Commentary - Research and Reports in Gynecology and Obstetrics (2025) Volume 6, Issue 1

Understanding pelvic inflammatory disease and endometriosis: Challenges and advances in management

Department of Obstetrics and Gynecology, King Saud University, Saudi Arabia

*Corresponding Author:

Amdi Mari
Department of Obstetrics and Gynecology
King Saud University, Saudi Arabia
E-mail: amdi@mari.edu

Received: 01-Mar-2025, Manuscript No. AARRGO-25-169775; Editor assigned: 03-Mar-2025, PreQC No. AARRGO-25-169775(PQ); Reviewed: 16-Mar-2025, QC No. AARRGO-25-169775; Revised: 22-Mar-2025, Manuscript No. AARRGO-25-169775(R); Published: 28-Mar-2025, DOI:10.35841/aarrgo-6.1.165

Citation: Mari A. Understanding pelvic inflammatory disease and endometriosis: Challenges and advances in management. Res Rep Gynecol Obstet. 2025;6(1):165

Introduction

Pelvic Inflammatory Disease (PID) and endometriosis are two significant gynecological conditions that pose substantial health challenges for women worldwide. Both disorders can lead to chronic pelvic pain, infertility, and a reduced quality of life if not diagnosed and managed effectively. PID is an infectious condition involving the upper female genital tract, often resulting from sexually transmitted infections (STIs) such as Chlamydia trachomatis or Neisseria gonorrhoeae, but can also arise from non-sexually transmitted pathogens. Endometriosis, on the other hand, is a non-infectious, chronic inflammatory disorder characterized by the presence of endometrial-like tissue outside the uterus, leading to pain, adhesions, and reproductive complications. While PID often presents acutely and requires urgent intervention, endometriosis is typically a long-term condition with progressive symptoms. Understanding the pathophysiology, diagnosis, and management of both conditions is crucial for healthcare providers aiming to improve patient outcomes and prevent long-term sequelae.

Pelvic Inflammatory Disease affects millions of women annually, with the highest prevalence among sexually active women under 25 years of age. Risk factors for PID include multiple sexual partners, a history of sexually transmitted infections, unprotected intercourse, and intrauterine device insertion without appropriate prophylaxis. In contrast, endometriosis affects approximately 10% of women of reproductive age, with higher incidence reported among those with a family history of the disease, early menarche, shorter menstrual cycles, and nulliparity. While PID is strongly linked to microbial invasion and subsequent inflammation, endometriosis is associated with hormonal imbalances, immune dysfunction, and genetic predisposition. The overlap between the two conditions lies in their potential to cause chronic pelvic pain and infertility, highlighting the importance of early recognition and targeted intervention [1].

The pathophysiology of PID involves ascending infection from the lower genital tract to the endometrium, fallopian tubes, and ovaries, resulting in inflammation, tissue damage, and possible abscess formation. If untreated, the infection can lead to tubal scarring, adhesions, and chronic pelvic pain. Endometriosis develops when endometrial-like cells implant and proliferate outside the uterine cavity, most commonly on the ovaries, peritoneum, and pelvic ligaments. These ectopic lesions respond to hormonal fluctuations, particularly estrogen, leading to cyclical bleeding, inflammation, and fibrosis. The progressive nature of both PID and endometriosis means that timely diagnosis and intervention are essential to prevent irreversible reproductive damage [2].

PID typically presents with lower abdominal pain, abnormal vaginal discharge, fever, dyspareunia, and irregular bleeding. Physical examination may reveal adnexal tenderness, cervical motion tenderness, and uterine tenderness. Laboratory tests, including elevated C-reactive protein and erythrocyte sedimentation rate, alongside positive STI screening, support the diagnosis. In contrast, endometriosis often presents with dysmenorrhea, chronic pelvic pain, deep dyspareunia, and infertility. Diagnosis is challenging because symptoms may overlap with other gynecological disorders, including PID. While PID can often be diagnosed clinically, endometriosis typically requires laparoscopic visualization and histological confirmation, making early detection difficult.

The management of PID involves broad-spectrum antibiotic therapy to cover likely pathogens, including C. trachomatis, N. gonorrhoeae, and anaerobes. Common regimens combine a cephalosporin with doxycycline and metronidazole for 14 days. Hospitalization is recommended for severe cases, pregnant women, or those unresponsive to outpatient therapy. In addition to antibiotics, pain management, partner notification, and sexual abstinence during treatment are essential to prevent reinfection. Prompt treatment is vital to avoid complications such as infertility, ectopic pregnancy, and chronic pelvic pain [3].

Endometriosis management is tailored to symptom severity, lesion extent, and patient reproductive goals. Medical therapies aim to suppress ovarian estrogen production, thereby reducing endometriotic lesion activity and inflammation. Options include combined oral contraceptives, progestins, gonadotropin-releasing hormone (GnRH) agonists, and aromatase inhibitors. Nonsteroidal anti-inflammatory drugs (NSAIDs) provide symptomatic pain relief. Surgical intervention, typically laparoscopic excision or ablation of lesions, is indicated for patients with severe pain or infertility unresponsive to medical therapy. For women with completed families and refractory symptoms, hysterectomy with bilateral salpingo-oophorectomy may be considered. Post-surgical hormonal suppression is recommended to reduce recurrence risk.

Both PID and endometriosis are leading causes of female infertility. PID damages the fallopian tubes, impairing ovum transport, while endometriosis distorts pelvic anatomy and creates an inflammatory environment hostile to fertilization and implantation. Early intervention is critical to preserving fertility. In cases of endometriosis-associated infertility, assisted reproductive technologies (ART), including in vitro fertilization (IVF), offer a viable solution. For women with a history of PID, tubal surgery or IVF may be necessary depending on the extent of tubal damage. Counseling patients about reproductive planning and fertility preservation is an integral component of long-term management [4].

Prevention of PID focuses on STI screening, safe sexual practices, consistent condom use, and prompt treatment of genital infections. For endometriosis, there are no definitive preventive measures; however, early recognition of symptoms and timely intervention can mitigate disease progression. Patient education is paramount for both conditions. Women should be encouraged to seek medical attention for persistent pelvic pain, menstrual irregularities, or reproductive difficulties. Educating patients on treatment options, potential complications, and lifestyle modifications such as maintaining a healthy weight and managing stress—can improve quality of life and disease outcomes.

Advances in molecular biology, imaging, and surgical techniques hold promise for improved management of PID and endometriosis. Biomarker discovery may facilitate earlier, less invasive diagnosis of endometriosis, while novel antibiotic regimens and antimicrobial resistance monitoring may enhance PID treatment outcomes. Minimally invasive surgical methods, robotic-assisted laparoscopy, and fertility-preserving procedures are likely to expand in the coming years. Moreover, integrating multidisciplinary care—including gynecologists, reproductive endocrinologists, pain specialists, and mental health professionals—can offer a more comprehensive approach to patient management. [5].

Conclusion

Pelvic Inflammatory Disease and endometriosis remain significant public health challenges, impacting women’s reproductive health, emotional well-being, and overall quality of life. While PID requires urgent antimicrobial treatment to prevent long-term sequelae, endometriosis demands a multifaceted, often long-term management plan to control symptoms and preserve fertility. The similarities in their impact—particularly chronic pelvic pain and infertility—underscore the need for heightened clinical vigilance, patient education, and early intervention. Continued research into pathophysiology, diagnostics, and therapeutics promises to improve the prognosis for affected women. By fostering awareness and advancing treatment strategies, healthcare providers can make substantial strides in reducing the burden of these conditions and improving patient outcomes.

References

1. Petraglia F, Hornung D, Seitz C, et al. Reduced pelvic pain in women with endometriosis: Efficacy of long-term dienogest treatment. Arch Gynecol Obstet. 2012;285(1):167-73.

Indexed at, Google Scholar, Crossref

2. Streuli I, de Ziegler D, Santulli P, et al. An update on the pharmacological management of endometriosis. Expert Opin Pharmacother. 2013;14(3):291-305.

Indexed at, Google Scholar, Crossref

3. Busacca M, Riparini J, Somigliana E, et al. Postsurgical ovarian failure after laparoscopic excision of bilateral endometriomas. Am J Obstet Gynecol. 2006;195(2):421-5.

Indexed at, Google Scholar, Crossref

4. Parker JD, Leondires M, Sinaii N, et al. Persistence of dysmenorrhea and nonmenstrual pain after optimal endometriosis surgery may indicate adenomyosis. Fertil Steril. 2006;86(3):711-5.

Indexed at, Google Scholar, Crossref

5. Harb HM, Gallos ID, Chu J, et al. The effect of endometriosis on in vitro fertilisation outcome: A systematic review and meta-analysis. BJOG. 2013;120(11):1308-20.

Indexed at, Google Scholar, Crossref