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  • Image not available.Endometriosis should be suspected in any woman of reproductive age with recurring cyclic or acyclic pelvic pain and/or subfertility, especially if pain does not improve with nonsteroidal antiinflammatory drugs and hormonal contraceptives.
  • Image not available. The etiology of endometriosis is likely multifactorial and requires a genetic or immunologic predisposition. Retrograde menstruation is the most widely accepted theory to account for displacement of endometrial tissue, although alternative theories have been proposed.
  • 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. Both drug therapy and surgery may treat endometriosis-related pain, but infertility can only be treated with surgery or assisted reproductive techniques.
  • Image not available. No medical therapy has been proven to be more effective than another; thus, the choice among agents is determined primarily by side effect profile, cost, and individual patient response.
  • Image not available. For endometriosis pain, surgical therapy is typically reserved for medical therapy failure.
  • Image not available. Diagnosis of endometriosis can be made only via surgical visualization of lesions, not by physical examination or laboratory testing. Empiric treatment without confirmation of diagnosis is acceptable in most cases.
  • Image not available. To help avoid loss of bone mineral density, add-back therapy should be strongly considered in any woman receiving a gonadotropin-releasing hormone agonist.

On completion of this chapter, the reader will be able to:

  1. Identify four risk factors for development of endometriosis.

  2. Identify up to four theories that explain why endometrial tissue is found outside the uterus in women with endometriosis.

  3. Explain the mechanisms by which endometriosis causes pain.

  4. Explain the mechanisms by which endometriosis causes infertility.

  5. Identify patient-specific goals for endometriosis treatment.

  6. Identify situations in which laparoscopic surgery should be offered for diagnostic and/or therapeutic purposes in the patient with endometriosis.

  7. Identify indications for hysterectomy in patients with endometriosis.

  8. Differentiate between drug treatments of first choice and alternative drug treatments for endometriosis.

  9. Explain the mechanisms by which various drugs treat endometriosis pain.

  10. Identify common or potentially serious side effects of the drugs used to treat endometriosis.

  11. Identify two nonpharmacologic, nonsurgical methods that may help treat endometriosis pain.

  12. Explain the rationale for add-back therapy during endometriosis treatment.

  13. Select a treatment plan for a patient with endometriosis based on clinical practice guidelines and patient-specific factors.

  14. Recommend an add-back plan for patients receiving gonadotropin-releasing hormone agonists.

  15. Create a monitoring plan for a patient receiving a given medical therapy for endometriosis.

Image not available.Endometriosis causes secondary dysmenorrhea and is associated with infertility. Presence of endometrial tissue outside the uterus is chronic and relapsing. Endometriosis treatment targets pain relief and fertility improvement.

The prevalence of endometriosis is estimated at 5% to 10% of the general female population.14 Four percent of premenopausal women presenting to primary care for nongynecologic problems have endometriosis, and up to 80% of adult women and 50% of adolescents with chronic pelvic pain are diagnosed with the disorder.1,48 The incidence is 10-fold higher in ...

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