Endometriosis

Endometriosis is a chronic inflammatory condition defined by endometrial stroma and glands found outside of the uterine cavity. The most common sites affected are the pelvic peritoneum and ovaries.

May present incidentally in asymptomatic women, or more commonly in women of reproductive age who complain of chronic pelvic pain and/or sub-fertility.

Clinical suspicion is generally sufficient to initiate therapy, but the diagnosis can only be confirmed by direct visualisation and focused biopsies during laparoscopy.

Treatment options include non-steroidal anti-inflammatories (NSAIDs), combined oral contraceptive pills, progestin-containing compounds, gonadotrophin-releasing hormone (GnRH) agonists and antagonists, danazol (or related androgens), and surgical destruction or excision of lesions. Controlled ovarian hyper-stimulation and IVF may be considered for women with sub-fertility.

Individualised care for women with pelvic pain should incorporate a multi-disciplinary evaluation and treatment plan that focuses on limiting the risk of recurrence and improving quality of life.

Endometriosis is defined as the presence of endometrial glands and stroma outside the endometrial cavity and uterine musculature. Surgical appearance varies significantly from superficial blebs to infiltrating fibrosis. While direct visualisation confirmed by histological examination remains the gold standard for diagnosis, surgical confirmation of endometriosis is not required before starting therapy.