**7. Conclusions**

One of the main objectives of the gynaecologist is to diagnose endometriosis without the use of laparoscopy or laparotomy. Currently, laparoscopy offers the most specific and sensitive technique for evaluating and monitoring endometriosis. Even so, microscopic or occult endometriosis may be misdiagnosed because of the inability to visualize some lesions. Attempts for early diagnosis and treatments of endometriosis have been weighed down by lack of proper methods to study and manage the disease. Furthermore, the need for noninvasive diagnostic methods is evident because the laparoscopy is a surgical procedure with potentially dangerous risks.

At present, there are no reliable markers for the diagnosis and prognosis of endometriosis and identification of serum and endometrial markers is decisive for disease diagnosis and follow-up of patients.

The diagnostic laboratories are using new genomic and proteomic technologies to develop novel diagnostic and therapeutic approaches for endometriosis. These technologies will facilitate the generation of molecular expression profiles and then identifying potential gene and protein targets. This will lead to available markers with high sensitivity and specificity for screening of endometriosis, then to the development of serum diagnostic tools, therapeutic strategies and prognosis markers.

The combination of immunological discoveries and recent advances in DNA technologies may provide the long sought screening tool with the desirable diagnostic accuracy for this puzzling disorder.

The identification of specific genetic alterations and protein profiles associated with endometriosis offers a unique opportunity to develop assays for early diagnosis and/or treatment. By identifying proteins in biological samples, a minimally invasive tool should be feasible to assess the presence of disease and monitor response to treatment and/or disease progression.

The promise for gene-based diagnostic tests for endometriosis and rational development of genetically targeted and molecular therapeutic strategies is, in principle, excellent. The evolving genomic and proteomic technologies remain poised to revolutionize the diagnosis and treatment of endometriosis, but have not yet lead to a single new therapy or tested biomarker. Many problems remain to be resolved and, while some of these are technical in nature, the most intractable ones have mainly to do with the complex and multifactorial character of the disease itself.
