A 40-Year-Old G1P1 Woman with Endometriosis Desiring Definitive Management

A 40-year-old gravida 1, para 1001 presents with worsening pelvic pain. Her symptoms have been present for over 15 years and are progressing. Most recently, she has daily symptoms described as sharp, stabbing, intermittent pelvic pain. Her menstrual cycle exacerbates the pain. In addition to dysmenorrhea, she reports deep dyspareunia and a history of infertility. She denies any bowel or bladder dysfunction. Menarche was early at age 10. Menses occur every 25 days, with an 8- to 10-day duration with heavy bleeding and dysmenorrhea. Past treatments include combined oral contraceptive pills, gonadotropin-releasing hormone (GnRH) agonist following laparoscopy-proven endometriosis, and she is currently in her fourth year of a levonorgestrel-containing intrauterine device (IUD). She has no significant past medical history. Her past surgical history is significant for operative laparoscopy 12 years ago with excision of endometriosis (pathology confirmed) and adhesiolysis to improve fertility. She is not taking any medications and is allergic to sulfa (rash). She is a non-smoker, drinks alcohol socially. She is happily married and works for a non-profit organization. Her daughter is 10 years old and healthy. Due to her increasing pelvic pain she now requests hysterectomy.