Endometriosis: new insights and opportunities for relief of symptoms.

Endometriosis is a chronic neuroinflammatory disorder believed to impact on the wellbeing of more than 190 million women and people assigned female at birth. The defining hallmark of endometriosis is the growth of endometrial-like tissue as "lesions" outside the uterus. Most lesions are found in the pelvis and referred to as peritoneal (superficial), ovarian (endometrioma) or deep depending on location. Patients often suffer from persistent pelvic pain which can be worse during menstruation as well as fatigue, gastro-intestinal and urinary symptoms and mood disorders that impact quality of life. It is estimated 30-50% of patients with endometriosis may have problems conceiving. Diagnostic delay is ~7-9 years after first symptoms. There are currently no reliable biomarker(s). Advances in imaging have improved diagnosis of ovarian and deep subtypes but definitive diagnosis may require invasive laparoscopic surgery. Standard treatment options include surgery as well as drugs that suppress ovarian hormones which have unwanted side effects. New approaches to symptom management have been informed by the reframing of endometriosis as a multisystem disease. Genetic studies have identified shared risk factors with inflammatory and other chronic pain conditions. Alterations in hormonal, metabolic, and inflammatory pathways in samples from endometriosis patients have opened-up new avenues for medical therapy, including drug repurposing. There is increased interest in non-medical and self-management strategies including nutrition. In this narrative review we discus recent research studies and ongoing clinical trials which are addressing the need for novel approaches to reduce the impact of symptoms on quality of life.