Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- dismenorreia
- dor pélvica crônica ou cíclica
- dispareunia
- subfertilidade
- nodularidade do ligamento uterossacro
- massa pélvica
- útero fixo retrovertido
- depressão
- ansiedade
- incapacidade de ir ao trabalho ou à escola devida a dismenorreia
Other diagnostic factors
- disúria, dor no flanco, hematúria
- disquezia, hematoquezia
Risk factors
- faixa etária reprodutiva
- etnia branca
- história familiar positiva
- nuliparidade
- índice de massa corporal (IMC) baixo
- anomalias müllerianas
- doença autoimune
- primeiro contato sexual tardio
- tabagismo
- parto cesáreo prévio
Diagnostic investigations
1st investigations to order
- ultrassonografia transvaginal
Investigations to consider
- ultrassonografia endoscópica retal
- ultrassonografia 3D
- histerossalpingografia
- ressonância nuclear magnética (RNM) da pelve
- laparoscopia diagnóstica
Treatment algorithm
fertilidade imediata não desejada: dor sem endometrioma ou suspeita de doença grave/profunda
fertilidade imediata não desejada: dor com endometrioma ou suspeita de doença grave/profunda
fertilidade imediata desejada
Contributors
Authors
M. Jonathon Solnik, MD, FACOG FACS

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
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.
Differentials
- Adenomiose
- Cistite intersticial
- Doença inflamatória pélvica (DIP)
More DifferentialsGuidelines
- Endometriosis: diagnosis and management
- ACR appropriateness criteria: endometriosis
More GuidelinesPatient information
Ablação endometrial (método por micro-ondas)
Ablação endometrial (diatermia)
More Patient informationLog in or subscribe to access all of BMJ Best Practice
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