Endometriosis: Current Management

Lu PY, Peter Y. Lu, P Y Lu, S J Ory, Steven J. Ory
Mayo Clinic proceedings · 1995 · vol. 70(5) , pp. 453–463 · doi:10.4065/70.5.453 · PMID:7731255 · W1977583704
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This review details current therapeutic strategies for endometriosis, focusing on hormonal, surgical, and pain management approaches.

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Abstract

ObjectiveTo review the clinical features, theories of pathogenesis, and current treatment of endometriosis-associated pain and infertility.DesignWe review the manifestation of endometriosis and the possible mechanisms that lead to its symptoms, examine the efficacy of current therapeutic options for pelvic pain and infertility, and provide specific recommendations for treatment based on the current literature.Material and methodsEndometriosis is the presence of hormonally responsive endometrial tissue occurring outside the uterine cavity. This condition may be asymptomatic but is often found in association with pelvic pain or infertility (or both). The precise pathogenesis has not been clearly established but likely involves retrograde menstruation with subsequent seeding of endometrial glands at extrauterine sites. The definitive diagnosis and staging of endometriosis are performed by laparoscopy. Various strategies have been used to treat endometriosis including expectant, medical, surgical, and combination management.ResultsThe efficacy of treatment varies for pelvic pain and infertility. Endometriosis-associated pain may respond to both medical and surgical management. The use of medical therapy for endometriosis-associated infertility is not supported by current studies. Surgical management of infertility may be efficacious when pelvic anatomy is distorted because of endometriosis. The use of superovulation strategies and in vitro fertilization has been shown to be effective in overcoming endometriosis-associated infertility.ConclusionPelvic pain and infertility in the presence of endometriosis necessitate individualization of therapy to achieve treatment goals. Neither medical nor surgical management is efficacious in all circumstances. As a better understanding of the pathogenesis of endometriosis evolves, treatment of this perplexing condition will probably continue to improve.

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Condition tags

endometriosischronic_pelvic_pain

MeSH descriptors

Endometriosis Adult CA-125 Antigen CA-125 Antigen Endometriosis Endometriosis Endometriosis Female Fertilization in Vitro Hormones Hormones Humans Hysterectomy Infertility, Female Infertility, Female Infertility, Female Laparoscopy Pelvic Pain Pelvic Pain Pelvic Pain

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