title: Consensus statement for the management of chronic pelvic pain and endometriosis: proceedings of an expert-panel consensus process.
abstract: OBJECTIVE
  To develop recommendations for the medical and surgical care of women who present with chronic pelvic pain (CPP) and are likely to have endometriosis as the underlying cause.
  
  
  METHODS
  An expert panel comprised of practicing gynecologists from throughout the United States and experts in consensus guideline development was convened. After completion of a structured literature search and creation of draft algorithms by an executive committee, the expert panel of >50 practicing gynecologists met for a 2-day consensus conference during which the clinical recommendations and algorithms were reviewed, refined, and then ratified by unanimous or near-unanimous votes.
  
  
  METHODS
  Women presenting with CPP who are likely to have endometriosis as the underlying cause.
  
  
  METHODS
  None.
  
  
  CONCLUSIONS
  Chronic pelvic pain frequently occurs secondary to nongynecologic conditions that must be considered in the evaluation of affected women. For women in whom endometriosis is the suspected cause of the pain, laparoscopic confirmation of the diagnosis is unnecessary, and a trial of medical therapy, including second-line therapies such as danazol, GnRH agonists, and progestins, is justified provided that there are no other indications for surgery such as the presence of a suspicious adnexal mass. When surgery is necessary, laparoscopic approaches seem to offer comparable clinical outcomes to those performed via laparotomy, but with reduced morbidity. The balance of evidence supports the use of adjuvant postoperative medical therapy after conservative surgery for CPP. There is some evidence that adjuvant presacral neurectomy adds benefit for midline pain, but currently, there is inadequate evidence to support the use of uterosacral nerve ablation or uterine suspension. Hysterectomy alone has undocumented value in the surgical management of women with endometriosis-associated CPP.
authors.affiliation: Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA. jgambone@mednet.ucla.edu
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Gambone
authors.forename: Brian S
authors.initials: BS
authors.lastname: Mittman
authors.forename: Malcolm G
authors.initials: MG
authors.lastname: Munro
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Scialli
authors.forename: Craig A
authors.initials: CA
authors.lastname: Winkel
mesh_terms: D000465:Algorithms; D002908:Chronic Disease; D004715:Endometriosis / Q000628:therapy*; D005104:Expert Testimony; D005260:Female; D006801:Humans; D017699:Pelvic Pain / Q000628:therapy*