Endometriosis--an update.

BACKGROUND: Endometriosis is one of the major causes of pelvic pain and subfertility in women. OBJECTIVE: This article discusses the diagnosis and treatment of endometriosis. DISCUSSION: Empiric treatment in women presenting with pain symptoms suggestive of endometriosis is the usual first option. Ultrasound does not diagnose peritoneal disease but will recognise endometriomas. Laparoscopy remains the gold standard for diagnosis and surgical removal at that time should be first line treatment. Medical treatment is proven effective for superficial disease. It is most frequently used where surgical skills do not allow removal of the endometriosis or where incomplete removal is suspected in severe disease. Long term treatment after surgical removal with diet, exercise and hormones provides long term pain control and may reduce the risk of recurrence. Medical treatment has no place in infertility treatment, however surgical removal of milder disease enhances pregnancy rates. Early referral for assisted reproduction treatment is suggested with severe disease.