The utility of advanced pelvic ultrasound techniques in the diagnosis and management of patients with endometriosis

Abstract

Endometriosis is a disease that affects approximately 10% of individuals assigned female at birth. Endometriosis is a chronic oestrogen-dependent and -promoted inflammatory response secondary to ectopic yet functional endometrial-like cell growth outside the uterine cavity. It is generally thought to be a pain-causing disease and has a strong link between endometriosis and infertility.

Imaging has emerged as the most optimistic non-invasive and non-surgical tool to diagnose endometriosis. In many centres in Australia and around the world, current evidence-based ultrasound techniques for endometriosis are not utilised or under-utilised. People are therefore reliant on healthcare providers either using clinical and physical examination information to be given a diagnosis, with high false positive or false negative diagnoses, or diagnostic laparoscopy, which is an invasive procedure with risks of surgical complications and poor surgical outcomes.

The goals of this thesis were to better understand the current limitations and gaps that exist for ultrasound as a diagnostic and management tool, increase awareness of evidence-based techniques internationally, and initiate solutions to overcome deficiencies. Altogether, the aim was to contribute original knowledge to improve the process of diagnosis and surgical management of patients with endometriosis.

The research performed and presented as part of this thesis has evolved our understanding of how ultrasound is a tool to diagnose and optimise the management of endometriosis. It has also evoked new research questions, challenged our way of thinking of old ideas, and established interdisciplinary international research teams. The novel ultrasound techniques studied in this thesis may have significant benefit for the endometriosis community who are left without a diagnosis or are destined for a delayed diagnosis.