression. Endometriosis is a significant cause of infertility; 50% of patients seeking fertility care have endometriosis. Definitive diagnosis typically requires histological examination of excised lesional tissue, necessitating surgical excision of lesions. Therefore, many patients have a significant diagnosis delay-up to 11 years following the first onset of symptoms. While modern research technologies hold the potential to vastly improve diagnosis and treatment, women's health, particularly genitopelvic health, is understudied and underfunded. Here, we summarize what is currently known about the mechanism and ongoing efforts to develop new biomarkers and therapies that target the root causes of disease.

Endometriosis affects an estimated 200 million women globally, yet significant barriers hinder access to timely and appropriate care. These barriers encompass various aspects, including societal normalization of menstrual pain, leading to delayed diagnosis and misinterpretation of symptoms as "normal" period pain. This normalization, coupled with the stigma surrounding menstrual health, often results in the dismissal of symptoms by both individuals and healthcare providers. Furthermore, access is often limited by socioeconomic factors and healthcare disparities, making specialized treatments financially prohibitive for many. There is an urgent need for a multi-pronged approach to improve access to quality endometriosis care. This includes increased education and awareness for patients, healthcare providers, and the public to destigmatize the condition and promote early recognition of symptoms. Additionally, addressing healthcare system reforms and socioeconomic disparities is essential to ensuring equitable access to effective diagnostic tools and treatment options for all affected individuals. Further research is crucial to better understand the underlying mechanisms of the disease, improve diagnostic tools, and develop more effective treatments.

Endometriosis is a chronic, estrogen-dependent inflammatory disorder characterized by ectopic endometrium-like tissue, leading to debilitating pain and reduced quality of life. Pain is the hallmark of endometriosis, with individuals experiencing dysmenorrhea, dysuria, dyschezia, dyspareunia, and chronic pelvic pain. However, pain does not always correlate with the severity or location of the lesions, which suggests additional factors are involved in the generation of endometriosis-associated pain. The underlying mechanisms are multifactorial, involving peripheral and central sensitization, inflammation, aberrant innervation, immune dysregulation, and hormonally influenced processes. Additionally, many individuals with endometriosis experience comorbid pain syndromes, including pelvic floor dysfunction (PFD), irritable bowel syndrome, interstitial cystitis, abdomino-pelvic myalgia, and vulvar vestibulodynia. These conditions share overlapping pathophysiological mechanisms, such as cross-sensitization of pelvic organs and maladaptive neuroplastic changes, further amplifying pain perception. Despite advances in understanding these mechanisms, current treatment strategies remain inadequate, with hormonal suppression and surgical intervention providing variable relief. A comprehensive, multimodal approach targeting neuroinflammatory pathways, PFD, and central sensitization may be essential for improving pain management. Further research is needed to refine therapeutic strategies and develop targeted interventions for this challenging condition.

Endometriomas affect up to 44% of women with endometriosis and are associated with chronic pelvic pain, infertility, and reduced ovarian reserve. Diagnosis and management are clinically challenging, requiring a nuanced understanding of imaging, clinical presentation, and patient goals. This review offers a comprehensive overview of the diagnosis and management of ovarian endometrioma, with a focus on clinical presentation, advanced diagnostic imaging, and treatment strategies. It addresses the complex balance between symptom relief, disease progression, fertility preservation, and long-term ovarian function, while also exploring emerging innovations in care. Endometriomas are often associated with significant pelvic pathology, including deep endometriosis and adenomyosis. Advanced imaging modalities, such as transvaginal ultrasound and magnetic resonance imaging, have significantly improved diagnostic accuracy. Management strategies range from surveillance in asymptomatic patients to medical therapy for symptom control. Surgical options of laparoscopic cystectomy remain the gold standard for patients with pain, infertility, or concerning imaging findings, but do carry the risk of affecting ovarian reserve. Emerging evidence suggests that conservative surgical techniques and postoperative hormonal therapy may reduce recurrence rates. Endometriomas represent a complex gynecological condition requiring individualized management strategies. Future research should focus on biomarkers for diagnosis and recurrence prediction, refining noninvasive diagnostic tools, and optimizing surgical techniques to minimize ovarian damage.

Endometriosis is a prevalent gynecological condition affecting approximately 10% of women of reproductive age and up to 50% of those with infertility. It is characterized by the presence of endometrial-like tissue outside the uterine cavity. Despite its high prevalence, diagnosis is often delayed by up to 10 years from symptom onset, partly due to the historical lack of accurate, noninvasive diagnostic tools. Although major reproductive societies continue to define videolaparoscopy as the gold standard for diagnosing endometriosis, it does not reliably predict disease extent. Consequently, once a presumptive diagnosis is established, accurate and detailed imaging is invaluable for patient management. Comprehensive endometriosis mapping enhances surgical planning, facilitates appropriate triage to specialized centers for advanced disease, and improves patient counseling regarding potential complications and risks.