When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Endometriosis

View PDF
  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 24 Nov 2025
Last updated: 16 Oct 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presencia de factores de riesgo
  • dismenorrea
  • dolor pélvico crónico o cíclico
  • dispareunia
  • subfertilidad
  • nodularidad del ligamento uterosacro
  • masa pélvica
  • útero fijo y retrovertido
  • depresión
  • ansiedad
  • no puede asistir al trabajo o a la escuela debido a la dismenorrea
Full details

Other diagnostic factors

  • disuria, dolor en la fosa lumbar, hematuria
  • disquecia, hematoquecia
Full details

Risk factors

  • grupo en edad reproductiva
  • raza blanca
  • antecedentes familiares positivos
  • nuliparidad
  • índice de masa corporal (IMC) bajo
  • anomalías mullerianas
  • enfermedad autoinmune
  • primer encuentro sexual tardío
  • tabaquismo
  • cesárea previa
Full details

Diagnostic tests

1st tests to order

  • ultrasonido transvaginal
Full details

Tests to consider

  • ultrasonido endoscópico rectal
  • ultrasonografía 3D
  • histerosalpingografía
  • resonancia magnética (IRM) de pelvis
  • laparoscopia diagnóstica
Full details

Treatment algorithm

ONGOING

fertilidad inmediata no deseada: dolor en ausencia de endometrioma o de sospecha de enfermedad grave/profunda

fertilidad inmediata no deseada: dolor en presencia de endometrioma o sospecha de enfermedad grave/profunda

deseo de fertilidad inmediata

Contributors

Authors

M. Jonathon Solnik, MD, FACOG FACS
M. Jonathon Solnik

Professor of Obstetrics, Gynaecology and Medical Imaging by Cross-Appointment

Temerty School of Medicine at the University of Toronto

Head of Gynaecology & Minimally Invasive Surgery

Sinai Health System & Women's College Hospital

Toronto

Canada

Disclosures

MJS is an author of a number of references cited in this topic. He acts as a consultant for AbbVie (manufacturer of depot leuprolide and elagolix), Medtronic, Felix Health and Olympus.

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 acts as a speaker for Abbvie, Hologic, and Bayer. He is an author of one of the articles cited in this topic.

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 declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020 Mar 26;382(13):1244-56. Abstract

Falcone T, Flyckt R. Clinical management of endometriosis. Obstet Gynecol. 2018 Mar;131(3):557-71. Abstract

Hughes E, Brown J, Collins JJ, et al. Ovulation suppression for endometriosis for women with subfertility. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD000155.Full text  Abstract

Sutton CJ, Pooley AS, Ewen SP, et al. Follow-up report on a randomized controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal to moderate endometriosis. 1997 Dec;68(6):1070-4. Abstract

Abbott JA, Hawe J, Clayton RD, et al. The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2-5 year follow-up. Hum Reprod. 2003 Sep;18(9):1922-7.Full text  Abstract

Marcoux S, Maheux R, Bérubé S. Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. N Engl J Med. 1997 Jul 24;337(4):217-22.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Endometriosis images

  • Differentials

    • Adenomiosis
    • Cistitis intersticial
    • Enfermedad inflamatoria pélvica (EIP)
    More Differentials

  • Guidelines

    • Endometriosis: diagnosis and management
    • ACR appropriateness criteria: endometriosis
    More Guidelines

  • Patient information

    Menstruación dolorosa

    Endometriosis: ¿Qué tratamientos funcionan?

    More Patient information
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer