Current guidelines for treatment of endometriosis. The present status in Japan.

Laparoscopy currently remains the only effective tool for the diagnosis and evaluation of endometriosis, and in Japan is particularly recommended in patients with concurrent infertility. Diagnosis based on clinical examination alone is associated with a false-negative rate of 19% and a false-positive rate of 44%. Furthermore, unidentified and untreated endometriosis progresses 0.3 revised American Fertility Society (Re-AFS) stage points per month. Given this gradual progression, medical therapy, including long-term treatment, should be initiated in women with definitive evidence of endometriosis who need to maintain their reproductive potential. Gonadotropin- releasing hormone (GnRH) agonists are recommended for the treatment of endometriosis-associated pelvic pain in younger women who wish to become pregnant at a later date, and in women in whom reproductive status is not a concern. Laparoscopy should be used in patients with endometriosis and infertility, while GnRH agonists should be used in patients with pelvic pain.