EXPPECT Edinburgh and MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
Michigan State University, Grand Rapids, MI, USA.
BMJ. 2022 Nov 14;379:e070750. doi: 10.1136/bmj-2022-070750.
Endometriosis affects approximately 190 million women and people assigned female at birth worldwide. It is a chronic, inflammatory, gynecologic disease marked by the presence of endometrial-like tissue outside the uterus, which in many patients is associated with debilitating painful symptoms. Patients with endometriosis are also at greater risk of infertility, emergence of fatigue, multisite pain, and other comorbidities. Thus, endometriosis is best understood as a condition with variable presentation and effects at multiple life stages. A long diagnostic delay after symptom onset is common, and persistence and recurrence of symptoms despite treatment is common. This review discusses the potential genetic, hormonal, and immunologic factors that lead to endometriosis, with a focus on current diagnostic and management strategies for gynecologists, general practitioners, and clinicians specializing in conditions for which patients with endometriosis are at higher risk. It examines evidence supporting the different surgical, pharmacologic, and non-pharmacologic approaches to treating patients with endometriosis and presents an easy to adopt step-by-step management strategy. As endometriosis is a multisystem disease, patients with the condition should ideally be offered a personalized, multimodal, interdisciplinary treatment approach. A priority for future discovery is determining clinically informative sub-classifications of endometriosis that predict prognosis and enhance treatment prioritization.
子宫内膜异位症影响全球约 1.9 亿女性和出生时被指定为女性的人。它是一种慢性、炎症性妇科疾病，其特征是子宫内膜样组织出现在子宫外，在许多患者中与衰弱性疼痛症状有关。子宫内膜异位症患者也更有可能不孕、出现疲劳、多部位疼痛和其他合并症。因此，子宫内膜异位症最好被理解为一种在多个生命阶段表现和影响不同的疾病。从症状出现到确诊的时间通常较长，尽管进行了治疗，但症状仍持续和复发较为常见。这篇综述讨论了导致子宫内膜异位症的潜在遗传、激素和免疫因素，重点介绍了妇科医生、全科医生和专门治疗子宫内膜异位症患者风险较高的疾病的临床医生的当前诊断和管理策略。它研究了支持治疗子宫内膜异位症患者的不同手术、药物和非药物方法的证据，并提出了一种易于采用的分步管理策略。由于子宫内膜异位症是一种多系统疾病，因此理想情况下，应为该疾病患者提供个性化、多模式、跨学科的治疗方法。未来发现的重点是确定具有临床意义的子宫内膜异位症亚分类，这些亚分类可预测预后并增强治疗优先级。
