#397 ‒ Endometriosis and adenomyosis: diagnosis, fertility, reproductive aging, and emerging treatments | Renato Tomioka, M.D., Ph.D.

Endometriosis and adenomyosis represent significant, often under-diagnosed conditions that profoundly impact female reproductive health and fertility. Endometriosis, affecting roughly 10% of reproductive-aged women, involves endometrial-like tissue growing outside the uterus, while adenomyosis involves similar tissue infiltrating the myometrium. Both conditions are driven by estrogen dependence and progesterone resistance, often leading to chronic pelvic pain and infertility. Diagnostic delays frequently span years due to the normalization of female pain and reliance on outdated surgical laparoscopy rather than specialized ultrasound or MRI protocols. Effective management requires a shift toward early clinical diagnosis and hormonal suppression to prevent central sensitization. For those struggling with infertility, age remains the primary determinant of egg quality, with aneuploidy rates rising exponentially after age 35, necessitating strategic approaches like IVF and fertility preservation to navigate the complexities of reproductive aging.