Abstract
Aim: To review the Leuven data on endometriosis to demonstrate the shifts that occurred
over the years in diagnosis of endometriosis, classification of women with endometriosis
and thus in interpretation of results. Results: The contributions to the LUF syndrome, to non-pigmented endometriosis, to cystic
ovarian endometriosis, to deep endometriosis, to endometriosis as an immunologic disease
and to the development of an animal model of endometriosis, illustrate the persistent
interest in endometriosis over 20 years. Using these data it can be shown how progressively
the recognition of endometriosis caused important shifts from women who in the beginning
of this period were classified as normal, to women who later became classified as
having minimal or mild endometriosis. This was caused initially by the active search
for small typical lesions and later by the recognition of non-pigmented lesions as
endometriosis. The second important shift was caused by the recognition that deep
endometriosis is not only a frequent disease, but that these women are predominantly
classified as having mild to moderate endometriosis and even as women without endometriosis.
The third shift is still ongoing, since the deep lesions reported become progressively
smaller, by the “enthusiasm” of the surgeons, and by the introduction of a menstrual
clinical exam. A fourth bias in the literature concerns the diagnosis and treatment
of cystic ovarian endometriosis. Together with these shifts in recognition and treatment
of endometriosis, our understanding of the physiopathology of endometriosis has changed.
This is illustrated by the new concepts which have emerged over this period. These
are, the focal treatment of cystic ovarian endometriosis, the concept that mild endometriosis
could be a normal physiological condition and the endometriotic disease theory. Conclusion: To interpret the data of the literature we should be aware of the shifts that have
occurred in the classification of endometriosis over the past 20 years, and which
still can hamper the comparison of results between research groups.
Keywords
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