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New paradigms in the diagnosis and management of endometriosis

Kavoussi, Shahryar K.; Lim, Courtney S.; Skinner, Bethany D.; Lebovic, Dan I.; As-Sanie, Sawsan

Current Opinion in Obstetrics and Gynecology: August 2016 - Volume 28 - Issue 4 - p 267–276
doi: 10.1097/GCO.0000000000000288
MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew T. Siedhoff
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Purpose of review Endometriosis is a common gynecologic condition estimated to affect 10–15% of reproductive-aged women, 30% of women with subfertility, and 80% of women with chronic pelvic pain. Although mainstays of diagnosis and treatment are still commonly applied, there have been various advances in the modalities of diagnosis and management of this complex condition. This article provides an updated review of novel findings regarding the diagnosis and management of this challenging disease.

Recent findings Despite an abundance of studies on noninvasive diagnostic markers for endometriosis, there is no single imaging study, biomarker or panel of biomarkers that has been validated for clinical diagnosis. New technologies, such as use of indocyanine green and fluorescence, which visualize neovascularization often associated with endometriosis may improve diagnostic detection of endometriosis at the time surgery, but have not been demonstrated to improve pain outcomes after surgery. Hormone suppression remains the mainstay therapy prior to and following surgery. Although most methods demonstrate similar efficacy in reducing endometriosis-associated pain, newer pharmacologic agents that may prove advantageous include oral gonadotropin receptor antagonists, selective progesterone receptor modulators, and angiogenesis inhibitors.

Summary Although there have been some advances in the study of noninvasive imaging and biomarkers, more investigation into effective modalities are being conducted and are needed.

aAustin Fertility and Reproductive Medicine/Westlake IVF, Austin, Texas

bDepartment of Obstetrics and Gynecology, University of Michigan Healthcare System, Ann Arbor, Michigan

cCenter for Reproductive Medicine, Minneapolis, Minnesota, USA

Correspondence to Shahryar K. Kavoussi, MD, MPH, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX 78746, USA. Tel: +1 011 512 444 1414; e-mail: austinfertility@gmail.com

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