Upon completion of the chapter, the reader will be able to:
- 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.
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.
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.
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.1,3–5 A genetic predisposition for endometriosis has been noted, as evidenced by disease rates that are up to seven times higher in primary relatives ...