Contemporary Diagnostic and Therapeutic Approaches in Endometriosis: A Systematic Review

Endometriosis is a chronic inflammatory disorder characterized by pelvic pain, infertility, and reduced quality of life, and is frequently associated with prolonged diagnostic delay and variable treatment response. Although advances in noninvasive diagnostics and multimodal therapies have accelerated in recent years, the evidence remains heterogeneous and insufficiently integrated into clinical pathways. This systematic review provides a qualitative synthesis of contemporary (2015-2025) diagnostic and therapeutic evidence in endometriosis rather than a comparative effectiveness analysis. A structured search of major electronic databases (e.g., PubMed, Scopus, and Web of Science) following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-based study selection methods identified eligible diagnostic accuracy studies, biomarker validation cohorts, randomized controlled trials, and non-randomized interventional studies. Ten studies met the inclusion criteria, comprising four diagnostic and six therapeutic investigations, with conclusions limited by heterogeneity and the modest volume of available evidence, particularly for therapeutic interventions. Diagnostic findings indicated that transvaginal sonography demonstrates site-dependent performance for deep infiltrating disease, while serum microRNA models combined with machine-learning classifiers achieved high discriminatory accuracy in surgically confirmed cohorts, which may limit generalizability. Urinary microRNA signatures show slightly lower but comparable performance. Therapeutic evidence encompassed pharmacologic, nutraceutical, digital, exercise-based, and behavioral interventions. Melatonin demonstrated improvement in sleep-related outcomes, but these symptom-specific benefits did not consistently translate into broader therapeutic effectiveness, with inconsistent effects on pain. Omega-3 supplementation did not significantly reduce pain, and digital or behavioral modalities, including immersive virtual reality and mindfulness-based interventions, produced short-term reductions in pain intensity or improvements in quality-of-life domains, with pilot data indicating feasibility despite limited evidence of sustained efficacy, supporting their potential for evaluation in larger trials. Contemporary research reflected meaningful innovation but remained constrained by small sample sizes, short follow-up, surgical cohort bias in diagnostic studies, and heterogeneity in outcome reporting. Robust multicenter validation, standardized endpoints, and phenotype-informed therapeutic trials are required to translate emerging innovations into sustained clinical benefit.