Endometriosis: A Review.
Level 5 - mechanism / opinion, no new human data
Narrative clinical review summarizing existing evidence without a formal systematic review methodology.
PubMed 40323608 · doi:10.1001/jama.2025.2975
What was done
This was a narrative clinical review evaluating the epidemiology, presentation, diagnosis, and medical and surgical management of endometriosis based on current published literature.
What was found
Endometriosis affects up to 10% of reproductive-age women globally (9 million in the US); 90% report pelvic pain and 26% report infertility. Clinical diagnosis is delayed on average 5 to 12 years. In a cited network meta-analysis of 15 clinical trials (n = 1,680), hormonal therapies (combined oral contraceptives, progestins, GnRH agonists) achieved pain reduction compared to placebo, with mean differences between 13.15 and 17.6 points on a 0-100 visual analog scale and minimal differences between options. However, 11% to 19% of individuals have no pain reduction with hormones, and 25% to 34% experience recurrent pelvic pain within 12 months of discontinuation. Following hysterectomy with lesion excision, approximately 25% experience recurrent pain and 10% undergo subsequent surgery.
Why it matters
This review provides a structured overview of clinical diagnostic criteria and stepwise pharmacologic and surgical interventions, highlighting substantial rates of non-response and post-treatment recurrence.
Limits
As a narrative review, it presents no original data or systematic search protocol. Exact diagnostic accuracy for imaging modalities is not quantified in the abstract, and long-term recurrence rates rely on disparate secondary sources.