Two articles in CMAJ look at endometriosis from sharply different angles. One shows how devastating delayed recognition can be, following a patient whose deep infiltrating endometriosis led to renal atrophy, bowel obstruction, sciatic nerve impingement and a permanent ostomy. The other offers a more reassuring picture, finding only a small increased risk of congenital anomalies among infants born to patients with endometriosis. Together, they show why endometriosis deserves earlier recognition, better imaging and more serious clinical attention.

Dr. Sony Singh, chair of the Department of Obstetrics and Gynecology at the University of Ottawa and head of the Department of Obstetrics, Gynecology and Newborn Care at The Ottawa Hospital, discusses the CMAJ practice article, “Renal atrophy, bowel obstruction, and sciatic nerve impingement secondary to endometriosis”. He explains how deep infiltrating endometriosis can invade adjacent organs and cause severe fibrosis when left untreated.

Bailey Milne, a PhD candidate in epidemiology at Queen’s University, discusses the CMAJ article, Risk of congenital anomalies for infants born to patients with endometriosis: a population-based cohort study. She emphasizes that although the study found a small increased risk of congenital anomalies, the overall risk remains low.

For physicians, the episode highlights the importance of considering endometriosis in patients with cyclical pelvic, abdominal, bowel, urinary or sexual pain, even when initial imaging is normal.

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