Demystifying cervical endometriosis: A case series and systematic review

Cervical endometriosis (CE) is an uncommon diagnosis with a paucity of evidence on its management.

To examine 10 years of data to identify CE cases and to conduct a systematic review to evaluate evidence for managing CE.

Cases of CE were obtained retrospectively via a pathology coding system. Literature search was performed using Ovid MEDLINE, EMBASE, and Cochrane Library (1949-2022).

Studies on diagnoses and management of CE were included, and those with retrospective diagnosis of CE on histology and no further management were excluded.

An Excel spreadsheet was used for data collection. Two independent authors went through individual cases, extracting and analyzing data.

In case series, women presented with intermenstrual bleeding (IMB)/post-coital bleeding (PCB) n-25, (30%), followed by abnormal uterine bleeding (AUB) n-24, (29%), dysmenorrhea n-12, 12%, and/or dyspareunia (12%). In all, 44% had an initial cervical biopsy confirming CE diagnosis and 48% had CE on hysterectomy specimen. Main reasons for hysterectomy were AUB (36%) and fibroids/adenomyosis (28%). In the systematic review, 1737 studies were identified from databases, 181 were assessed for eligibility, and 14 studies discussed individual case reports and case series specifically on treating CE. Nine full-text and abstract studies were available to identify potential treatment options for CE. Treatments were based predominantly on presentation at time of diagnosis.

Findings from case series suggest that CE was the main diagnosis in women who had a hysterectomy for AUB or had a cervical biopsy for PCB/IMB. Investigations should be considered to rule out CE to have the potential for conservative alternative treatment rather than major surgery. There is no clear guidance on managing CE and good-quality studies are required to provide conclusive treatment options.