Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Dysmenorrhea• Constant aching lower abdominal pain, beginning 2-7 days before the onset of menses, and increasing in severity until menstrual flow subsides• Clinical diagnosis is presumptive and must be confirmed in severe cases with laparoscopy or laparotomy +++ Epidemiology + • Prevalence in United States is 2% among fertile women and 3- to 4-fold greater in infertile women +++ Symptoms and Signs + • Lower abdominal pain• Infertility• Dyspareunia• Rectal pain with or without hematochezia when ectopic endometrial implants involve the rectum• Tender indurated nodules in the cul-de-sac (can appreciate best during menses) +++ Laboratory Findings + • β-hCG negative• UA normal• WBC count within normal range +++ Imaging Findings + • US: Findings will often reveal complex fluid-filled masses that cannot be distinguished from neoplasms• MRI: More sensitive and specific in diagnosing adnexal masses•Barium enema: May delineate colonic involvement + • Pelvic inflammatory disease• Uterine myomas• Ovarian neoplasms• Polycystic ovarian disease• Appendicitis• Acute enteritis• Ruptured corpus luteum cyst +++ Rule Out + • Ectopic pregnancy• Threatened abortion• Acute appendicitis + • Thorough history and physical exam• Complete pelvic exam• β-hCG• Transvaginal US +++ When to Admit + • Significant abdominal pain and the diagnosis is uncertain + • Goal is to ameliorate symptoms and preserve fertility• Mainstay of therapy is medical inhibition of ovulation• Laparoscopy/laparotomy to resect the lesions, free adhesions (with or without suspension of the uterus for patients younger than 35 to preserve reproductive function is controversial)• Foci of endometriosis can be treated laparoscopically by bipolar coagulation or laser vaporization• Hysterectomy with bilateral salpingo-oopherectomy for patients older than 35 with debilitating pain +++ Surgery +++ Indications + • Definitive diagnosis via laparoscopy• Failure of medical management +++ Medications + • Gonadotropin-releasing hormone (GnRH) analogs• Danazol• Oral contraceptive pills• Medroxyprogesterone acetate• NSAIDs during menses +++ Complications + • Recurrent symptoms• Infertility +++ Prognosis + • Prognosis for reproductive function in mild or moderately advanced endometriosis is good with conservative management• Bilateral oopherectomy is curative in severely affected patients +++ References ++Hughes E et al: Ovulation suppression for endometriosis. Cochrane Database Syst Rev 2000;CD000155. ++Lebovic DI et al: Immunobiology of endometriosis. Fertil Steril 2001;75:1. [PubMed: 11163805] ++Moore J et al: Modern combined oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev 2000;CD001019. Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free a profile for additional features.