Endometriosis

Endometriosis is a 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 women, or more commonly in women of reproductive age who complain of chronic pelvic pain and/or subfertility.

Clinical suspicion is generally sufficient to initiate therapy, but the diagnosis can only be confirmed by direct visualization and focused biopsies during laparoscopy.

Treatment options include nonsteroidal anti-inflammatories (NSAIDs), combined oral contraceptive pills, progestin-containing compounds, gonadotropin-releasing hormone (GnRH) agonists and antagonists, danazol (or related androgens), and surgical destruction or excision of lesions. Controlled ovarian hyperstimulation and IVF may be considered for women with subfertility.

Individualized care for women with pelvic pain should incorporate a multidisciplinary 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. While direct visualization confirmed by histologic examination remains the gold standard for diagnosis, surgical confirmation of endometriosis is not required before starting therapy.