Talk:Endometriosis

Conservative treatment

"Conservative treatment consists of the excision (called cystectomy) of the endometrium, adhesions,"

This is clearly surgical treatment which is not conservative. Conservative treatment is noninvasive treatment usually with medication. Am I not right?

Pronunciation?

Just come across this disease for the first time. Pronunciation? Endometriôsis? Endometrîosis? Rothorpe (talk) 00:38, 29 September 2015 (UTC)

UK and USA has similar pronunciation, "end oh mee tree oh sis", with a bit of stress on "end" and equal stress on the rest. I will check MOS to see if the article can include this formally with sourcing. 10:58, 2 October 2025 (UTC) ChrysGalley (talk) 10:58, 2 October 2025 (UTC)

Disease of the female reproductive system

This is a poor first sentence. Endo has been (albeit very rarely) found in individuals assigned male at birth, and implants/lesions of endo can be found on, e.g., the digestive system, urinary system, lungs, heart, and even brain. It is associated with systemic neurological and hormonal changes. It is a whole-body disease. Framing it as a disease of the reproductive system is part of the reason why it almost always progresses undiagnosed for years or even decades. 68.199.114.39 (talk) 11:30, 23 April 2024 (UTC)

Endo also effects intersex and other people with diversities of sexual development that defy binary classification. This article is archaic and contributes to, instead of alleviating, poor public knowledge about the condition. Talonx77.191.150.204 (talk) 06:11, 6 May 2024 (UTC)

Added a section yesterday. I am not completely satisfied with the heading name, but something feels stylistically wrong about "AMAB endometriosis" as a section name -- I might change to it after some more thinking.

There are about a dozen case reports on this thing. No real secondary source, but recent case reports do tend to cite other cases. Artoria2e5 🌉 06:21, 21 May 2024 (UTC)

feedback

Responding to an external request for feedback on the mechanisms section from femke

• While the exact cause of endometriosis remains unknown, many theories have been presented to understand and explain its development. These concepts do not necessarily exclude each other bit of a prose concern but the first setence here feels a little wordy (would get rid of "understand" and just have " to explain"). however the second setence is a bit confusing. do you mean that the lack of known cause doesn't exclude theories or that the several theories don't exclude each other. Assuming the second, maybe something like "several of these proposed theories could work together to cause the disease"
• The pathophysiology of endometriosis is likely to be multifactorial and to involve an interplay between several factors this feels repetitive. perhaps shorten to "is likely to involve multiple different factors and the interactions between them" or something. multifactoral and several factors convey the same thing.

  I've replaced this introduction completely, as I had overlooked it and it was still based on a 2011 source. Also gave me some space to teach jargon I use later on (fibrosis/adhesions). —Femke 🐦 (talk) 21:00, 23 November 2025 (UTC)

• The main theories for the formation of the endometrium-like tissue outside the womb are retrograde menstruation i would include a brief explanation of retrograd menstration here (backwards flow of menstral blood)

  I've removed the jargon here, so it's only in the paragraph where we start delving in deeper. —Femke 🐦 (talk) 21:00, 23 November 2025 (UTC)

• Furthermore, animals like rodents and non-human primates whose endometrium is not shed during the estrous cycle do not naturally produce endometriosis contrary to animals that have a natural menstrual cycle like rhesus monkeys and baboons. this is a bit unclear, I'm not sure what estrous cycle is but it should be wikilinked or at least explained a bit. also "naturally produce" is a bit of an odd phrase, perhaps change to "develop"

  They've got mouse models of the disease, where they artificially give them endometriosis (poor things). Not important here, so omitted. —Femke 🐦 (talk) 21:00, 23 November 2025 (UTC)

  I figured this was the reasoning but assumed you didn't plan to delve into that so figured I would mention it. IntentionallyDense ^(Contribs) 21:14, 23 November 2025 (UTC)

• blocked hemivagina is there a wikitionary link for this term? if so that may be more appropriate here
• Endometriosis has shown up in people who have never experienced menstruation shown up seems like odd phrasing, maybe "discovered" or "diagnosed"

  Done. —Femke 🐦 (talk) 17:33, 24 November 2025 (UTC)

• I think the distinction of males instead of men may be important here

  The source does say men. Not sure if it's ever been found in young males. —Femke 🐦 (talk) 17:33, 24 November 2025 (UTC)

• I think the stem cell theory could use a bit of elaboration as someone unfamiliar with the concept of stem cells may be confused as to how they are involved
• to grow outside of the womb I would use the term pelvis here for consistancy.

  The womb is what I meant: endometrium-like tissue outside of where it's supposed to be. —Femke 🐦 (talk) 21:00, 23 November 2025 (UTC)

• decrease in clearance of endometrial cells outside the womb a little unclear as to what this means. I can make a guess but the text itself isn't quite clear as not everyone may understand what clearance means in a physiological context
• release more factors that stimulate angiogenesis is there a wikilink you could add for factors that would help clarify what you mean by factors here? IntentionallyDense ^(Contribs) 05:20, 23 November 2025 (UTC)

• Just to say thank you @IntentionallyDense for that great feedback, and pointers. I fixed the estrous cycle wikilink since that was easy. I was surprised-butnotsurprised that retrograde menstruation does not have a standalone article yet. "Obstructed hemi-vagina" is the term we would use in the UK, I don't know about elsewhere but I see "blocked" in other wikipedia articles. It can result from a single womb too (though rarely so), so that wording is indeed in scope for improvement. Again thank you for doing this. ChrysGalley (talk) 08:19, 23 November 2025 (UTC)

  Fantastic feedback, as always. Made a start addressing it. —Femke 🐦 (talk) 21:00, 23 November 2025 (UTC)

Womb or uterus?

Hello User:~2025-38058-18. I see you've changed the normal English womb to the more technical uterus. Are you saying that these words aren't exact synonyms? In the case of synonyms, WP:Make technical articles understandable gives a preference to the plain-English version of a word, so non-experts can understand the article too. My preference is that we use womb in the lead, and that we mention uterus in a synonym in the body, so people can understand the images that use the jargon. —Femke 🐦 (talk) 07:54, 3 December 2025 (UTC)

I would agree with the above comments by @Femke. Not within policy or guidelines, the unfortunate reality is that many women will be coming to this article due to the shoddy treatment and explanations that unfortunately tends to happen with this condition, probably more than any other, and reassuring plain English is helpful. As far as dealing with patients are concerned, womb and uterus are the same. The thing clinicians need to guard against is using womb when someone is having a healthy pregnancy and then uterus when not (ie. there is a problem and uterus becomes "bad news"). ChrysGalley (talk) 08:28, 3 December 2025 (UTC)

@ChrysGalley @Femke As a woman, I changed this because other body parts are referred to anatomically, and the word "womb" carries a connotation relation to childbearing/motherliness, while "uterus" is medical and neutral. People (like me) visiting this page while concerned for their health and experiencing pain are likely to be more concerned with medical information than motherliness. A uterus is not only a vessel/womb, it is an organ even when it is not used for that purpose. ~2025-38058-18 (talk) 13:06, 3 December 2025 (UTC)

@Femke Uterus is no more jargony than other anatomical words in this article. I think it would be more appropriate to use uterus and mention womb as a synonym. Womb carries connotations that uterus does not. ~2025-38058-18 (talk) 13:11, 3 December 2025 (UTC)

It may also be friendlier to at least some non-L1 speakers of English. « Utérus » is the usual French word, so “uterus” is immediately understandable to a French speaker (whereas it might not be immediately clear exactly what “womb” refers to). Spidermario (talk) 22:44, 3 December 2025 (UTC)

@Femke Also, yes I am saying they are not exact synonyms (few words are). the definition for "uterus" is the organ, only. The definition for "womb" includes uterus, but also can be used to describe a thing which encloses or contains something growing, in a literal or metaphorical sense. I think it is more appropriate to use the more accurate "uterus" and include "womb" as a synonym if necessary (it is already mentioned in the page for uterus, which is linked). ~2025-38058-18 (talk) 04:42, 4 December 2025 (UTC)

I support using “uterus” in the lead and throughout. This article already uses standard anatomical terms, and “uterus” is precise, medically neutral, and consistent with WP:MEDMOS. “Womb” can be mentioned once as a synonym, but relying on it risks ambiguity and metaphor rather than clarity. Evathedutch (talk) 00:52, 6 January 2026 (UTC)

Images of subtypes

Different subtypes of endometriosis. Clockwise from the top left is peritoneal endometriosis, adhesions seen in deep endometriosis, a ruptured chocolate cyst and a mass of scar endometriosis next to a ceasarian section scar.

Currently, we're displaying a chocolate cyst in the subtypes. I'm wondering if we can display all four types? There's a lot of images of Commons, but unfortunately they're not citing papers or explaining what's being displayed. Some look like deep endometriosis to me, but I have no clue how to interpret these images. So, would this collage work? I'm least certain about the first image. It's called 'peritoneal endometriosis', might might not be superficial. Is there a better image that's more clearly superficial? — Preceding unsigned comment added by Femke (talk • contribs)

Nulliparity as risk factor

Hello User:ActuallyApathy. Thanks for helping out with this article. What sentences in the cited source did you use to write "Though infertility is a symptom of endometriosis as well, which can contribute to the correlation with nulliparity". I can't find it. Note that WP:SYNTHESIS of different bits of information and drawing our own conclusions isn't allowed. Thr source only seems to say that infertility is more common in endometriosis, I don't think it connects this to nulliparity as a risk factor. Well-designed risk studies have hopefully already corrected for this. —Femke 🐦 (talk) 18:44, 31 December 2025 (UTC)

understood! my apologies, I am fairly new to editing wikipedia articles. i have removed my edit and will leave it that way unless/until i find an appropriate source that backs up that edit. thank you for the constructive feedback! ActuallyApathy (talk) 19:43, 31 December 2025 (UTC)

Thanks :). Always happy to answer any questions you might have about wikipedia editing, or to get feedback on the article. —Femke 🐦 (talk) 15:56, 1 January 2026 (UTC)

GA review

This review is transcluded from Talk:Endometriosis/GA1. The edit link for this section can be used to add comments to the review.

Nominator: Femke (talk · contribs) 12:31, 21 December 2025 (UTC)

Reviewer: Strange Orange (talk · contribs) 00:33, 12 January 2026 (UTC)

Sorry for the delay. Something unexpected came up. I should be able to do this within the next 5 days. — Strange Orange | 18:27, 17 January 2026 (UTC)

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)

Lead image

current lead image

Alternative lead image

.

Final diagram with annotation, removal of unclear within-uterus adhesions, and slightly lighter colour to make arrows clear.

I don't like the current lead image that much. It looks a bit unprofessional. What do people think of this alternative, which shows endometrioma and adhesions more clearly, but does not show possible endometriosis on the bowels, or where the uterus is wrt the rest of the body.

The alternative image does not have text, but I can remedy that.

What do others think? —Femke 🐦 (talk) 10:21, 28 February 2026 (UTC)

I've gone ahead and changed the image the second alternative above. I've removed what seemed like adhesions within the uterus, as I don't see that on other images of endometriosis and have never seen it described in papers. Hope this image is more accessible and clear than the previous one. —Femke 🐦 (talk) 22:27, 28 February 2026 (UTC)

Comments and suggestions

Here by request on my Talk page, as a non-medical editor. I'll give the article a read and add thoughts below over the next couple of days.

• I wondered about the first paragraph -- we seem to be studiously avoiding saying that it affects the female reproductive system. That would perhaps clarify things (does everyone know what a uterus is?), at the cost of excluding trans and non-binary sufferers -- but then we go on later to say Endometriosis can be removed surgically in women whose symptoms are not relieved by other treatments. So at the moment we're achieving neither objective -- I would go for one or the other. I note that we talk extensively about "women" later on.

  This omission wasn't for inclusivity (even though I'm conscious it's a difficult trade-off between making women visible + making the article inclusive), but for two other reasons: (1) it stems from the female reproductive system, but it is more and more recognised as a systemic disease with possible impacts throughout the body and (2) to me, these seem unnecessary complicated words. I can add something like 'it mostly affects women of reproductive age' in the first paragraph?

• The exact cause is not known. Possible causes include backwards...: presumably it's at least possible that it could have multiple causes: should we pluralise as such?

  I've made it ambiguous with the phrasing "It is not known exactly what causes the disease." —Femke 🐦 (talk) 20:02, 28 March 2026 (UTC)

• Other causes of similar symptoms include adenomyosis, uterine fibroids, irritable bowel syndrome, and interstitial cystitis.: with the perhaps obvious exception I have only a vague idea what any of these are. Could we say something like "diseases of the uterus such as adenomyosis and uterine fibroids, irritable bowel syndrome, or a type of chronic pain known as interstitial cystitis"?

  Done. —Femke 🐦 (talk) 09:26, 22 March 2026 (UTC)

• several treatments may improve symptoms. This includes : these include.

  Done. —Femke 🐦 (talk) 09:26, 22 March 2026 (UTC)

• Taking the birth control pill continuously: there are different types of birth control pill, and we link to the combined one: does it have to be that one?

  It's the one the sources talk about when saying you should take it continuously. There are other ones, but while it's plausible that these are taken similarly, I can't find a source.

  So should we add "combined"? UndercoverClassicist ^T·C 11:35, 20 March 2026 (UTC)

  I've now figured out why sources do not speak about taking the progestin-only 'minipill' continuously: they are always taken continuously. So the sentence is correct in either interpretation (whether you read birth control pill as the standard pill or any type of pill), and I prefer to have a slightly more general statement about birth control pills.

• Taking the birth control pill continuously or using a hormonal IUD (coil) is another first-line treatment: there are two treatments here, so are.

  Done.

• even though drugs may lose effectiveness over time: this is a bit unclear: do we mean that ibuprofen doesn't work as well if you leave it in the cupboard too long? Or that ibuprofen made in 2020 isn't as good as the stuff from 2005?

  It's the approach of treating endometriosis with drugs; hopefully clarified (the lesions may develop 'resistance' against the hormones). —Femke 🐦 (talk) 08:24, 20 March 2026 (UTC)

• The pictures in the "subtypes" section -- it's pretty hard to know what I'm looking at. The arrow at NW is a good addition. The big red circle in the SE image helps, but then there's also a yellow arrow pointing to the scar; it may be worth clarifying which is the thing being indicated, or making a new version of the image to remove the arrow. On the NE image ("adhesions seen...") I have no idea which bit of that anatomy is meant to be unusual.

  In the image of the adhesions, I know the white stringy bits of the image are adhesions. The image description said there is extensive adhesions, so I suspect that there are more sheet-like adhesions that I cannot recognise. With a bit of help of chatGPT I found an alternative image that directly shows deep endometriosis, encircled by the paper authors, so have replaced the image instead. Have amended the description for the SE image to point to the red circle. —Femke 🐦 (talk) 16:55, 28 March 2026 (UTC)

• Is it worth defining "lesions"?

  Done. —Femke 🐦 (talk) 08:38, 25 March 2026 (UTC)

• Endometriomas appear dark brown: we haven't actually explained what an endometrioma is. I can parse the word and figure it out, but many readers won't be able to do that.

  It's defined in the list definition just above. I can hint by giving being a bit more verbose (ovarian endometriomas...) if that's better?

  Oh, yeah -- I'd missed the connection. Why not put this bit about "chocolate cysts" up there?

  I prefer to keep the definition short, and talk more about appearance and contents in the prose. That way, people skimming the section learn the essential jargon. —Femke 🐦 (talk) 20:02, 28 March 2026 (UTC)

• Endometriosis is often associated with pain and infertility: can we say "often causes", or do we need more caution?

  That can be more forceful. Sources typically say 'symptoms of endometriosis are..', which I think can be paraphrased as endometriosis causes. I've dropped the often because we don't have good population based samples and have no idea how frequent they are in a general population with endo. —Femke 🐦 (talk) 17:44, 21 March 2026 (UTC)

• Those with 'minimal' endometriosis may have significant pain, while those with 'severe' endometriosis may have few symptoms: the WP:SCAREQUOTES aren't ideal here: suggest something like "those with relatively small amounts of endometriosis tissue..." (or similar).

  I've simply removed the quotes, as the previous sentence explains it's about the extent of endometriosis. —Femke 🐦 (talk) 08:39, 26 March 2026 (UTC)

• Scar endometriosis can form on the abdominal wall as a complication of surgery: I didn't find this massively clear. Do I take it right that, when healing a surgical wound to the abdominal wall, the body sometimes puts tissue similar to the uterine lining "in" or alongside the scar?

  Yes, that's right. I've added a short sentence clarifying. —Femke 🐦 (talk) 08:39, 26 March 2026 (UTC)

• Some individuals describe the sensation as resembling "clawing fingernails" or "stabbing knives" in the lower abdomen: possibly another case for WP:QUOTEPOV.

  I've removed them, but wouldn't be surprised if others ask for them to come back. Not entirely sure what's best. —Femke 🐦 (talk) 08:39, 26 March 2026 (UTC)

• Deep infiltrating endometriosis: hyphen.

  I've not seen sources use a hyphen here, it might not be a compound (it's both infiltrating and deep?). —Femke 🐦 (talk) 17:44, 21 March 2026 (UTC)

  They might not have the Wikipedia MoS to follow, but there are a couple of compounds that are basically never hyphenated ("death metal band" being one of them); it's possible this is the same, or as you describe. UndercoverClassicist ^T·C 17:59, 21 March 2026 (UTC)

  Have double checked. There are a few sources that say deeply infiltrating endometriosis, but none that hyphenate. —Femke 🐦 (talk) 09:26, 22 March 2026 (UTC)

• Thoracic endometriosis, endometriosis on the diaphragm, lungs or pleura around the lungs, can cause cyclical cough: clearer if you bracket off the definition with something stronger, like brackets (parentheses) or dashes.

  Done. —Femke 🐦 (talk) 17:44, 21 March 2026 (UTC)

• that is, symptoms that are worse during menstruation: I'd be tempted to make clearer that we're defining "cyclical" here by cutting the first paragraph at "Bowel obstruction", then starting the next with something like "Many of the symptoms of endometriosis can be cyclical, which means that they are worse during menstruation. These can include..."

  Not sure I fully understand, but I've moved the explanation of cyclical to the first paragraph under the bullet points where I first explain the concept of cyclical symptoms. —Femke 🐦 (talk) 09:26, 22 March 2026 (UTC)

• Endometriosis may be associated with complications during pregnancy. Women with endometriosis have a three-fold increased risk of a placenta previa, in which the placenta partially or completely covers the cervical opening: so it definitely is "associated with" complications, and may cause them? Assuming the second sentence is robust, I can't see that there's any way in which it can't be associated with complications.

  Changed. —Femke 🐦 (talk) 20:32, 21 March 2026 (UTC)

• high blood pressure and arrhythmia: "and irregular heartbeat", perhaps bracketing arrythmia?

  Done. —Femke 🐦 (talk) 17:44, 21 March 2026 (UTC)

• Depression and anxiety are more common in endometriosis compared to healthy people: in people with endometriosis, I think.

  Changed. —Femke 🐦 (talk) 20:32, 21 March 2026 (UTC)

• Endometriosis increases the risk of developing ovarian and thyroid cancers compared to women without the condition: I'm interested that we've made an unequivocally causal statement here, having been extremely cautious about doing so beforehand (even avoiding directly saying "endometriosis hurts").

  That was not warranted in this case. Probably me being tired while trying to do some elegant variation. Changed. —Femke 🐦 (talk) 20:32, 21 March 2026 (UTC)

• Studies attribute 50% of the risk to genetics, the other 50% to environmental factors.: need a conjunction here.

  changed to a semicolon instead. —Femke 🐦 (talk) 21:01, 26 March 2026 (UTC)

  Then we need the second part to be a sentence, so "the other 50% is attributed to..." or similar. UndercoverClassicist ^T·C 21:14, 26 March 2026 (UTC)

  Done. —Femke 🐦 (talk) 21:30, 26 March 2026 (UTC)

• Individuals with a first-degree relative who has endometriosis: "a parent, child or full sibling"?

  Changed. —Femke 🐦 (talk) 12:26, 22 March 2026 (UTC)

• Individuals with a first-degree relative who has endometriosis face a three- to nine-fold higher risk of developing it themselves: coming back to my recurring theme of "women" versus "individuals", this seems an odd place not to use "women". I mean, technically, a man who finds out his daughter has endometriosis now has a risk of 0% * 9, but most readers will read our sentence as implying that the risk is higher. (Reading on, I see that men have a really small risk of developing it: is this statement still robust if we take them into account? I'd be surprised if there's enough of them to have solid statistics about their relative risk rate. This is probably relevant for certain statements: see for example In addition, cells in the peritoneum of women with endometriosis release more growth factors that stimulate angiogenesis: only women?).

  The source I'm citing does not talk about gender, and the source that source cited doesn't mention women explicitly either. That said, endo is extremely rare in cis men, and the population of trans men is so small that it does little to move these numbers. Similarly, the source I'm citing only talks about the peritoneum of women, not of all folks with endo. —Femke 🐦 (talk) 12:26, 22 March 2026 (UTC)

  I suspect what's going on here is that other editorial considerations are introducing noise -- some sources will be happy calling all endometriosis patients "women", others won't. It's a similar sort of thing to an ancient history article: different sources use e.g. BC vs BCE, "Byzantine Empire" versus "Roman Empire", "Tyrtaios" vs "Tyrtaeus", and so on. In those cases we pick a lane: it would be very confusing if we swapped between forms from sentence to sentence depending on which source we were citing. There's a couple of ways around the problem here -- I think the best would be to use "patients", "individuals" etc unless the source is explicitly contrasting women and other patients, and make it clear in those cases. Otherwise, we end up inadvertently doing WP:SYNTH and implying that some of these facts apply to patients who aren't woman and others don't, when the sources don't say that. Alternatively, we could go for "women" as consistently as possible throughout except where we acknowledge the rare exceptions. UndercoverClassicist ^T·C 13:11, 22 March 2026 (UTC)

  There's a couple of discussions I've had on this over time (e.g. at Talk:Polycystic_ovary_syndrome#Update_planned), and I'm not sure what the best answer is. At the FAC for ME/CFS someone argued that I wasn't using elegant variation enough (mostly using 'people with ME/CFS'), so I'm taking the opportunity here to vary. Some of the top sources use both women and individuals seemingly interchangeably, with a preference for women (similar to this article). Some almost exclusively use women. I'm not entirely sure how much we should be lead by external sources here, as this is partially a style choice.

  About the synth issue: I think that issue remains in either case. Without delving into the primary sources (which might be a few layers away from the source we're citing), it's difficult to know if it's a style choice or a scientific choice in the sources to use women / individuals.

  In most medical writing on Wikipedia the term patient is avoided, as it implies the people are receiving care. Not all people with endometriosis are of course, if only for the long diagnostic delays. —Femke 🐦 (talk) 19:05, 22 March 2026 (UTC)

  It is only an essay, but WP:ELEVAR contains a lot of good sense as to why elegant variation isn't always a good thing in Wikipedia writing. I'll take another look on this question when it comes up at FAC: for me, the big issue is avoiding putting "women" and "people" together in close proximity in a way that might imply that one sentence covers only women and the other doesn't. UndercoverClassicist ^T·C 19:26, 22 March 2026 (UTC)

  That's a good point. Will do a close read to avoid that implication throughout. In terms of putting some caution against ELEVAR in guideline text, I'm doing another big push on the Wikipedia:Make technical articles understandable/Workshop text. If you feel like giving even more brilliant feedback, I'd be happy to trade for any kind of review. —Femke 🐦 (talk) 21:19, 25 March 2026 (UTC)

  I've replaced individuals twice. I kept it in for sentences where it felt too unnatural to focus on adults. I find 'women and girls' too awkward, and it's not something sources do, but for early stage disease individuals feels more accurate. —Femke 🐦 (talk) 16:58, 28 March 2026 (UTC)

• At least 42 different loci (regions on a chromosome) have been associated with endometriosis risk: does everyone know what a chromosome is?

  Enough that I'm comfortable with just giving a link (wasn't linked before). —Femke 🐦 (talk) 12:26, 22 March 2026 (UTC)

• For instance, endometriosis shares a genetic underpinning with migraine and neck, shoulder and back pain: hold on a minute: at least as far as I know, the genetic underpinnings of migranes at least are very complicated and not singular. Furthermore, at the risk of stating the blindingly obvious, neck/shoulder/back pain often (usually?) has basically zero genetic component. Do we mean that the same genetic markers often found in people with migranes or other joint pains are often found in people with endometriosis?

  All of these conditions have a complicated genetic signal, and that includes pain conditions. Heritability of back pain is about 40-68%. They are defining some type of correlation coefficient, that goes from -1 to 1, just like the normal Pearson's correlation. The strongest correlation is actually for back pain out of the different pain conditions. The paper does use wording that's quite confident: "Our results demonstrate genetic underpinning of shared pathogenesis of endometriosis with other chronic pain conditions, as well as other inflammatory conditions.", so I think this is defensible, even though weakening the wording to speak of correlations is also an option. I have changed out shoulder pain with headache, as shoulder pain likely came from a mistranslation of dorsalgia. —Femke 🐦 (talk) 08:39, 26 March 2026 (UTC)

• Just noting my approval that you've followed WP:MEDRS to the letter in dealing with the environmental risk factors -- this is the sort of area where there's usually a lot of very shaky correlations in the literature that don't always stand up well to replication or methodological analysis.

  My experience is that Wikipedia articles often underreport these associations. There is good epidemiological evidence that one can do if you fund a research field well, using the Bradford Hill criteria. Research one this for endometriosis is quite difficult, because diagnosis is strongly delayed, making causal inferences much more difficult. —Femke 🐦 (talk) 12:26, 22 March 2026 (UTC)

• It strikes me that we get a long way into the body of the article before we get the key definition of what we're talking about: Endometriosis is an inflammatory disease defined by the presence of tissue similar to the lining of the uterus (the endometrium) elsewhere in the body. I know that medical articles tend to follow a certain structure, but would it be worth finding a way to get that up front somewhere -- perhaps moving the "mechanism" section to the top? Or moving/copying this sentence to the start of "signs and symptoms"? It seems odd to talk about the symptoms of Fooitis, or the sort of people who tend to get Fooitis, before actually saying what Fooitis is.

  Normally, and I don't want to rely on information from the lead to be known in the body. Readers might click on the TOC before finishing the lead. But as this is explained in the first sentence, I'm not too worried about it, and don't want to deviate from MOS:MED here. —Femke 🐦 (talk) 12:26, 22 March 2026 (UTC)

  What would be the MOS:MED breach here? That page advises the subheadings we use, but not the order of them, and gives "characteristics" as a possible alternative for "signs and symptoms", which would seem to allow putting a definition in that section. UndercoverClassicist ^T·C 13:14, 22 March 2026 (UTC)

  In terms of 'signs and symptoms' vs 'characteristics', I feel that having symptoms in the heading makes it easier to understand. Characteristics might not be immediately clear to readers, who could interpet this as including causes, findings from tests, or even epidemiology. I think it might be useful in articles like autism, where not characteristic is a symptom per se.

  WP:MEDORDER does suggest this is a standard heading order, where you're free to deviate if it makes more sense with the specific condition. I'm not convinced it does. —Femke 🐦 (talk) 18:32, 24 March 2026 (UTC)

  Sorry -- I don't think I was very clear about my point with "characteristics". I was thinking along the following lines:

  • I think it would be clearer if the first body section (that is, "signs and symptoms"), started with a basic definition of what the condition is.
  • If the section were titled "characteristics", nobody would have a problem with including a definition at the start of it.
  • Under WP:MEDRS, it's much of a muchness as to whether you call the section "signs and symptoms" or "characteristics" -- the two sections do the same job.
  • Therefore, I would hope nobody would have a problem with including a definition at the start of the "signs and symptoms" section. UndercoverClassicist ^T·C 19:50, 24 March 2026 (UTC)
    • I've now included a definition in subtypes, where I feel it's more natural. Does that work for you? —Femke 🐦 (talk) 08:38, 25 March 2026 (UTC)

      Definitely good to get the definition of the type in before we start talking about subtypes. UndercoverClassicist ^T·C 09:30, 25 March 2026 (UTC)

• almost all women have some backward flow of menstrual fluid, but only some of them develop endometriosis: we put a number on this later, but I wonder whether it's worth saying it here: building suspense isn't generally one of our major aims in a Wiki artice.

  Do we put a number on this? I remember seeing a number like 90% in sources, but I don't that's in the article? I am blind, so maybe I'm missing it. —Femke 🐦 (talk) 20:02, 28 March 2026 (UTC)

  I was talking about the number who develop endometriosis. UndercoverClassicist ^T·C 22:04, 28 March 2026 (UTC)

  Done, that makes more sense. —Femke 🐦 (talk) 19:05, 31 March 2026 (UTC)

• This type of pain can also cause poor sleep, memory problems and fatigue: can't most types of pain cause poor sleep?

  I may have lost some precision in translating here. The source says: "Nociplastic pain (pain from altered pain perception in the central nervous system) manifests as widespread body pain, fatigue, memory difficulties, and poor sleep and is associated with systemic inflammation from immunoreactive white blood cells". I've now rewritten it as 'is associated with', as it's not quite clear what, if anything, comes first. It seems like it's possible to treat fibromyalgia pain (the typical example of nociplastic pain) with sleep medication for instance. —Femke 🐦 (talk) 20:02, 28 March 2026 (UTC)

• Ultrasounds cannot be used to exclude a diagnosis of endometriosis: I'm not 100% sure what this means, especially as we just talked about how ultrasounds could be used to diagnose. I've got a hunch (that ultrasounds can give you strong evidence towards a "yes", but can never give you a "no") but the wording doesn't help me feel confident in it.

  Reorganised the paragraph to put this information just after the two subtypes you can detect (implying that it cannot detect superficial endometriosis), and replace the term 'exclude' with 'rule out'. —Femke 🐦 (talk) 19:35, 22 March 2026 (UTC)

• Endometriosis, abdominal wall. The adipose (fat) tissue contained blood-filled cysts, fibrous bands and areas of bleeding.: again, I'm not 100% what I'm looking at here. I think the yellow stuff is fat and the stringy white stuff in the middle is the fibrous matter? Are the cysts the things that look like holes?

  yes! I put the colours in the description. —Femke 🐦 (talk) 20:47, 26 March 2026 (UTC)

• a cystoscopy, which shows pinpoint hemorrhages in bladder pain syndrome: I know what all of these words mean, but have no idea what this sentence is telling me.

  Tried to clarify with " It can be distinguished from endometriosis with a cystoscopy (bladder examination), which shows pinpoint bleeding spots in the bladder in bladder pain syndrome.". Is that more clear. It's mostly trying to explain jargon, so perhaps not yet nailed it. —Femke 🐦 (talk) 20:02, 28 March 2026 (UTC)

• The (very short) prevention section basically repeats the environmental risk factors paragraph above, but there are differences. I don't really understand why there are, to be honest. I do like the comment that women with a painful condition drink more and eat more unhealthy food -- there seems to be an obvious explanation for that!

  I've had a look at current disease FAs, and many do not have a prevention section. My motivation is that endometriosis is one of those conditions with plenty of influencer misinformation (as all underfunded conditions seem to have), so I want to include two new statements that don't quite fit in risk factors: (a) there is no proven way to prevent endometriosis and (b) exercise is not shown to prevent endo, but does help with pain. Less thought went into the rest of the paragraph. I've expanded slightly with a note about that there is controversy about whether contraceptives could prevent endometriosis, and more explicitly talked about modifiable risk factors to signal why this theme is coming back. —Femke 🐦 (talk) 19:41, 27 March 2026 (UTC)

• Coming back to Taking the birth control pill continuously or using a hormonal IUD (coil) are other first-line treatments in the lead after reading the "Management" section -- I think it probably needs to be said that there's no good evidence that the pills actually work!

  Having looked at this in more detail, I think the best solution is to remove the Cochrane study. I think by keeping it, the article is putting too much doubt on the combined pill. I don't think the evidence for other cheap hormonal treatment modalities (progestin-only) is better. A year before this analysis, NICE used a more sophisticated statistical technique to test the effectiveness of various hormonal options. That technique can take into account indirect evidence (pill is equally good as the GnRHa antagonists, which perform well against placebo, so the pill will likely also work well against placebo). The confidence bars p.200 are equally big for most of the hormonal options. Both Cochrane and NICE are still being cited by top sources, but as NICE directly compares the different hormonal options, it's likely the better source to rely on. I might go into more detail about contraindications instead. 17:43, 23 March 2026 (UTC)

  Have replaced the Cochrane study with some info about which combined pill to use (lowest estrogen) and contraindications. —Femke 🐦 (talk) 20:02, 28 March 2026 (UTC)

• Evidence is limited: evidence of their effectiveness? Of their action?

  The source does not say: it says "A systematic review of 5 systematic reviews reported low-quality evidence for the use of aromatase inhibitors for endometriosis". I imagine it's mostly effectiveness, but also the adverse effects.

• NSAIDs like naproxen are anti-inflammatory medications commonly used for endometriosis pain: probably worth saying that they're commonly used for pain in general.

  I've now given a second example of a NSAIDs that readers may be more familiar with (ibuprofen), so that readers can draw that conclusion themselves. —Femke 🐦 (talk) 19:35, 22 March 2026 (UTC)

• NSAIDs ... are generally safe to try: is it worth pointing out that there are some notable exceptions here, such as people with asthma or clotting disorders?

  Added a few contraindications here and for the combined pill for consistency. —Femke 🐦 (talk) 10:53, 28 March 2026 (UTC)

• or is contraindicated.: "or where the patient has another condition that makes the treatments unsuitable"?

  Changed. —Femke 🐦 (talk) 10:53, 28 March 2026 (UTC)

• The abdomen is filled with gas so that the surgeon can see better and have space for instruments.: this does, strictly, need to be cited.

  Done. —Femke 🐦 (talk) 22:22, 25 March 2026 (UTC)

• For instance, for rectovaginal endometriosis, 7% of surgeries had complications: awkward tense here: I would either say "have" or something like "a 2025 review found that..."

More to follow. UndercoverClassicist ^T·C 07:49, 20 March 2026 (UTC)

• A real nitpicky FAC one -- check the formatting of author initials in references. The MoS would go for "J. R. R. Tolkien" under MOS:INITIALS.

  this is a WP:CITEVAR choice: in medical articles, it's the default to omit these full stops after initials, hence the use of the vauthors parameter in the citations instead of the default first/last. —Femke 🐦 (talk) 18:56, 26 March 2026 (UTC)

  Hm -- perhaps a dubious one, as it's not normal for CITEVAR to explicitly ask us to break other MoS rules. However, if we're going to go this way, it needs to be consistent. UndercoverClassicist ^T·C 19:30, 26 March 2026 (UTC)

  Should be fixed now. Not sure why the cs1 config template at the top of the article didn't force the style. —Femke 🐦 (talk) 19:45, 26 March 2026 (UTC)

  @UndercoverClassicist: did you have any further comments? Almost back from holiday to do the last push before nominating. Thanks! —Femke 🐦 (talk) 15:15, 18 April 2026 (UTC)

• In an analysis with a median follow-up of 24 months pain after surgery recurred in about 16% of women: I would put a comma after months, as the prefatory bit is quite long. We do this a little lower down in a very similar sentence.

  Done. —Femke 🐦 (talk) 06:56, 19 April 2026 (UTC)

• At a median follow-up of 18 months, endometriosis recurred in 26% of women without postoperative hormonal suppression, compared with 10% of women who received it: not your fault, but this is a very odd way of phrasing the data. Imagine a survey that included 100 women aged 90, 100 women aged 20, and one aged 21 -- with a median age of 21, we'd conclude that about 50% of women struggle to run for a bus! Can we footnote or add the range on that followup?

  Added the original meta-analysis and the range. —Femke 🐦 (talk) 16:32, 19 April 2026 (UTC)

• and the both NICE: typo. It's usually just called NICE in the UK, rather than "the NICE". However, I don't think we've introduced what it is yet.

  Done. —Femke 🐦 (talk) 06:56, 19 April 2026 (UTC)

• The disease does not always worsen over time; in repeat surgeries, endometriosis became worse in 29%, improved in 42% and stayed the same in 29%.: I don't quite understand this. We're talking about repeat surgeries -- is that the same as the proportion of people for whom it gets worse? And don't we need "of cases", or something, at the end?

  I've now read the primary source this was based on: it's the control groups in surgery trials. Instead of focusing on surgery, I'm now stressing that this is following people over time. I think the previous wording implied that people got a treatment in the first surgery. Have added 'of cases'. —Femke 🐦 (talk) 11:09, 19 April 2026 (UTC)

• with studies reporting recurrence rates anywhere between 6% and 67%.: five-year recurrence rates? Lifetime?

  It doesn't say, nor does the paper it cites say. Given the limited research on the topic, I suspect somewhere between 1 and 5 years, not lifetime. —Femke 🐦 (talk) 15:37, 19 April 2026 (UTC)

• Endometriosis is commonly reported to affect approximately 10% of women of reproductive age. Worldwide, an estimated 176–190 million girls and women are affected: I think we need an "as of" on these. The WHO estimated that there were 1.9 billion women of reproductive age worldwide in 2021, which would correspond to ~190 million cases. There's about 300 million more people alive now than then, which would suggest that this estimate needs to go up a bit.

  I've removed the lower estimate, which entered the literature in 2018, probably based on older numbers then. Might tweak further once I've regained access to NICE (apparently, UK only). —Femke 🐦 (talk) 06:56, 19 April 2026 (UTC)

• It is most diagnosed when women are in their 30s: I would always restate the subject when starting a new paragraph.

  Changed it to 'The disease' to prevent the two paras from starting the same. —Femke 🐦 (talk) 06:56, 19 April 2026 (UTC)

• symptoms typically start in early 20s or in adolescence: in the early 20s, or similar.

  Changed. —Femke 🐦 (talk) 06:56, 19 April 2026 (UTC)

• People can develop endometriosis symptoms before their first period and in menopause too: this feels like an odd place for "people".

  I've changed to individuals. I find it odd to talk about women when talking about young girls. Hopefully individuals doesn't "feel" as gender-neutral as people. —Femke 🐦 (talk) 06:56, 19 April 2026 (UTC)

  Fair point. UndercoverClassicist ^T·C 07:15, 19 April 2026 (UTC)

• The condition is more commonly diagnosed in women of East Asian and Southeast Asian descent than in white women: is this an ethnicity thing or a geography thing? Are we saying effectively that endometriosis care in (say) Vietnam is bad, or that endometriosis care in the United States is racialised (both, I suspect)? A bit more detail here would help tease out the distinctions, I think.

  I don't think we know. The arguments in the paper are a bit subtle and difficult to summarise without giving undue attention. —Femke 🐦 (talk) 06:56, 19 April 2026 (UTC)

  Can we at least say "worldwide", "in the United States", "in Europe", or similar? UndercoverClassicist ^T·C 12:09, 19 April 2026 (UTC)

  I've changed to a different paper, which does specify the disparaty relates to the US. Added that. —Femke 🐦 (talk) 15:17, 19 April 2026 (UTC)

• In Ancient Greece, the Hippocratic Corpus outlines symptoms similar to endometriosis, including adhesions, and infertility: rough date?

  Added. —Femke 🐦 (talk) 16:13, 19 April 2026 (UTC)

• The now-discredited diagnosis of hysteria may have been endometriosis in many cases: this doesn't quite make sense as phrased. I think we mean that the diagnosis may have been given to people who were really suffering from endometriosis?

  Reworded. —Femke 🐦 (talk) 15:54, 19 April 2026 (UTC)

• Some attribute the first description to Carl von Rokitansky in 1860, even though other authors consider it more likely he was describing malignant tissue: the phrasing even though sounds a bit incredulous to me. What name did Rokitansky use here?

  He used sarcoma, which is a term for a type of cancer. Some argue he didn't mean cancer when using the word. —Femke 🐦 (talk) 06:56, 19 April 2026 (UTC)

  That might be worth spinning out a little -- something like "Carl von Rotikansky, in 1860, described what he called 'sarcomas' which became painful during a patient's period [or whatever it was]; some consider this to have been a description of endometriosis, while others consider it more likely that he was describing cancerous tissue, to which the term 'sarcoma' more usually refers."? UndercoverClassicist ^T·C 12:11, 19 April 2026 (UTC)

  Done. —Femke 🐦 (talk) 16:54, 19 April 2026 (UTC)

• John A. Sampson defined endometriosis: when?

  Added

• was the first to propose the theory of retrograde menstruation as a cause: I think we can cut "the theory of", since we've got "propose ... as a cause".

  Done. —Femke 🐦 (talk) 15:37, 19 April 2026 (UTC)

• Link cesarean section?

  Relinked and made spelling consistent. —Femke 🐦 (talk) 09:36, 19 April 2026 (UTC)

• For elder women, another approach was surgery: I don't think we generally use elder as a non-comparative adjective like that -- either older or elderly, or perhaps post-menopausal?

  Fixed. —Femke 🐦 (talk) 06:56, 19 April 2026 (UTC)

• Karnaky: we haven't introduced this person yet, so full name if we have it.

  We only have initials (in the reference list of the paper). Prefer to keep it more concise, also later on with a few other less prominent folks. —Femke 🐦 (talk) 16:13, 19 April 2026 (UTC)

• Pseudopregnancy (high-dose estrogen–progestogen therapy) for endometriosis: I think this is a case where we explain the obscure with the obscure. Presumably the point is to give the patient hormones that make the body think it's pregant?

  Yes. We explain estrogen-progestogen therapy earlier on (like the coil). —Femke 🐦 (talk) 16:13, 19 April 2026 (UTC)

  Is that in the same section? Not everyone reads top to bottom (for example, people clicking on a section of particular interest in the ToC). UndercoverClassicist ^T·C 16:24, 19 April 2026 (UTC)

  Fair, explained a bit more now. —Femke 🐦 (talk) 16:58, 19 April 2026 (UTC)

• Masculizing: I think the word is masculinizing, despite the corresponding feminizing -- see e.g. here.

  Fixed. —Femke 🐦 (talk) 06:56, 19 April 2026 (UTC)

• This causes delays in diagnosis: not convinced about Teen Vogue as a source here. We've cited five sources (a lot!), but some of them are more anecdotes than robust data -- I'd trim.

  I've trimmed; hadn't noticed the recent addition. —Femke 🐦 (talk) 15:37, 19 April 2026 (UTC)

• the stereotype that black women have a higher pain threshold may reduce quality of care: is this a worldwide stereotype? Are they believed to have a higher pain threshold than black men?

  The source does not say. It cites two sources, one of which is US-specific, the other does not say. That source cites 7 sources, many of which are US-specific. I've added US here with this US-specific source, as wider reading lets me believe we have different stereotypes in Europe (BIPOC/Mediterranean women would exaggerate pain). —Femke 🐦 (talk) 16:32, 19 April 2026 (UTC)

• "changuería" or "changas": I think we need to explain what these words literally mean (and, of course, stick them in lang templates).

  The source does not say and the meaning is very region-specific according to chatGPT. I don't trust chatGPT for this, but it might mean 'minor pain' or 'skin irritation'. —Femke 🐦 (talk) 15:37, 19 April 2026 (UTC)

  Can we find a Spanish dictionary that'll say enough to tell that these words refer to trivial pain or annoyance, even if we can't pin it down to an exact translation? UndercoverClassicist ^T·C 16:26, 19 April 2026 (UTC)

  I found one dictionary describing it, but I don't know how reliable it is: https://tureng.com/en/spanish-english/changa%20%28puerto%20rico%29. The meanings that might be related the research are "silly", "person with childlike manners", "young or adolescent person", "annoying". I think it's best to use the translations from the paper. Can't find changaria in a dictionary. —Femke 🐦 (talk) 16:50, 19 April 2026 (UTC)

• Healthcare providers sometimes dismiss described symptoms as normal menstruation, or psychologize the issue: as a rule of thumb, if we're linking to Wiktionary, we probably ought to find a way to make the word clearer in context. "Dismiss the issue as a product of poor mental health"?

  Explained. —Femke 🐦 (talk) 15:37, 19 April 2026 (UTC)

• Menstrual disorders generally do not get covered extensively in medical education: some will baulk at "get" -- suggest "are generally not extensively covered..."

  Done. —Femke 🐦 (talk) 09:36, 19 April 2026 (UTC)

• Annual productivity losses ranged from $293 per person in Nigeria to $33,428 in Italy (in 2022 currency values): are these PPP adjusted? Aren't we basically measuring annual income here, and saying that if a person with a higher salary takes a year off work, it costs more than a person with a lower salary doing the same thing?

  It's a combination of salary and how good your healthcare is. If you only lose 20% of workdays in Italy, but 50% in Nigeria, that should affect these numbers. —Femke 🐦 (talk) 16:13, 19 April 2026 (UTC)

  If they're not PPP adjusted (in other words, if they don't normalise so that the average salary is more or less the same, for accounting purposes), we should probably include relevant data in a footnote: Nigeria's GNI per capita is about 1/30th of Italy's, but not every reader will know that. UndercoverClassicist ^T·C 16:25, 19 April 2026 (UTC)

  The paper does not allude to this. I believe putting those numbers there is mild synth (as we're explaining the results from a paper in a way they do not even allude to). I imagine people will typically know that Nigeria is much poorer than Italy. —Femke 🐦 (talk) 16:56, 19 April 2026 (UTC)

• For example, in the US, the NIH spends 5 to 10 times less on endometriosis research than on other conditions, relative to the number of healthy life years lost to each disease: "other conditions" is a bit vague. I'm sure they also spend more on endometriosis than on other conditions, unless it's literally the least-funded thing in the medical establishment. Can we tighten it up: "than on any other condition with the same number of healthy life years lost"? Not to mention that this is a 2021 source, and NIH funding has recently been rather radically overhauled, so I suspect it's out of date (not that I would expect the 2026 figures to be less depressing).

  Changed to average condition, and specified the time period. —Femke 🐦 (talk) 16:13, 19 April 2026 (UTC)

• A priority area of research is the search for endometriosis biomarkers, which can help with earlier diagnoses: diagnosis. Can we explain "biomarkers" rather than relying on the link?

  I've tried to explain by giving an example, as the explanation is quite difficult. Typo fixed. —Femke 🐦 (talk) 06:56, 19 April 2026 (UTC)

• I wonder whether the "Research directions" section would be better divided between "Diagnosis" and "Management"? At the moment we have quite a lot of smallish sections, and the order isn't entirely intuitive -- information seems to come in a fairly random order. Of course, this may be following the layout guidelines elsewhere.

  Could this be a display error? There are two paragraphs when I read it, one of biomarkers for diagnosis and the other on management. —Femke 🐦 (talk) 06:56, 19 April 2026 (UTC)

  Yes, that's exactly my point -- we have two paragraphs, which is a short section, and each of these paragraphs is closely related to another of the sections further up. I'm suggesting removing the "Research directions" section and dividing the spoils between the two existing sections. UndercoverClassicist ^T·C 07:16, 19 April 2026 (UTC)

  The reason we put research in a separate heading is that it can be a magnet for primary sources to be added to the main sections. Plus, these are all still experimental, so I wouldn't not want to put undue emphasis on them higher up in the article. —Femke 🐦 (talk) 15:37, 19 April 2026 (UTC)

• The "Cited sources" list isn't a list of the cited sources: I would suggest another title.

  I've changed it to 'Books, papers and monographs', but must admit I'm not entirely sure this very long paper I've put there is a monograph. The philosophy is to put long sources (>30 pages) there. —Femke 🐦 (talk) 11:09, 19 April 2026 (UTC)

• Which bit of the article is a Swedish government utterance?

  I've left only one in I believe: the sentence in diagnosis /ultrasound that details the advantages. —Femke 🐦 (talk) 06:56, 19 April 2026 (UTC)

• My usual Further Reading carp: if these have anything useful, why aren't they cited? If not, why ask readers to read them after the article?

  Two of the sources are patient stories. I think it's important to have that perspective, but it would be inappropriate to use that language on Wikipedia. The final one is a great overview of current research in a non-MEDRS source. —Femke 🐦 (talk) 06:56, 19 April 2026 (UTC)

That's all for a pass through the text -- I look forward to seeing it at FAC. UndercoverClassicist ^T·C 15:56, 18 April 2026 (UTC)

This has been a fantastic review, thanks for taking the time to go so deeply into the article! —Femke 🐦 (talk) 16:59, 19 April 2026 (UTC)

Case reports in men

Two recent edits have now changed text regarding endometriosis in cis men, perhaps by the same person. Pinging User:~2026-19458-48 and User:SunflowerTru. The last edit changed 'men' into intersex, which is not supported by the cited source (https://www.sciencedirect.com/science/article/pii/S0344033823005484). Is there something I'm missing? The way I understand it is that the handful of cases of endo in men are accepted in the scientific literature, even if the explanation isn't quite. —Femke 🐦 (talk) 07:54, 31 March 2026 (UTC)

Sorry, I (not the same person as ST) took the passage to mean there were whole organs left from lack of Müllerian inhibiting rather than some tissue. The latter looks like PMDS doesn’t qualify. I usually cannot access the deeper citations but the 2006 Urology [(sci-hub.ru/storage/moscow/1710/6e811cb8f10bfde5ee5f13afc31e9d39/giannarini2006.pdf) paper] agrees, tho has confusing passages that allude to PMDS:

”The patient we report did not show any malformations of the genitourinary tract and had a normal karyotype; therefore, alternative mechanisms for the development of the cyst were considered.”

”in keeping with the same phenomenon described in the female peritoneum, it has also been suggested that müllerian lesions in males may arise because of metaplasia of the mesothelial lining of the tunica vaginalis, in part accounting for the development of paratesticular masses with müllerian mor-phology.”

”All previously reported cases have been described in elderly patients who underwent estrogen therapy for prostate carcinoma; it is therefore reasonable to postulate that the therapy induced endometrial differentiation from a persistent müllerian remnant.”

I’ll remove the intersex claim if someone hasn’t already. ~2026-19458-48 (talk) 09:15, 31 March 2026 (UTC)

Thanks :). I've further changed the wording back for that specific sentence, as it sounded a bit odd to say fetal woman, given that woman usually means adult female. —Femke 🐦 (talk) 19:09, 31 March 2026 (UTC)

Did you know nomination

The following is an archived discussion of the DYK nomination of the article below. Please do not modify this page. Subsequent comments should be made on the appropriate discussion page (such as this nomination's talk page, the article's talk page or Wikipedia talk:Did you know), unless there is consensus to re-open the discussion at this page. You can locate your hook here. No further edits should be made to this page.

The result was: promoted by Zzz plant (talk) 03:26, 4 April 2026 (UTC)

(

• Comment or view
• Article history

)

• ... that some women with endometriosis bleed from their lungs during their period?

• Source: https://www.eshre.eu/guideline/endometriosis (full guideline, page 149, "Thoracic endometriosis syndrome includes five well-recognised clinical entities .. catamenial haemoptysis")

• • Reviewed: Template:Did you know nominations/CDG-2

Improved to Good Article status by Femke (talk). Number of QPQs required: 1. Nominator has 16 past nominations.

—Femke 🐦 (talk) 17:48, 31 March 2026 (UTC).

• – GA met in time. QPQ done. Hook is indeed interesting and well-sourced (not verbatim), but medical terms prove the hook's meaning for a layman's words. It is GTG; my only question is if you wish, Femke, to specify the type of this endometriosis (thoracic, pelvic, etc.) or leave it at this? Good work. CoryGlee 02:57, 3 April 2026 (UTC)

  Given that thoracic is a complicated word, I prefer to keep it as is. Thanks! —Femke 🐦 (talk) 06:05, 3 April 2026 (UTC)

No references?

There isn't a single reference for the introduction. The first reference only appears in the first section (subtype). There needs to be some added. ~2026-39333-52 (talk) 23:00, 10 July 2026 (UTC)

Hello @~2026-39333-52: the convention on Wikipedia is to m for the introduction to summarise the rest of the article. That means that you don't have to repeat references on the lead. In solidarity, —Femke (talk) 🐦 06:51, 11 July 2026 (UTC)

CITEVAR

@Chris Capoccia: the citevar for this article is that dates for academic journals and books only contain the year (so that it's easier to distinguish them from non-academic sources). Could you revert those changes? Thanks! In solidarity, —Femke (talk) 🐦 14:16, 11 July 2026 (UTC)

sure, but where am i supposed to have noticed this information? i mean it seems like a really convoluted rule to me. the way i tell academic sources from non-academic is completely different and not based on date format.   — Chris Capoccia 💬 14:20, 11 July 2026 (UTC)

It's the style I'm used to in my academic work. Not blaming you for not guessing this style, but it's not uncommon. In solidarity, —Femke (talk) 🐦 14:34, 11 July 2026 (UTC)

how does this style handle non-academic citations that only have a year? like vanity press books? or are those just so rare that it doesn't matter?   — Chris Capoccia 💬 14:40, 11 July 2026 (UTC)

Those wouldn't be a high-quality reliable source, but for other sources without more info, year only would be a fallback. In solidarity, —Femke (talk) 🐦 14:57, 11 July 2026 (UTC)