A Synopsis of "Evaluation and Treatment of Endometriosis" from American Family Physician

A review of "Evaluation and Treatment of Endometriosis"

SARINA SCHRAGER, MD, MS; JULIANNE FALLERONI, DO, MPH, and JENNIFER EDGOOSE, MD, MPH, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin

Am Fam Physician. 2013 Jan 15;87(2):107-113.

     Endometriosis is the presence of endometrial cells outside of the uterus. They are most often found in the peritoneum, around the ovary, or in the cul-de-sac between the rectum and vagina. There are several theories about how the tissue got there (retrograde menstruation, embryological development, or through lymphatic/ vascular channels) but no one knows for sure. It has a wide range of symptoms from dysmenorrhea to abdominal, pelvis, or low back pain, to no symptoms at all. The physical and pelvic exam varies widely as well. The diagnosis is made clinically and there are no labs that can help you. CA125 has been researched a lot but has shown limited value at this point. Transvaginal ultrasound can be helpful in diagnosis and is the imaging modality of choice. Laparoscopy can help, but it is very invasive something only to be considered down the line.
    Whats great about this disease is that the first line treatment is NSAIDs.  This medication is helpful for a lot of the diseases on the differential, so at least the patient will get relief while your confirm a diagnosis. Oral contraception, vaginal ring, and depot medications have also been effective, but if your patient is trying to conceive, then you may want to consider a referral to a gynecologist for a surgical evaluation.