Endometriosis is a chronic, inflammatory, benign gynecologic condition characterized by the presence of endometrial-like glands and stroma outside the uterus, associated with severe, life-impacting symptoms. Given the complexity of the disease and the broad spectrum of symptoms, a multi-disciplinary treatment approach should be implemented for patients. Using a systematic review, this study aims to evaluate the current trends in research for endometriosis, mainly regarding whether multi-modal approaches are being used or not, and which patient outcomes are improved by each therapy.

Design:

A systematic literature search was performed using PubMed and MEDLINE following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for studies published 2009-2023. Search terms included Endometriosis, Treatment/Management, Dysmenorrhea, Dyspareunia, and Chronic Pelvic Pain, and was limited to prospective studies.

Setting:

Systematic review

Patients or Participants:

None

Interventions:

Medical, surgical and combined management

Measurements and Main Results:

91 studies of 241 found were included in the analysis. There were 62(68%) randomized controlled studies. 32 (35.2%) studies used multimodal treatments, 29 (32%) used hormonal medications only, 8 (8.7%) used surgery alone and 8 (8.7%) used dietary/nutritional therapy. Among the analyzed studies dysmenorrhea improved in 25 (86%) hormonal medication-only studies, 4 (50%) with surgery only, 11 (73%) with hormones and surgery dual therapy. Non-cyclic pelvic pain improved in 22 (76%) in hormonal medication-only studies, 2 (25%) in surgery only, 10 (66%) with hormones and surgery dual therapy. Dyspareunia improved in 14 (48%) with hormones only, 4 (50%) with surgery only and 10 (66%) with surgery and hormones.

Conclusion:

The systematic review of studies for endometriosis related pain revealed that the minority of research are multi-modal, which is not in alignment with recognizing endometriosis is best managed as a multidisciplinary condition. Dysmenorrhea and non-cyclic pain seem best managed with hormonal treatment whereas dyspareunia seems best managed with combined hormones and surgery.