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  • Image not available.Endometriosis should be suspected in any woman of reproductive age, including adolescents, with recurring cyclic or acyclic pelvic pain and/or subfertility.
  • Image not available. The etiology of endometriosis is likely multifactorial; no single theory is satisfactory to explain all cases.
  • Image not available. No physical examination findings or laboratory tests are considered diagnostic for endometriosis. A definitive diagnosis can be made only via surgical visualization of lesions. Confirmation of diagnosis is not necessary in all cases.
  • Image not available. Treatment goals include improvement of painful symptoms and maintenance or improvement of fertility. Therapy is considered successful based on resolution of the patient's symptoms or achievement of pregnancy.
  • Image not available. All medical therapies are equally efficacious in treating endometriosis-related pain based on available evidence. The choice among agents is determined primarily by side effect profile, cost, and individual patient response.
  • Image not available. Endometriosis-related pain can be treated by medical or surgical therapy. Empirical medical therapy is likely more cost-effective and is recommended based on consensus guidelines.
  • Image not available. Endometriosis-related infertility is unresponsive to medical therapy. Conservative surgical therapy is the preferred treatment.

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Upon completion of the chapter, the reader will be able to:

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  • 1. Identify potential etiologies of endometriosis.
  • 2. Discuss the likely pathophysiologic mechanisms underlying endometriosis.
  • 3. Select common presenting signs and symptoms of endometriosis.
  • 4. Identify the goals of endometriosis therapy.
  • 5. Determine if empiric medical or surgical therapy should be recommended for endometriosis based on patient-specific data.
  • 6. Identify common side effects and/or risks associated with the various medical and surgical therapies for endometriosis.
  • 7. Choose an appropriate type of surgical therapy (conservative vs nonconservative) for endometriosis based on patient-specific data.
  • 8. Identify the mechanism of action of each drug therapy used to treat endometriosis.
  • 9. Recommend appropriate medical therapy for endometriosis based on clinical practice guidelines and known patient and agent characteristics.
  • 10. Recommend, when appropriate, therapy to manage the common side effects of gonadotropin-releasing hormone agonists.
  • 11. Create a monitoring plan for a patient receiving a given medical therapy for endometriosis.
  • 12. For each drug used in the treatment of endometriosis, list topics to be covered when educating patients about their drug therapy.

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Endometriosis is a common cause of chronic pelvic pain in women and is associated with infertility. Characterized by the presence of endometrial tissue outside the uterus, endometriosis is a chronic, recurring disease.

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Image not available.Endometriosis should be suspected in women, including adolescents, with subfertility, dysmenorrhea, dyspareunia, or chronic pelvic pain. Therapy is targeted at relieving symptoms and improving fertility.

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The prevalence of endometriosis in the general population is estimated to be 5% to 10% of women.1,2 Up to 70% of adult women and up to 50% of adolescents presenting with chronic pelvic pain may have endometriosis, and ∼20% to 50% of women with infertility may have the disorder.1,35 A genetic predisposition for endometriosis has been noted, as evidenced by disease rates that are up to seven times higher in primary relatives ...

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