In endometriosis, tissue similar to the lining of the uterus grows outside it, most often on the ovaries and pelvic lining, causing inflammation and scarring. It is a common cause of chronic pelvic pain and infertility, and the diagnosis is often delayed for years.
Key symptoms
- Painful periods that worsen over time
- Chronic pelvic pain
- Pain with sex, especially deep
- Painful bowel movements or urination during periods
- Difficulty getting pregnant
What you find on exam
- Tenderness of the posterior fornix or uterosacral ligaments
- Fixed, tilted-back uterus
- Tender adnexal mass (endometrioma)
- Exam may be normal
Tests
- Pregnancy test and STI testing to rule out other causes
- Transvaginal ultrasound: endometrioma or deep nodules
- MRI for deep disease in selected cases
- Laparoscopy with biopsy for a definite diagnosis
Treatment basics
- NSAIDs such as naproxen for pain
- Continuous combined hormonal contraceptives or a progestin such as norethindrone
- Levonorgestrel IUD
- GnRH antagonist such as elagolix, or a GnRH agonist with add-back therapy
- Laparoscopic excision, and fertility referral if trying to conceive
Red flags
- Sudden severe pelvic pain with vomiting (ovarian torsion or cyst rupture)
- Fever with pelvic pain
- Positive pregnancy test with pain (ectopic pregnancy)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.