Literature review: diagnostic and treatment challenges of endometriosis in premenopausal women

Background and aim Endometriosis is an inflammatory disease that highly decreases the quality of life. The gold standard of diagnosis is considered laparoscopy with tissue biopsy, which can often lead to excess surgical interventions. To this day there is an ongoing discussion about the best treatment for endometriosis, which has led to multiple different guidelines and no clear conclusion. The aim of this review is to discuss whether diagnostic laparoscopy can be safely replaced by non-surgical imaging techniques and to compare different treatment guidelines for endometriosis. Materials and methods In order to evaluate whether transvaginal ultrasound and magnetic resonance imaging can take the role of diagnostic laparoscopy with tissue biopsy we did literature research using PubMed and Google Scholar databases. We also reviewed different endometriosis treatment algorithms to try and depict the best treatment method of today. Results Radiological endometriosis diagnosis although highly sensitive and specific does depend on the disease location. Nevertheless, it should be the primary choice for diagnosis as it carries less risk for the patient. Most of the treatment algorithms are based on the main symptoms: pain and infertility. The guidelines agree that medical therapy should be the primary choice of treatment. However, surgery is still irreplaceable while removing already existing endometriotic lesions. Conclusion Non-surgical diagnosis can safely replace diagnostic laparoscopy with tissue biopsy in diagnosing endometriosis. Pharmaceutical therapy is the first choice for treatment when the primary symptom is pain. If the main complaint is infertility treatment should depend on the size of the endometrioma and fertility