Longitudinal ultrasound-based follow up of non-surgically treated endometriosis using #Enzian classification

OBJECTIVES: This study aimed to compare clinical and ultrasound outcomes over 24 months in premenopausal women with ultrasound-diagnosed endometriosis/adenomyosis, never treated surgically, and managed with or without hormonal therapy. We specifically assessed ultrasonographically disease progression progression, symptom control, and lesion dynamics using the compartment-based #Enzian classification. MATERIALS AND METHODS: This single-center retrospective study included patients with endometriosis/adenomyosis who underwent transvaginal ultrasound (TVUS) and clinical assessment at baseline, 12, and 24 months. All lesions were classified according to #Enzian compartments. Patients were divided into Group A, receiving continuous hormonal therapy, and Group B managed without hormonal treatment. RESULTS: A total of 125 patients were included (Group A: n = 95; Group B: n = 30). In Group A, endometrioma prevalence declined from 87.4 % at baseline to 66.3 % at 24 months (p = 0.001), with O2 lesions decreasing from 45.3 % to 6.3 % and O1 lesions increasing from 42.1 % to 60.0 %, reflecting lesion shrinkage. Group B showed no significant changes in the O compartment (p = 0.7). FA (adenomyosis) lesions remained stable in Group A (p = 0.3) but increased from 53.0 % to 73.0 % in Group B over 24 months (p = 0.01). Compartments A, B, and C of deep endometriosis showed no significant changes in either group. Symptom prevalence decreased significantly in Group A compared with Group B. CONCLUSIONS: #Enzian-based ultrasound provides a standardized approach for non-invasive longitudinal monitoring of endometriosis/adenomyosis. Hormonal therapy mainly improved symptoms, with significant lesion changes limited to O compartment, supporting its use ad a conservative management strategy while reserving surgery for selected cases.