Treatment

Expectant management is sufficient for most patients.

Mild to moderate pelvic pain without complications

• Empiric treatment with NSAIDs and continuous hormonal contraceptives

• NSAIDs alone if pregnancy is desired

• Synthetic androgens (e.g., danazol)

Severe symptoms: GnRH agonists (e.g., buserelin, goserelin) and estrogen-progestin OCPs

First-line: laparoscopic excision and ablation of endometrial implants

• To confirm the diagnosis and exclude malignancy (see “Diagnostics” above)

• To treat patients who do not respond to pharmacological therapy

• To treat expanding endometriomas and complications, including:

  • Infertility (Laparoscopy significantly improves natural conception rates.) [8]

  • Bowel and/or bladder obstruction

  • Rupture of endometrioma

Second-line: open surgery with hysterectomy with or without bilateral salpingo-oophorectomy

• Treatment-resistant symptoms

• No desire to bear additional children

Anemia

Endometriosis in the uterotubal junction inhibits implantation of the zygote: ↑ risk of ectopic pregnancy

Endometriosis → fibrous adhesions → strictures and entrapment of organs

• Intestines: constipation or diarrhea; in rare cases, intestinal obstruction, ileus, or intussusception may occur [10]

• Ureter: urine retention

Endometriosis is associated with a slightly elevated risk of ovarian cancer.