Endometriosis: An update on diagnosis and medical management

Endometriosis is a common condition of reproductive-aged women that negatively impacts their quality of life. The gold standard for diagnosing endometriosis is direct visualization at laparoscopy; however, current guidelines support the initiation of empiric treatment prior to laparoscopy in patients with suspected endometriosis. Clinically diagnosing endometriosis can be challenging because the signs and symptoms are nonspecific. A thorough history and a comprehensive assessment of a patient's pain experience is recommended. A stepwise pelvic exam may reveal anatomic features of endometriotic implants, and imaging, predominantly transvaginal ultrasound, can be a useful adjunct. First-line medical management of endometriosis-related pain includes combined hormonal contraceptives or progestin-only hormone treatment. If there is no improvement in symptoms after a 3-month trial, a referral to a gynecologist is appropriate in order to consider gonadotropin-releasing hormone (GnRH) agonist, GnRH antagonist, or laparoscopic treatments. In patients with more complex disease, a referral to the Centre for Pelvic Pain and Endometriosis at BC Women's Hospital and Health Centre should be made.