Endometriosis: current management.
OBJECTIVE
To review the clinical features, theories of pathogenesis, and current treatment of endometriosis-associated pain and infertility.


METHODS
We review the manifestation of endometriosis and the possible mechanisms that lead to its symptoms, examine the efficacy of current therapeutic options for pelvic pain and infertility, and provide specific recommendations for treatment based on the current literature.


METHODS
Endometriosis is the presence of hormonally responsive endometrial tissue occurring outside the uterine cavity. This condition may be asymptomatic but is often found in association with pelvic pain or infertility (or both). The precise pathogenesis has not been clearly established but likely involves retrograde menstruation with subsequent seeding of endometrial glands at extrauterine sites. The definitive diagnosis and staging of endometriosis are performed by laparoscopy. Various strategies have been used to treat endometriosis including expectant, medical, surgical, and combination management.


RESULTS
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 infertility is not supported by current studies. Surgical management of infertility may be efficacious when pelvic anatomy is distorted because of endometriosis. The use of superovulation strategies and in vitro fertilization has been shown to be effective in overcoming endometriosis-associated infertility.


CONCLUSIONS
Pelvic pain and infertility in the presence of endometriosis necessitate individualization of therapy 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 condition will probably continue to improve.
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Section of Reproductive Endocrinology and Infertility, Mayo Clinic Rochester, Minnesota 55905, USA.
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D000328:Adult; D018394:CA-125 Antigen / Q000302:isolation & purification; D004715:Endometriosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005307:Fertilization in Vitro; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D007044:Hysterectomy; D007247:Infertility, Female / Q000503:physiopathology / Q000628:therapy; D010535:Laparoscopy; D017699:Pelvic Pain / Q000503:physiopathology / Q000628:therapy; D013480:Superovulation; D013514:Surgical Procedures, Operative / Q000379:methods; D000267:Tissue Adhesions / Q000601:surgery
D018394:CA-125 Antigen; D006728:Hormones