Chronic inflammatory condition defined by endometrial stroma and glands found outside of the uterine cavity. The most common sites affected are the pelvic peritoneum and ovaries.
May present incidentally in asymptomatic patients, or more commonly in women of reproductive age who complain of chronic pelvic pain and/or sub-fertility.
Clinical suspicion is generally sufficient to initiate therapy, but the diagnosis can only be confirmed by direct visualisation and focused biopsies during laparoscopy.
Treatment options include non-steroidal anti-inflammatories (NSAIDs), combined oral contraceptive pills, Gonadotrophin-releasing hormone (GnRH) agonists and antagonists, progestin-containing compounds, danazol (or related androgens), and surgical destruction of lesions. Controlled ovarian hyper-stimulation and IVF may be considered for patients with sub-fertility.
Individualised care for patients with pelvic pain should incorporate a multi-disciplinary evaluation and treatment plan that focuses on limiting the risk of recurrence and improving quality of life.
Endometriosis is defined as the presence of endometrial glands and stroma outside the endometrial cavity and uterine musculature. Surgical appearance varies significantly from superficial blebs to infiltrating fibrosis. Direct visualisation confirmed by histological examination remains essential for diagnosis.
History and exam
Associate Professor of Obstetrics & Gynaecology
Head of Gynaecology & Minimally Invasive Surgery
Faculty of Medicine at the University of Toronto
Mt. Sinai Hospital
MJS is an author of a number of references cited in this monograph. He acts as a consultant for AbbVie (manufacturers of depot leuprolide) and Medtronic.
Advanced Gynaecologic Surgery Department
Department of Obstetrics & Gynecology
Mt. Sinai Hospital
University of Toronto
AS declares that he has no competing interests.
Dr M. Jonathon Solnik and Dr Ari Sanders would like to gratefully acknowledge Dr Sharon M. Jakus, a previous contributor to this topic. SMJ declares that she has no competing interests.
Department of Obstetrics, Gynecology, and Reproductive Sciences
Division of Reproductive Endocrinology and Infertility
University of Pittsburgh
JSS declares that he has no competing interests.
Professor of Obstetrics and Gynaecology
Leicester Royal Infirmary
JCK is an author of a reference cited in this monograph.
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