Definition of endometriosis
Koninckx PR, Donnez J, Brosens I.
Microscopic endometriosis: impact on our
understanding of the disease and its surgery.
Fertil Steril. 2016;105:305-306.
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Endometriosis was defined 100 years ago as endometrial glands and stroma outside the uterus.
Not all “endometriosis” is pathology
Not all “endometrial glands and stroma outside the uterus” are pathology. Microscopic nests are found in 18% of lymph nodes in deep endometriosis, in over 10% of normal looking peritoneum and at a distance up to more than 5cm in bowel deep endometriosis. Today there is no evidence that these will progress to pathology
Subtle endometriosis lesions are debated since over 20 years. Until today there is no evidence that these lesions cause infertility or pain or that they will progress to pathology. This is not in contradiction with the hypothesis that typical, cystic or deep lesions could start as subtle lesions : thus some lesions could progress although no evidence has been obtained so far.
One day definition of endometriosis has to be changed
When we will be able to distinguish between initial lesions that will progress and lesions that will remain dormant or disappear, we will change the definition of endometriosis into something that indicates pathology, and that is associated with pelvic pain and/or infertility.
Implications for the patient and the gynecologist
- subtle endometriosis does not explain pain or infertility
- subtle endometriosis does not increase the risk to develop more severe endometriosis later
- aggressive excision of large areas of peritoneum should not be done
- excision of large segments of the bowel to be complete should not be done.
- conservative excision of deep endometriosis should be preferred instead of bowel resections.