Superficial endometriosis : micoscopical, subtle, typical
Microscopical endometriosis can be found in normal peritoneum in over 10% of women.
Subtle endometriosis is found in up to 80% of women with pain and/or infertility. It is unclear what the prevalence is in women without symptoms.
Typical endometriosis is found in some 50% of women with pain and/or infertility and in 5% to 10% of normal women.
It remains controversial if and which of these lesion will progress
For a full discussion see the recent editorial in Fertil Steril:
Koninckx PR, Donnez J, Brosens I. Fertil Steril. 2016;105:305-306.
can only be made by laparoscopy
for microscopical endometriosis microscopy of biopsies is needed
occasionally typical endometriosis in the uterosacral ligaments can be felt as ‘shots’
imaging cannot make the diagnosis
Subtle lesions : Since they do not cause pain or infertility it is unclear whether they should be treated. Since they are so small and vaporisation is without risks most surgeons prefer to treat. It is unclear whether treatment will decrease progression.
Typical lesions : Treatment of choice is excision or vaporisation. Coagulation is not recommended since the depth if a typical lesion is difficult to judge.
After surgery: during a diagnostic laparoscopy the diagnosis is made and we can assume that all lesions are removed.
Medical therapy can be given in order to prevent progression or recurrences. Although the available evidence is weak, it seems wise to give oral contraception after surgery until a pregnancy is desired in order to decrease recurrence rate. The rationale is that “if not proven beneficial it probably does not harm.
Medical therapy without laparoscopy and thus without a diagnosis could be given for a short time to help in the diagnosis. Long term medical therapy without a diagnosis should not be given.
Stephan Gordts, Life Expert Centre, Leuven, Belgium, Errico Zupi Prof Univ Tor vergate, Rome Italy, Anastasia Ussia Gruppo Italo Belga, Villa del Rosario Rome Italy, Consultant Università Cattolica, Rome, Italy, Michel Canis, Prof & Chairman, Univ Clermond Ferrand, France, Roberta Corona Infertility Centre Barbados.,Leila Adamyan, Academician Moscow state University,Moscow, Russia,Fabio Imperato, Villa del Rosario, Rome, Italy, Renato Seriaccholi, Prof and chairman Univ Bologna Italy, Jacques Donnez,em prog and chairman Catholic university of Louvain, David Soriano, President ISGE, Director of Center for Multidisciplinary Management of Endometriosis, Ron Schonman, Head of endometriosis clinic, Meir Medical Center, Kfar Saba, Israel, Tamer Seckin,Founder, Endometriosis Foundation of America Lenox Hill Hospital Department of Obstetrics and Gynecology, Hofstra University, 872 5th Ave New York, NY 10021 www.drseckin.com