Endometriosis: etiology, pathobiology and therapeutic prospects

Endometriosis is a common condition associated with infertility that causes chronic pain in many but not all women. It is defined by the presence of endometrial-like tissue outside the uterus. Whilst the cause and natural history of the disorder remain uncertain, hormonal, neurological and immunological factors are all implicated in the mechanisms contributing to development of symptoms. As definitive diagnosis requires surgery, there is often a long diagnostic delay after onset of symptoms. Current interventions for endometriosis have limited efficacy, unacceptable side effects/risks, and are associated with high rates of symptom recurrence. Here, we review recent advances in our understanding of the etiology of endometriosis, discuss current diagnostic and treatment strategies, highlight current clinical trials, and consider how recent results offer new avenues for the identification of endometriosis biomarkers and the development of effective non-surgical therapies that are fertility-sparing.