Endometriosis: Unveiling the contemporary issues in diagnosis and treatment

  • Adetokunbo O Fabamwo Lagos State University College of Medicine, Ikeja, Lagos http://orcid.org/0000-0003-2313-1815
  • Onyinyechi J Agbara Lagos State University College of Medicine, Ikeja, Lagos
Keywords: Chronic Inflammation, Endometrium, Non-Steroidal Anti-Inflammatory Drugs, Nulliparity, Oestrogen, Pelvic pain


Endometriosis is characterized by the presence of ectopic endometrial-like tissue in extra-uterine sites which may induce chronic inflammatory reaction, scar tissue, and adhesions that may distort the pelvic anatomy. The true prevalence of the disease is not known. The disease usually affects women of the reproductive age group and is most typically diagnosed in women aged between 25-30years. Some of the factors which increase the risk of disease include early menarche, shorter menstrual cycles and nulliparity. The symptoms are often non-specific making diagnosis difficult with resultant delay in initiation of appropriate therapy. However, chronic cyclical or non-cyclical pelvic pain with or without menstrual abnormality is common. This review describes the various management options in endometriosis with emphasis on the effective medical and surgical interventions which are useful in the developing world.

Author Biography

Adetokunbo O Fabamwo, Lagos State University College of Medicine, Ikeja, Lagos


Department of Obstetrics and Gynaecology


1. West CP. Endometriosis in Obstetrics and Gynaecology: An evidence based text for the MRCOG. Luesley DM, Kilby MD (Eds). 3rd Edition. Danvers London, Taylor and Francis Group. CRC Press. 2016; pg 602-612.
2. Ballard KD, Seame HE, de Vries CS, Wright JT. Can symptomatology help in the diagnosis of endometriosis? Findings from a national case study: Part 1. BJOG 2008; 115: 1382-1391.
3. Falcone T, Lebovic DI. Clinical management of endometriosis. Obstet Gynecol 2011; 118: 691-705.
4. Mahmood TA, Templeton A. Prevalence and genesis of endometriosis. Hum Reprod 1991; 6: 544-549.
5. Somigliana E, Vigano P, Benegla L, Crovetto P, Fede le P. Endometriosis in a rural remote setting: A cross sectional study. Gynecol Endocrinol 2012; 28(12): 979-782.
6. Ikechebelu JI, Mbamara SU. Should laparoscopy and dye test be a first line evaluation for infertile women in SouthEastern Nigeria? Niger J Med 2011; 20(4): 462-465.
7. Alabi OC, Zowa PK, Onwumere UN. Incidence of endometriosis in laparoscopy in a Nigerian hospital. Trop J Obstet Gynecol 2013; 30(Suppl 1): S28.
8. Fawole AO, Bello FA, Ogunbode O, Odukogbe AT, Nkwocha GC, Nnoaham KE, et al. Endometriosis and associated symptoms in Nigerian women. Int J Gynecol Obstet 2015; 130(2): 190-194. http://dx.doi.org/10.1016/j.ijgo.2015.02.030.
9. Shah DK, Correia KF, Vitrus AF, Missner SA. Body size and endometriosis: Results from 20 years of follow-up within Nurses’ Health Study II Prospective cohort. Hum Reprod 2013; 28(7): 1783-1792.
10. ESHRE Endometriosis Guideline Development Group. Management of women with endometriosis. Guideline of European Society of Human Reproduction and Embryology. 2013.
11. Wukes CB, Clark TJ, Khan KS. Accuracy of laparoscopy in the diagnosis of endometriosis: a systematic review. BJOG 2004; 111: 1204-1212.
12. Brown J, Kives S, Akhtar M. Progestogen and anti-progestogens for pain associated with endometriosis. Cochrane Database of Syst Rev 2012; Issue 3.Art No:.CD002122.DOI:10.1002/14651858.CD002122.pub 2.
13. Lockhart FB, Emembolu JE, Konje JC. Serum and peritoneal fluid levels of levonorgestrel in women with endometriosis who were treated with intrauterine contraceptive device containing levonorgestrel. Fertil Steril 2005; 83: 398-404.
14. Abou-setta A, Houstin B, Al-Inmay HG, Farquhar C. Levonorgestrel-releasing intrauterine device for symptomatic endometriosis following surgery. Cochrane Database of Syst Rev 2013; Issue 1. Art No.:CD005072.DOI:10.1002/4651858.CD005072.pub 2
15. Brown J, Pan A, Hart RJ. Gonadotropin releasing hormone analogues for pain associated with endometriosis. Obstet Gynecol 2011; 117: 727-728.
16. Shakiba K, Bena JF, McGill KM. Surgical treatment of endometriosis: a 7-year follow-up on the requirement for further surgery. Obstet Gynecol 2008; 111:1285-1292.
17. Raffi F, Metwally M, Amer S. The impact of excision of ovarian endometriosis on ovarian reserve: Systematic review and meta-analysis. J Clin Endocrinol Metab 2012; 97: 3146-3154.
18. Jacobson TZ, Duffy JM, Barlow D, Korninckx PR, Garry R. Cochrane Database Syst Rev 2009; Issue 4. Art. No.: CD001300.DOI.10.1002/14651858.CD007864.pub 2
19. Procter M, Lattle P, Farguhar C, Klan K, Johnson N. Surgical interruption of pelvic nerve pathways for primary or secondary dysmenorrhea. Cochrane Database of Syst Rev 2005; Issue 4. Art. No.: CD001896.DOI.10.1002/1465185.CD001896.pub 2.
20. Hughes E, Brown J, Collins JJ, Farquhar C, Fedorkow DM, Vandekeckhore P. Ovulation suppression for endometriosis. Cochrane Database Syst Rev 2007; 3: CD000155.