Management of endometriosis‐related pelvic pain

Abstract

Key content The variable signs and symptoms of endometriosis contribute to significant diagnostic delay. Empirical hormonal treatment of endometriosis‐related pain with cycle suppression may be considered without a definitive diagnosis of endometriosis. When considering laparoscopy to diagnose and treat endometriosis, a balance must be found between the need to avoid the very long diagnostic delays currently experienced and the likelihood of treatment benefits, set against the cost and risk of laparoscopy. Treatment for endometriosis‐related pain symptoms includes a range of medical and surgical options with varying levels of evidence. Minimally invasive surgery should be performed by a surgeon trained to undertake surgical treatment for mild to moderate disease, thereby avoiding the need for repeat laparoscopy in the absence of severe disease, i.e. a ‘see and treat’ policy. Women with deep infiltrating endometriosis should be referred to an accredited endometriosis centre, such as the British Society for Gynaecological Endoscopy (BSGE) in the UK. Learning objectives To understand the diagnostic difficulties surrounding endometriosis diagnosis and management. To identify the supporting evidence for treating endometriosis‐related pain. Ethical issues When should laparoscopy for women with minimal endometriosis symptoms be performed? Should radical surgery always be performed in women in whom deep infiltrating endometriosis is found?