Patient with dysmenorrhea, pelvic pain, and dyspareunia.
Endometriosis is caused by menstrual tissue in the pelvic peritoneal cavity. Infertility, dysmenorrhea, and dyspareunia with postcoital bleeding are common.
Get Transvaginal Ultrasonography.
Laparoscopy (with histology) is the gold standard for diagnosis. However, transvaginal U/S is the noninvasive test of choice.
CA-125 will often be elevated but is nonspecific.
CT and MRI have low specificity.
Treatment Options
The goal of treatment is to relieve pelvic pain, NOT to improve infertility.
-NSAIDs
-Combined OCs
-Progestins
-GnRH agonists (Leuprolide, Goserelin, Nafarelin). Limit use to 6-12 months because of side effects (hot flashes and decrease bone density).
-Aromatase inhibitor (AI) – Letrozole or Anastrozole.
Patient handout from the AAFP.
What is endometriosis?
The word “endometriosis” = endometrium + the suffix -osis (which means condition). “The endometrium is the mucous membrane that lines the inside of the uterus (womb). The endometrium changes throughout the menstrual cycle. It becomes thick and rich with blood vessels to prepare for pregnancy. If the woman does not get pregnant, part of the endometrium is shed, causing menstrual bleeding.”
Endometrial tissue is usually only inside your uterus. Endometriosis is a condition in which endometrial tissue from the lining of the uterus moves through the fallopian tubes and gets on your ovaries, in your pelvis, on your bladder or in other areas. You have endometrial tissue spread out and deposited in all these areas where it’s not supposed to be. When you have your period, this tissue swells and bleeds, just like the lining of your uterus. This is often painful, and scar tissue can form in your pelvic area.
References
- Am Fam Physician. 2013 Jan 15;87(2):107-113. http://www.aafp.org/afp/2013/0115/p107.html
- Am Fam Physician. 2006 Aug 15;74(4):594-600. http://www.aafp.org/afp/2006/0815/p594.html
http://www.aafp.org/afp/1999/1015/p1767.html