Endometriosis and Adenomyosis Guidelines

Definition and Pathophysiology

Endometriosis is defined as an inflammatory disease process characterized by endometrial-like tissue outside the uterus, associated with pelvic pain and/or infertility, affecting approximately 10% of women during reproductive years, with an economic burden of $69.4 billion annually, according to the Human Reproduction Update 1, 2
The disease is estrogen-dependent and progesterone-resistant with a proliferative nature, and has a multifactorial etiology including genetic factors with epigenetic influences, environmental exposures, and chronic inflammation 1, 3
Deep endometriosis (DE) is specifically defined as lesions extending >5 mm under the peritoneal surface OR involving/distorting bowel, bladder, ureter, or vagina, and 50% of patients with endometriosis experience infertility 1, 2, 3

The r-ASRM classification system is the longest established method but has severe limitations, including poor correlation with fertility outcomes, pain symptoms, and quality of life, and poor prognostic information, according to the Human Reproduction Update 1, 3, 4
The Enzian classification should be employed with r-ASRM when deep endometriosis is present, but also has poor correlation with symptoms and infertility, and limited prognostic value, as stated in the Human Reproduction Update 1, 3, 4

Transvaginal ultrasound (TVUS) has a pooled sensitivity of 82.5% and specificity of 84.6% for diagnosing adenomyosis, as reported by Praxis Medical Insights 5
Expanded protocol TVUS can identify and map deep endometriosis, according to Praxis Medical Insights 2

More than 90% of endometrial cancers occur in women >50 years, with a median age at diagnosis of 63 years, and 80% are diagnosed in stage I with a 5-year survival >95%, as stated in the Annals of Oncology 6
The 5-year survival drops to 68% with regional spread, and 17% with distant disease, and Type I endometrial cancer (80-90%) is characterized by endometrioid adenocarcinoma with specific genetic alterations, according to the Annals of Oncology 6