US Pharm. 2024;49(9):3.

Endometriosis is a common, burdensome, chronic disease that affects more than 11% of women of reproductive age in the United States and 190 million women worldwide. Early diagnosis remains a major clinical and public health challenge: The average time to diagnose endometriosis is 7 years after the onset of symptoms, which include abdominal pain and cramping before, during, and after menstruation, among others.

Endometriosis occurs when tissue that is normally found in the uterine lining migrates and grows in other locations, most commonly the ovaries, fallopian tubes, and other organs. These circumstances may cause life-altering consequences such as chronic pain, infertility, and poorer quality of life.

In a commentary published in the Journal of Reproductive Medicine, Gynaecology & Obstetrics, researchers from Florida Atlantic University’s (FAU’s) Schmidt College of Medicine conducted a PubMed search to identify promising approaches for early diagnosis.

“Currently, diagnosing endometriosis involves a thorough review of the patient’s medical history and physical examination,” said Panagiota Kitsantas, PhD, first author and professor and chair of the Department of Population Health and Social Medicine, FAU Schmidt College of Medicine. “The most commonly used and accurate diagnostic methods are pelvic exams, abdominal ultrasound, MRI, and laparoscopy. Laparoscopic surgery is considered the gold standard for diagnosing endometriosis by gynecologists, but it can be expensive and carries potential risks of surgical complications. Moreover, the accuracy of laparoscopy can vary based on the surgeon’s experience and the stage of the disease.”

The authors said that the ideal test for early diagnosis of endometriosis would be to use symptom-based criteria to determine who should undergo testing and then set optimal cut-points to maximize sensitivity and specificity. A test with high predictive value would confirm endometriosis if positive and exclude it if negative. Although less ideal tests may not provide definitive results, they can be useful in reducing the number of patients who need to proceed to more invasive procedures, such as laparoscopy.

“Noninvasive methods like MRI and transvaginal ultrasound are only effective for advanced stages of endometriosis,” said Charles H. Hennekens, MD, coauthor, professor of medicine and preventive medicine in the Departments of Medicine and Population Health and Social Medicine and senior academic advisor, FAU Schmidt College of Medicine. “Recent research has focused on a novel noninvasive method of detecting myoelectric activity in the gastrointestinal tract as a potential diagnostic tool. Electroviscerography, or EVG, could detect unique myoelectric patterns associated with endometriosis, though this approach is promising but unproven.”

Currently, there is no FDA-approved noninvasive test for endometriosis, and studies leading to peer-reviewed publications are needed to refine these emerging technologies and establish effective diagnostic criteria..

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