Optimal Management of Endometriosis and Pain

The pathophysiology of endometriosis-associated pain involves inflammatory and hormonal alterations and changes in brain signaling pathways. Although medical treatment can provide temporary relief, most patients can achieve long-term sustained pain relief when it is combined with surgical intervention. Owing to its complexity, there is an ongoing debate about how to optimally manage endometriosis-associated pain. We believe optimal management for this condition requires (1) possible egg preservation in affected young patients with and without endometriomas, (2) preoperative medical suppression to inhibit ovulation and to avoid removal of functional cysts that might look like endometriomas, and (3) postoperative hormonal suppression to decrease recurrence, but this treatment should be modified according to disease severity, symptoms, and fertility goals. From the Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, the Stanford University Medical Center, Stanford, and the University of California-San Francisco, School of Medicine, San Francisco, California; and the Nezhat Medical Center, Atlanta, Georgia. The authors thank Drs. Farr Nezhat (Medical Director Nezhat Surgery, Weill Cornell Medical College of Cornell University), Gary Peltz and Lisa Saunders (Department of Anesthesia, Stanford University), and Azadeh Nezhat and Mailinh Vu (Camran Nezhat Institute) for assistance in manuscript preparation. Each author has confirmed compliance with the journal’s requirements for authorship. © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. ISSN: 0029-7844/19. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

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