Endometriosis

Last reviewed: 4 Jun 2022
Last updated: 16 Jul 2021

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
More key diagnostic factors

Other diagnostic factors

  • dysuria, flank pain, haematuria
  • dyschezia, haematochezia
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • transvaginal ultrasound
More 1st investigations to order

Investigations to consider

  • rectal endoscopic ultrasound
  • 3D ultrasonography
  • hysterosalpingography
  • MRI pelvis
  • diagnostic laparoscopy
More investigations to consider

Treatment algorithm

ONGOING

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
M. Jonathon Solnik

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.

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