Management of endometriosis‐related pelvic pain
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This review discusses diagnostic delays, hormonal treatments, surgical options, and referral guidelines for managing endometriosis-related pelvic pain.
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Abstract
Key content The variable signs and symptoms of endometriosis contribute to significant diagnostic delay. Empirical hormonal treatment of endometriosis‐related pain with cycle suppression may be considered without a definitive diagnosis of endometriosis. When considering laparoscopy to diagnose and treat endometriosis, a balance must be found between the need to avoid the very long diagnostic delays currently experienced and the likelihood of treatment benefits, set against the cost and risk of laparoscopy. Treatment for endometriosis‐related pain symptoms includes a range of medical and surgical options with varying levels of evidence. Minimally invasive surgery should be performed by a surgeon trained to undertake surgical treatment for mild to moderate disease, thereby avoiding the need for repeat laparoscopy in the absence of severe disease, i.e. a ‘see and treat’ policy. Women with deep infiltrating endometriosis should be referred to an accredited endometriosis centre, such as the British Society for Gynaecological Endoscopy (BSGE) in the UK. Learning objectives To understand the diagnostic difficulties surrounding endometriosis diagnosis and management. To identify the supporting evidence for treating endometriosis‐related pain. Ethical issues When should laparoscopy for women with minimal endometriosis symptoms be performed? Should radical surgery always be performed in women in whom deep infiltrating endometriosis is found?
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Cited by (7)
- [Psychoemotional state and sexual function in women with chronic pelvic pain in genital endometriosis] 2024
- The value of pre-operative outpatient flexible sigmoidoscopy in patients with deep infiltrating endometriosis 2023
- Chronic pelvic pain in endometriosis: from therapeutic Abstraction to clinical definition: A review 2023
- The interplay between endometriosis and fertility in rats: a systematic review 2022
- Evaluation of the Diagnostic Accuracy of the Interview and Physical Examination in the Diagnosis of Endometriosis as the Cause of Chronic Pelvic Pain 2021
- Facets of the problem of infiltrative endometriosis: from pathogenesis to effective therapy 2021
- Medical management of deeply infiltrating endometriosis - 7 year experience in a tertiary endometriosis centre in London 2019
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