Talk:Endometriosis/GA1

Subtypes

• An optional recommendation but I think it is worthwhile to include pictures of other types here if you can (like you mentioned on the talk page).

  The difficulty of including these images was that I could not cannot ascertain for certain what the first imagine shows (is it deep endometriosis or superficial). I've now found a CC-BY paper with an image and sourced information what the image shows, so will add it :). —Femke 🐦 (talk) 13:00, 1 February 2026 (UTC)

• "Deep endometriosis often appears as nodules, and can include fibrosis and adhesions." — probably should clarify that endometriosis is associated with fibrosis and adhesions. It does not typically appear as fibrosis and adhesions.

  Done.

• Horne AW and Andres MP should not be tagged as open access (unless I am missing something).

  Done for one. The other one has an open-source version, and the open source icon points correctly towards that version. —Femke 🐦 (talk) 19:44, 5 February 2026 (UTC)

Signs and symptoms

• Sasamoto N has an expired doi tag.

  Fixed on their side. —Femke 🐦 (talk) 11:58, 22 March 2026 (UTC)

• "In those going through assisted reproductive treatment, endometriosis is found in about 30% to 50% of women" needs either a more recent source or the values need to be updated based on what we find in more recent soruces. Sasamoto N derives that number from sources published in 1938 and 1937 1997.
  • I've contacted the publisher about these two issues. 1938 didn't have assisted reproduction treatment yet, right? So that seems an obvious error. I don't know if the 1997 paper does support the assertion; can't access it. Will find another source if I don't get a rapid reply.
• Would recommend adding that this can cause dyschezia with abdominal symptoms.
  • Constipation is mentioned (don't think we need the jargon)

  Fair. I meant "painful bowel movements" (dyschezia, which is a different entity from constipation) but didn't realize we do not have a separate article on that. — Strange Orange | 01:32, 5 February 2026 (UTC)

  I've removed dyschezia as a synonym from the constipation article (which is where I got confused). Painful bowel movements is mentioned as the last bullet point, together with painful urination. —Femke 🐦 (talk) 21:41, 5 February 2026 (UTC)

• "Blood in urine may point to endometriosis in the bladder or in the ureter. Sciatic endometriosis is a rare form in which endometrial tissue involves the sciatic nerve, causing cyclic nerve pain in the leg." might be grouped better with the preceding paragraph so that the paragraph is focused on the abdomen and pelvis.

  The sources I cited classified these two as extra-pelvic. I've looked at other sources, and discovered that bladder endometriosis is usually classified as pelvic, so have moved that one to the previous paragraph. —Femke 🐦 (talk) 20:57, 4 February 2026 (UTC)

• Other complications that occur in pregnancy such as ruptured endometriomas and perforated bowel can be added (optional, source).

  I've not seen those mentioned in my top-5 sources or two sources on pregnancy that fall within the 5 years of WP:MEDDATE. . I've added SHiP as a possible complication, which does get mentioned in both ESHRE and the Fertility and Sterility paper linked above. —Femke 🐦 (talk) 22:13, 5 February 2026 (UTC)

• While outcomes on pregnancy are mixed, there is a decent body of evidence that associates this with worse maternal mortality (source). I would recommend adding something about that.

  Again, I'm not seeing this mentioned yet in my top MEDRS secondary sources, or in the two sources specific to pregnancy. My above addition about ship does hint towards risks for the mother. —Femke 🐦 (talk) 22:13, 5 February 2026 (UTC)

• Postmenopausal endometriosis is uncommon but worth including (source).

  Have included a short paragraph. —Femke 🐦 (talk) 20:57, 4 February 2026 (UTC)

• Individuals with endometriosis carry a 2-3x increased risk of developing ovarian cancers, with the highest risk with deeply infiltrating endometriosis and endometriomas (source1, source2, source3). Should be included under complications.

  I've now included this under comobidities in the epidemiology section. I must admit I'm not sure when to call something a complication vs comorbidity. The sources I read don't consistently classify this as either (usually don't classify it at all). —Femke 🐦 (talk) 17:41, 2 February 2026 (UTC)

  You are right, the sources typically do not classify this as either a complication or a comorbidity. Going by the book, a complication is a direct mechanistic consequence of the primary disease process; for instance, diabetes and heart failure. A comorbidity is a disease state often seen with a primary disease process, and may result from multiple factors including the primary condition; for instance, diabetes and heart attack. Having said that, comorbidities are often presented as complications in communication/literature outside of academia/medicine as most individuals are probably not familiar with the term "comorbidity".

  The relation of endometriosis and ovarian cancer is probably best described as a risk-associated comorbidity. So would the other disease processes mentioned in Endometriosis#Complications. — Strange Orange | 18:45, 2 February 2026 (UTC)

  I've now put all of them together under a new heading of 'complications and co-occuring conditions'. Ironically, the best case of describing any of these as complication seems to be the cancer one, as the endometriosis tissue sometimes transforms in cancer. But not 100% clear. BMJ calls it a complication, JAMA calls it a comorbidity, ESHRE doesn't use either term. —Femke 🐦 (talk) 20:57, 4 February 2026 (UTC)

• "healthy controls" can be substituted with a more everyday phrasing.
  • Replaced with healthy people

Risk factors

• This is a fine section, covering all important risks factors and it stays concise.

Mechanism

• "Endometriosis is an inflammatory disease" is mostly correct. It is not an inflammatory disease in the sense that something like lupus is. It is a disorder that elicits an inflammatory response. This can be stated more clearly. I would also add a sentence stating that in endometriosis, ectopic endometrial cells implant and grow in places where they don't belong (and this is how they cause an inflammatory reaction).
  • I've repeated the definition (ectopic endometrium-like cells) in the first sentence, which makes inflammatory more of a characteristic. The wording is quite close to a few sources, but I think this is a case where there's WP:LIMITED ways of saying the same. Compare these three top-sources:
    • Endometriosis is a chronic inflammatory disease defined as the presence of endometrium-like tissue outside the uterus (ESHRE)
    • Endometriosis is a chronic, inflammatory, gynecologic disease marked by the presence of endometrial-like tissue outside the uterus (Horne et al, BMJ)
    • Endometriosis is a chronic, estrogen-dependent, inflammatory disease defined by endometrial-like tissue (lesions) outside the uterine lining. (As-Sanie et al, JAMA). —Femke 🐦 (talk) 17:38, 6 February 2026 (UTC)
• "For endometriosis to develop, as is done by some cancerous tumors, its cells must evade the immune system, attach to a surface, and promote the formation of new blood vessels" presents a theory in a matter of fact way. Needs a slight copyedit.
  • Is this a theory? Aren't these all prerequisites for both endo and cancer? The paper states it as a fact: "Endometriosis is a benigngynecological condition, yet it shares a number of features with cancer cells, including immune evasion, survival, adhesion, invasion, and angiogenesis. "

  The statement is accurate but feels too strongly worded, especially with "must". Because the pathogenesis of endometriosis seems heterogeneous and not as thoroughly understood, it is possible that immune evasion might be contributing in most cases, but maybe not always? — Strange Orange | 01:32, 5 February 2026 (UTC)

  There's two elements to immune evasion, right: the cells might do things themselves to make them less detectable to the immune system (like cancer does), or the immune system might not work as intended. I don't see how these cells can be in places they're not supposed to be without evading the immune system. —Femke 🐦 (talk) 21:24, 7 February 2026 (UTC)

• It feels a bit contradictory to state "It is not well understood how endometriosis causes infertility and pain", then to say that "There are multiple causes of pain" and "The infertility associated with endometriosis likely has multiple causes". You can potentially add to the former that "but there are several theories that try to explain its mechanism" (or similar).
  • The wording about pain was too confident, I've changed that to be more cautious. I don't feel there is a contradiction with the fertility line. Even with 'likely multilpe causes', there can be a lot of uncertainty. —Femke 🐦 (talk) 21:02, 7 February 2026 (UTC)
• "Inflammation and hormonal dysfunction explain some instances" — can you elaborate on how?
  • Expanded (via ovarian environemnt and egg quality). —Femke 🐦 (talk) 21:20, 7 February 2026 (UTC)

Diagnosis

• "A trauma-informed framework is recommended for a physical examination, where the health practitioner validates pain and fosters trust" is great but comes off as a recommendation for healthcare professionals. Probably needs simplification to make it understandable to a broader audience.
  • I knew when I wrote it down that it was awkward. I think it's an important idea to get across, given how important it is in giving good care. Any suggestions?

  Just an idea but something like this: "A patient-centered approach that is sensitive to past trauma, where the health practitioner validates pain and fosters trust"? The sentence is structured great. We probably only need to simplify "trauma-informed framework". — Strange Orange | 01:32, 5 February 2026 (UTC)

  Went for a different tack: 'Initial assessment includes a screening of risk factors and an evaluation of symptoms. Both general symptoms and those linked to deep endometriosis or endometriosis outside the pelvis are assessed. A trauma-informed approach validates pain, fosters trust and screens for trauma before a physical exam.' —Femke 🐦 (talk) 22:11, 7 February 2026 (UTC)

• For the physical exam, you can consider adding some of the suggestive findings which include focal tenderness on vaginal exam, nodules in the posterior fornix, lateral displacement of the cervix/uterus, and adnexal masses.
  • Added a few based on the JAMA paper. Not sure if it's the same ones you suggested, as I'm unfamiliar with these terms.
• "which allows a larger part of the bowel to be assessed" — the sentence is true but is not just limited to bowel and overall has a larger field of view. Recommend changing "bowel" to "pelvis" or re-writing to generally state that MRIs offer a greater AND more enhanced view of the area.
  • Expanded
• "In nearly 40% of cases, no cause for pelvic pain is discovered during laparoscopy" — does this imply that we do not find a cause for pelvic pain in 40% of endometriosis cases treated surgically, or that in 40% of surgeries for pelvic pain nothing is identified broadly?
  • Clarified (it's 40% of women that undergo surgery for pelvic pain, where they don't discover a cause).
• Need to describe what the ENZIAN system is.
  • Done
• "The rASRM and ENZIAN systems correlate poorly with how much pain women have" — this would benefit from a "how" description to make it more broadly understandable.
  • Not sure how to clarify this (I did discover a mistake in my wording. rASRM has been tested against pain, whereas ENZIAN only against specific symptoms). —Femke 🐦 (talk) 16:35, 7 February 2026 (UTC)
• Endometriosis, abdominal wall.jpg and Peritoneal endometriosis.jpg can use verbiage to describe what endometriosis is on the image to make it clear for our readers.
  • I've explained the first one, and removed the second one as it was getting too busy in the diagnosis section, and it's not repeated in the subtypes section with a better documented image.
• I am not sure if "anechoic content" on Endometrioma.jpg would be understandable to a broader audience (even I do not know what that really means and I am in medicine).
  • I've now reworded and simplified based on a source. Anechoic just seems to mean black on an ultrasound.
• Optional but "these factors cause the disease" instead of "these links are causative"?
  • Done
• Fang J does not appear to be freely accessible. — Preceding unsigned comment added by Strange Orange (talk • contribs) 16:34, 28 January 2026 (UTC)
  • Fixed

Management

• Women's Healthcare is not as reliable as other sources cited. It is cited for a fairly uncontroversial, almost a blue sky phrase, so I think we can let it be. I am leaving this here in case you want to purse an FA nomination for this in the future.
  • Actually, that contradicts NICE, so not quite blue sky. Sources disagree here: should ultrasound come first or should treatment start while waiting for an ultrasound. JAMA and BMJ say that ultrasound comes first, whereas NICE says simultaneous. I've more clearly indicated that these sentences contradict and have replaced the source with JAMA.
• "Evidence for their effectiveness is limited, with only one small study conducted" is not accurate. There are several studies that discuss NSAIDs and endometriosis (source).
  • Clarified it's only one small clinical trial
• Worth making a note that first line recommendation is a combined approach with NSAIDs + hormonal treatment (ESHRE and several other societies).
  • I think the guidelines say that you can go for either or combined. Have added more on how they are used (combined, or separately if fertility is desired), and that they are first-line treatments. —Femke 🐦 (talk) 16:35, 7 February 2026 (UTC)
• "Sometimes, a part of the bowel or bladder is removed" can use an explanation for why they might be removed (endometriosis can be implanted into them).
  • Done. —Femke 🐦 (talk) 20:37, 26 February 2026 (UTC)
• Can say cognitive behavioral therapy instead of "psychotherapy" to be more precise.
  • CBT isn't mentioned in the source. A few other therapies are mentioned in the ESHRE source.
• "Cohort studies indicate that surgery is effective in decreasing pain" and "The evidence was found to be insufficient regarding surgical intervention" are contradictory.
  • I've removed the entire paragraph of comparisons. My Swedish is nowhere competent enough to figure this one out, and the source was getting a bit too old anyway. With evidence of all interventions relatively weak, comparisons are difficult and sources contradict.
• Can discuss controlled ovarian hyperstimulation (with clomiphene, letrozole or similar agents) which is used in mild endometriosis or for moderate/severe endometriosis when ART is not possible.
  • It's not mentioned in ESHRE, and 10.1080/09513590.2024.2381504 indicates that there's not enough evidence on this. —Femke 🐦 (talk) 16:35, 7 February 2026 (UTC)

    Per the American Society for Reproductive Medicine, "In younger women (under age 35 years) with stage I/II endometriosis-associated infertility, expectant management or SO/IUI can be considered as first-line therapy... For women 35 years of age or older, more aggressive treatment, such as SO/IUI or IVF may be considered." Superovulation is not an uncommon practice for infertility from endometriosis, which is discussed briefly in endometriosis and infertility. I believe it would be worthwhile to include this in the article, though I will leave that to your discretion. — Strange Orange | 01:39, 30 March 2026 (UTC)

Epidemiology

• Looks great!

History

• Fascinating and well-written. The prose is verifiable and sources reliable.
• I am not sure if John A. Sampson.jpg is of much utility in terms of illustrating this article but I am not opposed to it being left here either.

Society and culture

• "creating an interconnected challenge that extends beyond reproductive health" is a great line but probably could be more accessible to a broader audience with simplification.
  • Removed
• Just a personal anecdote but "Menstrual disorders generally do not get covered extensively in medical education, leading to gaps in knowledge of healthcare professionals" is very true. When I was training to be a family physician, I had to put in way more effort to improve my competency in ob/gyn than in medicine or pediatrics.
  • I'm glad you did: your help here has been super, and I imagine a lot of people in your practice benefit too. —Femke 🐦 (talk) 16:35, 7 February 2026 (UTC)
• "Women's health research lacks funding – these charts show how" can use additional parameters.
  • Done

Just as a heads up: I belatedly found some issues with this section myself, so have rewritten it a bit to use higher-quality sourcing and double-checking text-source integrity. I'm on two minds wrt FA, and some of these sources didn't meet the bar of high-quality reliable source. —Femke 🐦 (talk) 20:38, 7 February 2026 (UTC)

Research directions

• "but the high diversity in expression" would benefit from simplification.
  • Simplified
• Should clarify that anakinra is still either still being researched or in a trial.
  • Clarified

References

• CS1 maint errors with Lippi D, Brosens I and World Health Organization (2025).
  • Either someone fixed them or I'm blind.

Lead

• "a laparoscopy (keyhole surgery) provides definite confirmation" might be tweaked to say "can provide" instead of "provides" with an addition of "definite confirmation with a biopsy". I will leave this up to you how you'd want to approach it.
  • Done
• This is a fine lead section, covering all the important aspects. Thoughts on switching the order of last two paragraphs? So that it goes from introduction → symptoms → diagnosis → management → epidemiology/ society.
  • Done

Overall

Good Article review progress box Criteria: 1a. prose () 1b. MoS () 2a. ref layout () 2b. cites WP:RS () 2c. no WP:OR () 2d. no WP:CV () 3a. broadness () 3b. focus () 4. neutral () 5. stable () 6a. free or tagged images () 6b. pics relevant () Note: this represents where the article stands relative to the Good Article criteria. Criteria marked are unassessed

Comprehensive and well-written. You have done a great job taking it from this to where it is now! — Strange Orange | 15:17, 28 January 2026 (UTC)

Sorry for the delay again, I will get back to you in the next day or two. — Strange Orange | 17:28, 19 February 2026 (UTC)

No worries, life gets in the way sometimes :). —Femke 🐦 (talk) 17:31, 19 February 2026 (UTC)

Apologies for continuing to edit; I'm a bit impatient and have changed my mind about getting the article to FAC. I hope all my edits are uncontroversial. —Femke 🐦 (talk) 13:04, 28 February 2026 (UTC)

Hi @Strange Orange. Was wondering if you had time to finalise the review. I hope I'm not making your job more difficult by asking for pre-FAC comments while the review is still open. —Femke 🐦 (talk) 12:09, 22 March 2026 (UTC)

I really should have gotten back to you sooner but it kept getting pushed back on my list of things to do. Which is unfair to you so I apologize for this delay. I reviewed the changes made to the article since my last pass, and it looks excellent. My only recommendation would be to consider adding a line on superovulation for completeness but it's not a big deal either way.

This is a comprehensive and well-written overview of a complex topic that you’ve made very accessible to a broad audience. Thank you for all the work you’ve put into this, and I hope it gets to be an FA someday — it would be well deserved! — Strange Orange | 01:39, 30 March 2026 (UTC)