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  • image Endometriosis is a chronic condition in reproductive age women that can cause chronic pelvic pain and infertility.

  • image Endometriosis is characterized by endometrial tissue outside the uterus, but the exact pathophysiology and biological mechanisms are multifactorial and still remain unclear.

  • image Endometriosis should be suspected in any woman of reproductive age presenting with recurring pelvic pain or otherwise unexplained infertility. Failure of first-line treatment options like nonsteroidal anti-inflammatory drugs (NSAIDs) or combined hormonal contraceptives (CHCs) to relieve dysmenorrhea is highly suspect of endometriosis.

  • image Definitive diagnosis of endometriosis requires direct surgical visualization; however, it is acceptable to empirically treat these symptoms without a definitive diagnosis.

  • image Treatment strategies are based on patient symptoms and preferences with regards to desire for pregnancy.

  • image Pharmacologic and surgical options are indicated to treat endometriosis-associated pain. Surgery/reproductive technology is the only treatment option for endometriosis-related infertility.

  • image Treatment options are not curative of endometriosis and only provide symptom management.

  • image First-line pharmacologic options include NSAIDs, CHCs, and progestins. Other options include gonadotropin-releasing hormone (GnRH) agonists, GnRH antagonists, danazol, and aromatase inhibitors.

  • image Add-back therapy can be utilized with certain agents to minimize hypoestrogenic adverse events such as bone mineral density (BMD) loss and vasomotor symptoms.


Preclass Engaged Learning Activity

Review the American College of Obstetricians and Gynecologists (ACOG) bulletin, European Society of Human Reproduction and Embryology (ESHRE) Guidelines and National Institute for Health and Care Excellence (NICE) guidelines to determine similarities and differences.


image Endometriosis is a common gynecologic condition that affects women during their reproductive years, defined as the growth of endometrial tissue outside the uterus. Clinically, endometriosis can cause several symptoms with the most common being dysmenorrhea, dyspareunia, and infertility. It is usually diagnosed in women in their thirties and forties; however, it is also common in adolescent age. Chronic pelvic pain is the most common complaint, especially in adolescents. Patients are often asymptomatic; therefore, it is difficult to confirm the true incidence of endometriosis.

While the pathophysiology of endometriosis isn’t completely understood, it is believed that retrograde menstrual flow causes several endometriosis symptoms. This backflow of fluid often leads to endometrial deposits in various areas of the genitourinary tract including the bladder, ureter, and ovaries in addition to the gastrointestinal tract. Other theories include hematogenous or lymphatic transport, stem cells from bone marrow, and coelomic metaplasia (ACOG). Interventions are focused on the desire of the patient to become pregnant, relieve symptoms, or both. Pregnancies are often beneficial for improving symptoms.


The incidence of endometriosis in the general population is approximately 10%.1,2 It is a common cause of infertility and chronic pelvic pain and has an incidence of approximately 38% in women with infertility (with some estimates of around 50%); and more than 60% of patients with chronic pelvic pain have a diagnosis of endometriosis (with some ...

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