It is an inflammatory, estrogen-dependent condition associated with pelvic pain and infertility. Randomized controlled trials consistently found no evidence that ovulation suppression was superior to placebo in patients who wished to conceiveĮndometriosis is defined by the presence of endometrial glands and stroma in extrauterine locations. Ovulation suppression can treat endometriosis-related pain however, there is no evidence that it improves conception compared with placebo if used up to six months before attempted conception for patients who wish to conceive. 22, 25, 26Įxpert opinion, consensus guidelines, and systematic review of disease-oriented studiesįirst-line treatment of symptoms of endometriosis is combined hormonal contraceptives. Transvaginal ultrasonography should be the initial imaging study for patients with suspected endometriosis. Patients presenting with clinical symptoms of endometriosis can start empiric treatment and then plan for diagnostic laparoscopy if symptoms do not improve or if medication is not tolerated. Alternative treatments have limited benefit in alleviating pain symptoms but may warrant further investigation. Referral to gynecology for surgical management is indicated if empiric therapy is ineffective, immediate diagnosis and treatment are necessary, or patients desire pregnancy. All of these treatments are effective but may cause additional adverse effects. Aromatase inhibitors are reserved for severe disease. Second-line treatments include gonadotropin-releasing hormone (GnRH) receptor agonists with add-back therapy, GnRH receptor antagonists, and danazol. Combined hormonal contraceptives with or without nonsteroidal anti-inflammatory drugs are first-line options in managing symptoms and have a tolerable adverse effect profile. Laparoscopy with biopsy remains the definitive method for diagnosis, although several gynecologic organizations recommend empiric therapy without immediate surgical diagnosis. Although transvaginal ultrasonography is used to evaluate endometriosis of deep pelvic sites to rule out other causes of pelvic pain, magnetic resonance imaging is preferred if deep infiltrating endometriosis is suspected. Diagnosis of endometriosis in the primary care setting is clinical and often challenging, frequently resulting in delayed diagnosis and treatment. Presentation of endometriosis can vary widely, from infertility in asymptomatic people to debilitating pelvic pain, dysmenorrhea, and period-related gastrointestinal or urinary symptoms. It is one of the most common gynecologic disorders, affecting up to 10% of people of reproductive age. Endometriosis is an inflammatory condition caused by the presence of endometrial tissue in extra-uterine locations and can involve bowel, bladder, and all peritoneal structures.
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