Demystifying cervical endometriosis: A case series and systematic review
Shailja Verma1, Ines Reis1, Neelam Potdar2
1Specialty Trainee Obstetrics & Gynecology, University Hospital of Leicester NHS Trust, Leicester, UK.
Summary
Cervical endometriosis (CE) often presents as abnormal uterine bleeding, necessitating investigation for conservative treatment. Current management lacks clear guidance, highlighting the need for further research.
Area of Science:
- Gynecology
- Reproductive Medicine
- Surgical Pathology
Background:
- Cervical endometriosis (CE) is a rare condition with limited evidence regarding its optimal management strategies.
- Understanding the clinical presentation and diagnostic pathways for CE is crucial for effective patient care.
Purpose of the Study:
- To identify cases of cervical endometriosis over a 10-year period.
- To conduct a systematic review to evaluate existing evidence for managing CE.
Main Methods:
- Retrospective case series analysis using pathology coding system data.
- Systematic literature search of Ovid MEDLINE, EMBASE, and Cochrane Library (1949-2022).
- Inclusion criteria: studies on CE diagnosis and management; exclusion criteria: retrospective diagnosis without further management.
Main Results:
- Common presenting symptoms include intermenstrual bleeding (IMB)/post-coital bleeding (PCB) (30%) and abnormal uterine bleeding (AUB) (29%).
- CE was confirmed via cervical biopsy in 44% and on hysterectomy specimens in 48% of cases.
- AUB and fibroids/adenomyosis were primary indications for hysterectomy (36% and 28%, respectively).
- Systematic review identified 14 studies on CE treatment, with management primarily based on diagnosis presentation.
Conclusions:
- CE is a significant diagnosis in women undergoing hysterectomy for AUB or biopsy for PCB/IMB.
- Considering CE in differential diagnosis may allow for conservative treatments over major surgery.
- There is a critical need for high-quality studies to establish clear management guidelines for CE.
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