Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- dysmenorrhoea
- chronic or cyclic pelvic pain
- dyspareunia
- sub-fertility
- uterosacral ligament nodularity
- pelvic mass
- fixed, retroverted uterus
- depression
- absenteeism
Other diagnostic factors
- dysuria, flank pain, haematuria
- dyschezia, haematochezia
Risk factors
- reproductive age group
- white ethnicity
- positive family history
- nulliparity
- low body mass index (BMI)
- mullerian anomalies
- autoimmune disease
- late first sexual encounter
- smoking
- previous caesarean section
Diagnostic investigations
1st investigations to order
- transvaginal ultrasound
Investigations to consider
- rectal endoscopic ultrasound
- 3D ultrasonography
- hysterosalpingography
- MRI pelvis
- diagnostic laparoscopy
Treatment algorithm
immediate fertility not desired: pain without endometrioma or suspected severe/deep disease
immediate fertility not desired: pain with endometrioma or suspected severe/deep disease
immediate fertility desired
Contributors
Authors
M. Jonathon Solnik, MD, FACOG FACS

Associate Professor of Obstetrics & Gynaecology
Head of Gynaecology & Minimally Invasive Surgery
Faculty of Medicine at the University of Toronto
Mt. Sinai Hospital
Toronto
Canada
Disclosures
MJS is an author of a number of references cited in this topic. He acts as a consultant for AbbVie (manufacturers of depot leuprolide), Medtronic, Hologic, and Olympus, and holds stocks in Felix and Field Trip Inc.
Ari Sanders, MD, FRSCS
Clinical Assistant Professor of Obstetrics and Gynecology
Division of Minimally Invasive Gynecologic Surgery
Department of Obstetrics and Gynecology
Peter Lougheed Centre
University of Calgary
Calgary
Canada
Disclosures
AS declares that he has no competing interests.
Acknowledgements
Dr M. Jonathon Solnik and Dr Ari Sanders would like to gratefully acknowledge Dr Sharon M. Jakus, a previous contributor to this topic.
Disclosures
SMJ declares that she has no competing interests.
Peer reviewers
Joseph S. Sanfilippo, MD, MBA
Professor
Department of Obstetrics, Gynecology, and Reproductive Sciences
Vice Chairman
Reproductive Sciences
Director
Division of Reproductive Endocrinology and Infertility
University of Pittsburgh
Pittsburgh
PA
Disclosures
JSS declares that he has no competing interests.
Justin C. Konje, MBBS, FMCOG, MRCOG, FWACS, MD, MBA
Professor of Obstetrics and Gynaecology
Leicester Royal Infirmary
Leicester
UK
Disclosures
JCK is an author of a reference cited in this topic.
Differentials
- Adenomyosis
- Interstitial cystitis
- Pelvic inflammatory disease (PID)
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