Monitoring
No specific monitoring guidelines have been proposed, and follow-up should be individualized and based on the primary complaint. Women with functional pain (i.e., no identifiable source) should be managed with a team approach and require response-led follow up. Multidisciplinary teams may include a combination of an endometriosis specialist, pelvic floor physical therapy, chronic pain services, and psychological support for mindfulness-based approaches to pain management.[55]
An exception would be women with an ovarian mass. If suspicious for an endometrioma and the woman is asymptomatic, imaging can be repeated at 3 to 6 month intervals. If the woman becomes symptomatic or the parameters of the cyst become more suspicious for a malignancy, then surgery is indicated. The risk of malignancy index, along with appropriate tumor marker studies, can help stratify risk and referral practices.[134] There is evidence that women with endometriosis may have up to a twofold increased relative risk of epithelial ovarian cancers (clear cell and endometrioid type epithelial ovarian carcinoma).[133] However, this amounts to a very small proportion of women with endometriosis and no standardized screening regimen exists.
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