open access: Endometriosis: where are we and where are we going?

Endometriosis: where are we and where are we going?

Abstract

Endometriosis currently affects ~5.5 million reproductive-aged women in the U.S. with symptoms such as painful periods (dysmenorrhea), chronic pelvic pain, pain with intercourse (dyspareunia), and infertility. It is defined as the presence of endometrial tissue outside the uterine cavity and is found predominately attached to sites within the peritoneal cavity. Diagnosis for endometriosis is solely made through surgery as no consistent biomarkers for disease diagnosis exist. There is no cure for endometriosis and treatments only target symptoms and not the underlying mechanism(s) of disease. The nature of individual predisposing factors or inherent defects in the endometrium, immune system, and/or peritoneal cavity of women with endometriosis remains unclear. The literature over the last 5 years (2010–2015) has advanced our critical knowledge related to hormones, hormone receptors, immune dysregulation, hormonal treatments, and the transformation of endometriosis to ovarian cancer. In this review, we cover the aforementioned topics with the goal of providing the reader an overview and related references for further study to highlight the progress made in endometriosis research, while concluding with critical areas of endometriosis research that are urgently needed. 

  Future research will clarify the likely complex interaction among genetic alterations, estrogen exposure, inflammatory cytokines, and the immunologic microenvironment in the transformation of endometriosis to endometrioid and clear cell ovarian and primary peritoneal cancers. Treatment of these cancers will hopefully improve with the use of targeted and immunologic therapies that address the underlying causes of malignant transformation.