Diagnostic and therapeutic challenges in endometriosis: A narrative review

Endometriosis is a multifactorial inflammatory disease associated with altered estrogen signaling, immune dysregulation, and the presence of endometrial-like tissue outside the uterine cavity. It affects nearly 10% of women of reproductive age and can substantially reduce quality of life through chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility. Despite its prevalence, diagnosis and treatment remain difficult because symptoms are heterogeneous and frequently nonspecific, contributing to an average diagnostic delay of seven to ten years. This review summarizes the shift from invasive diagnostic laparoscopy toward non-invasive multimodal imaging, particularly transvaginal sonography (TVS) and magnetic resonance imaging (MRI), for disease assessment. It also discusses current medical, surgical, and fertility-preservation strategies aimed at improving symptom control and treatment outcomes in affected patients. Early diagnosis and a multidisciplinary approach may help reduce delays in treatment and improve long-term clinical outcomes.