[In Process Citation]

Area of Science:

• Gynecology
• Reproductive Medicine
• Pathology

Background:

• Endometriosis is a prevalent benign gynecological condition with uncertain etiology and pathogenesis.
• The disease involves progressive organ destruction, adhesions, and inflammation, leading to pain and sterility.
• Approximately 50% of endometriosis cases exhibit progressive behavior driven by cytokines and hormonal factors.

Purpose of the Study:

• To review the pathogenesis and treatment of endometriosis.
• To highlight the importance of grading lesion activity for treatment selection.
• To evaluate the efficacy of combined hormonal and surgical treatment versus surgical removal alone.

Main Methods:

• Medline search of relevant scientific publications.
• Analysis of clinical trial data on endometriosis treatment outcomes.
• Microscopic and morphological grading of endometriosis lesion activity.

Main Results:

• Early-stage endometriosis is metabolically active, initiating a cycle of destruction and inflammation.
• Prostaglandin derivatives, cytokines, and estrogen contribute to the progressive nature of the disease.
• Individualized hormonal and surgical treatment demonstrated higher pregnancy rates and lower recurrence rates compared to lesion removal alone.

Conclusions:

• Combined hormonal and surgical treatment may represent a new gold standard for active endometriosis.
• Early and individualized treatment is crucial for managing mild to minimal endometriosis.
• Understanding lesion activity is key to optimizing therapeutic strategies for endometriosis.