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. 2025 Jul;170(1):101-107.
doi: 10.1002/ijgo.16187. Epub 2025 Feb 11.

Demystifying cervical endometriosis: A case series and systematic review

Shailja Verma  1 , Ines Reis  1 , Neelam Potdar  2
Affiliations

Demystifying cervical endometriosis: A case series and systematic review

Shailja Verma et al. Int J Gynaecol Obstet. 2025 Jul.

Abstract

Background: Cervical endometriosis (CE) is an uncommon diagnosis with a paucity of evidence on its management.

Objective: To examine 10 years of data to identify CE cases and to conduct a systematic review to evaluate evidence for managing CE.

Search strategy: Cases of CE were obtained retrospectively via a pathology coding system. Literature search was performed using Ovid MEDLINE, EMBASE, and Cochrane Library (1949-2022).

Selection criteria: Studies on diagnoses and management of CE were included, and those with retrospective diagnosis of CE on histology and no further management were excluded.

Data collection and analysis: An Excel spreadsheet was used for data collection. Two independent authors went through individual cases, extracting and analyzing data.

Main results: In case series, women presented with intermenstrual bleeding (IMB)/post-coital bleeding (PCB) n-25, (30%), followed by abnormal uterine bleeding (AUB) n-24, (29%), dysmenorrhea n-12, 12%, and/or dyspareunia (12%). In all, 44% had an initial cervical biopsy confirming CE diagnosis and 48% had CE on hysterectomy specimen. Main reasons for hysterectomy were AUB (36%) and fibroids/adenomyosis (28%). In the systematic review, 1737 studies were identified from databases, 181 were assessed for eligibility, and 14 studies discussed individual case reports and case series specifically on treating CE. Nine full-text and abstract studies were available to identify potential treatment options for CE. Treatments were based predominantly on presentation at time of diagnosis.

Conclusion: Findings from case series suggest that CE was the main diagnosis in women who had a hysterectomy for AUB or had a cervical biopsy for PCB/IMB. Investigations should be considered to rule out CE to have the potential for conservative alternative treatment rather than major surgery. There is no clear guidance on managing CE and good-quality studies are required to provide conclusive treatment options.

Keywords: cervical biopsy; cervical endometriosis; endometriosis; intermenstrual bleeding; laparoscopy and hysterectomy; post‐coital bleeding.

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References

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