Managing the misplaced: approach to endometriosis.
OBJECTIVE
To review the presentation of endometriosis, steps to diagnosis, and medical and surgical management options.


METHODS
MEDLINE was searched from January 1996 to November 2004, EMBASE from January 1996 to January 2005, and the Cochrane Database of Systematic Reviews for the 4th quarter of 2004.


RESULTS
Endometriosis is a common, progressive disease with an estimated prevalence of 10%. It can cause dyspareunia, dysmenorrhea, low back pain, and infertility. It can be diagnosed on clinical grounds and treated without laparoscopy provided pregnancy is not desired. First- and second-line medical treatments are nonsteroidal anti-inflammatory drugs, combined oral contraceptive pills, progestins, gonadotropin-releasing hormone agonists, and androgens. Surgical options should be considered when these medications are ineffective or if pregnancy is desired.


CONCLUSIONS
Family physicians have an important role in diagnosing and treating women with endometriosis.
Jackson
Bethany
B
University of Ottawa, Ottawa, Ontario, Canada. deanna.telner@utoronto.ca
Telner
Deanna E
DE
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003277:Contraceptives, Oral, Combined / Q000627:therapeutic use; D003613:Danazol / Q000627:therapeutic use; D004715:Endometriosis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D004965:Estrogen Antagonists / Q000627:therapeutic use; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy; D011372:Progestins / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D003277:Contraceptives, Oral, Combined; D004965:Estrogen Antagonists; D011372:Progestins; D007987:Gonadotropin-Releasing Hormone; D003613:Danazol