Primary gonadotropin-releasing hormone agonist therapy for suspected endometriosis: A nonsurgical approach to the diagnosis and treatment of chronic pelvic pain (Reprinted from the American Journal of Managed Care, vol 3, pg285-290, 1997)

Chronic pelvic pain is a condition that affects 1 in 7 women of reproductiv e age in the United States. Direct and indirect medical costs associated wi th this condition are estimated to be more than $3 billion annually before factoring in the costs of diagnostic testing. At many medical centers, endo metriosis is the most common single cause of chronic pelvic pain; other cau ses include intraabdominal adhesions, chronic pelvic inflammatory disease, ovarian cysts, and adenomyosis. The current approach to diagnosis and treat ment of chronic pelvic pain is a 2-step approach, with medical history, phy sical examination, laboratory testing, and empiric therapy (nonsteroidal an ti-inflammatory drugs, oral contraceptives, and/or antibiotics) comprising Step 1 and surgical diagnosis with laparoscopy as Step 2. At many centers, the most common diagnosis at the time of laparoscopy for chronic pelvic pai n is endometriosis, typically minimal to mild disease that can be effective ly treated with hormonal therapy. Therefore, a rational alternative approac h is a 3-month empiric course of therapy with a gonadotropin-releasing horm one agonist before laparoscopy. The advantages of this approach are the hig h rate of pain relief in women, the possibility of avoiding an invasive pro cedure (laparoscopy), the ability to extend therapy, if pain is relieved, t o the full 6-month therapeutic course for endometriosis, and a potentially lower cost relative to laparoscopy.