ENDOMETRIOSIS - CURRENT MANAGEMENT

Objective: To review the clinical features, theories of pathogenesis, and current treatment of endometriosis-associated pain and infertility . Design: We review the manifestation of endometriosis and the possibl e mechanisms that lead to its symptoms, examine the efficacy of curren t therapeutic options for pelvic pain and infertility, and provide spe cific recommendations for treatment based on the current literature. M aterial and Methods: Endometriosis is the presence of hormonally respo nsive endometrial tissue occurring outside the uterine cavity, This co ndition may be asymptomatic but is often found in association with pel vic pain or infertility (or both), The precise pathogenesis has not be en clearly established but likely involves retrograde menstruation wit h subsequent seeding of endometrial glands at extrauterine sites, The definitive diagnosis and staging of endometriosis are performed by lap aroscopy, Various strategies have been used to treat endometriosis inc luding expectant, medical, surgical, and combination management. Resul ts: The efficacy of treatment varies for pelvic pain and infertility, Endometriosis-associated pain may respond to both medical and surgical management, The use of medical therapy for endometriosis-associated i nfertility is not supported by current studies, Surgical management of infertility may be efficacious when pelvic anatomy is distorted becau se of endometriosis, The use of superovulation strategies and in vitro fertilization has been shown to be effective in overcoming endometrio sis-associated infertility. Conclusion: Pelvic pain and infertility in the presence of endometriosis necessitate individualization of therap y to achieve treatment goals, Neither medical nor surgical management is efficacious in all circumstances, As a better understanding of the pathogenesis of endometriosis evolves, treatment of this perplexing co ndition will probably continue to improve.