Treatment Guideline Chart

Endometriosis is an estrogen-dependent growth of extrauterine endometrial-like tissue that induces a chronic inflammatory response.

Main clinical features include chronic pelvic pain, dyspareunia and infertility.

Patients with endometriosis may also be completely asymptomatic.

Goals of treatment are decreasing pain, enhancing fertility, and preventing progression or recurrence. 


Endometriosis References

  1. Nasir L, Bope ET. Management of pelvic pain from dysmenorrhea or endometriosis. J Am Board Fam Pract. 2004;17(Suppl):S43-S47. http://www.ncbi.nlm.nih.gov/pubmed/?term=15575029. PMID: 15575029
  2. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril. 1997 May;67(5):817-821. http://www.ncbi.nlm.nih.gov/pubmed. PMID: 9130884
  3. Attaran M, Falcone T, Goldberg J. Endometriosis: still tough to diagnose and treat. Cleve Clin J Med. 2002 Aug;69(8):647-653. http://www.ncbi.nlm.nih.gov/pubmed. PMID: 12184473
  4. Birmingham A. Treatment of pelvic pain associated with endometriosis. Fertil Steril. 2008;90:561-574. doi: 10.1016/j.fertnstert.2008.08.057. PMID: 19007642
  5. Beatty MN, Blumenthal PD. The levonorgestrel-releasing intrauterine system: safety, efficacy, and patient acceptability. Ther Clin Risk Manag. 2009 Jun;5(3):561-574. PMID: 19707273
  6. Bulun SE. Endometriosis. N Engl J Med. 2009;360(3):268-279. doi: 10.1056/NEJMra0804690. PMID: 19144942
  7. Drake J. Diagnosis and management of the adnexal mass. Am Fam Physician. 1998 May;57(10):2471-2476. PMID: 9614415
  8. Cheng YM, Wang ST, Chou CY. Serum CA-125 in preoperative patients at high risk for endometriosis. Obstet Gynecol. 2002 Mar;99(3):375-380. PMID: 11864662
  9. Farquhar CM. Extracts from the "clinical evidence". Endometriosis. BMJ. 2000 May;320(7247):1449-1452. PMID: 10827052
  10. Huang HY. Medical treatment of endometriosis. Chang Gung Med J. 2008;31(5):431-440. PMID: 19097589
  11. Fauconnier A, Chapron C. Endometriosis and pelvic pain: epidemiological evidence of the relationship and implications. Hum Reprod Update. 2005;11(6):595-606. PMID: 16172113
  12. Kocakoc E, Bhatt S, Droga VS. Endometriosis. Ultrasound Clin. 2008;3:399-414
  13. Giudice LC. Clinical Practice. Endometriosis. N Engl J Med. 2010 Jun;362(25):2389-2398. http://www.nejm.org/doi/pdf/10.1056/NEJMcp1000274. Accessed 06 Feb 2013. PMID: 20573927
  14. Lapp T. ACOG issues recommendations for the management of endometriosis. Am Fam Physician. 2000 Sep;62(6):1431-1434. http://www.ncbi.nlm.nih.gov/pubmed. PMID: 11011865
  15. Ling FW. Randomized controlled trial of depot leuprolide in patients with chronic pelvic pain and clinically suspected endometriosis. Pelvic Pain Study Group. Obstet Gynecol. 1999 Jan;93(1):51-58. PMID: 9916956
  16. Kuriyama S, Murakami T, Ozawa Y, et al. Management of the pain associated with endometriosis: an update of the painful problems. Tohoku J Exp Med. 2006 Nov;210(3):175-188. PMID: 17077594
  17. Mounsey AL, Wilgus A, Slawson DC. Diagnosis and management of endometriosis. Am Fam Physician. 2006 Aug;74(4):594-600. PMID: 16939179
  18. Mol BW, Bayram N, Lijmer JG, et al. The performance of CA-125 measurement in the detection of endometriosis: a meta-analysis. Fertil Steril. 1998 Dec;70(6):1101-1108. PMID: 9848302
  19. Olive DL, Pritts EA. Treatment of endometriosis. N Engl J Med. 2001 Jul;345(4):266-275. PMID: 11474666
  20. Society of Obstetricians and Gynaecologists of Canada. Endometriosis: diagnosis and management. Journal of Obstetrics and Gynaecology Canada. 2010;32(7):S1-S32. http://www.sogc.org. Accessed 19 Jul 2011. PMID: 21545757
  21. Practice Committee of the American Society for Reproductive Medicine. Endometriosis & infertility; a committee opinion. Fertil Steril. 2012 Sep;98(3):591-598. PMID: 22704630
  22. Prentice A. Regular review: endometriosis. BMJ. 2001 Jul;323(7304):93-95. http://www.ncbi.nlm.nih.gov/pubmed. PMID: 11451786
  23. Surrey ES, Hornstein MD. Prolonged GnRH agonist and add-back therapy for symptomatic endometriosis: long-term follow-up. Part 1. Obstet Gynecol. 2002 May;99(5)(Pt 1):709-719. PMID: 11978277
  24. Vercellini P, Trespidi L, Colombo A, et al. A gonadotropin-releasing hormone agonist versus a low-dose oral contraceptive for pelvic pain associated with endometriosis. Fertil Steril. 1993 Jul;60(1):75-79. PMID: 8513962
  25. Taskin O, Yalcinoglu A, Kucuk S, et al. Effectiveness of tibolone on hypoestrogenic symptoms induced by goserelin treatment in patients with endometriosis. Fertil Steril. 1997 Jan;67(1):40-45. PMID: 8986681
  26. Wellbery C. Diagnosis and treatment of endometriosis. Am Fam Physician. 1999 Oct;60(6):1753-1768. PMID: 10537390
  27. ACOG Committee on Practice Bulletins - Gynecology. Practice bulletin no. 114: management of endometriosis. Obstet Gynecol. 2010 Jul;116(1):223-236. doi: 10.1097/AOG.0b013e3181e8b073. PMID: 20567196
  28. Mishell D, Stenchever M, Droegemueller W, Herbst A. Endometriosis and adenomyosis. In: Stenchever M. Comprehensive Gynecology. 4th ed. St. Louis: Mosby; 2001.
  29. Lobo RA. Endometriosis: etiology, pathology, diagnosis, management. In: Katz VL, Lentz GM, Lobo RA, Gerhenson DM. Comprehensive Gynecology. 5th ed. Philadelphia: Mosby, Elsevier; 2007
  30. Ferri FF. Endometriosis. In: Alvero R, Borkan JM, Dobbs MR, et al, eds. Ferri’s clinical advisor. 1st. Philadelphia: Mosby Inc, an affiliate of Elsevier; 2010.
  31. Prentice A, Deary AJ, Goldbeck-Wood S. Gonadotropin-releasing hormone analogues for pain associated with endometriosis (Cochrane Review). The Cochrane Library, Issue 2. Chichester, UK: John Wiley and Sons, Ltd; 2004.
  32. Moore J, Kennedy S, Prentice A. Modern combined oral contraceptives for pain associated with endometriosis (Cochrane Review). The Cochrane Library, Issue 2. Chichester, UK: John Wiley and Sons, Ltd; 2004.
  33. Selak V, Farquhar C, Prentice A. Danazol for pelvic pain associated with endometriosis (Cochrane review). The Cochrane Library, Issue 2. Chichester, UK: John Wiley and Sons, Ltd; 2004.
  34. MedWormhttp://www.medworm.com/rss/index.php/OBGYN/29/http://www.medworm.com/rss/medicalfeeds/specialities/OBGYN.xml
  35. American Society for Reproductive Medicine. Endometriosis. A guide for patients. http://www.asrm.org. 2012. Accessed 25 Apr 2013.
  36. College National des Gynecologues et Obstetriciens Francais. CNGOF guidelines for the management of endometriosis. http://www.cngof.asso.fr. Nov 2006. Accessed 21 May 2010.
  37. ESHRE Endometriosis Guideline Development Group. Management of women with endometriosis. Guideline of the European Society of Human Reproduction and Embryology [Draft version]. http://www.eshre.eu. Apr 2013. Accessed 25 Apr 2013.
  38. European Society of Human Reproduction and Embryology. The ESHRE guideline for the diagnosis and treatment of endometriosis. http://guidelines.endometriosis.org. Jun 2007.
  39. National Institute for Health and Care Excellence. Fertility. Assessment and treatment for people with fertility problems. NICE. http://www.nice.org.uk. Feb 2013. Accessed 25 Apr 2013.
  40. Royal College of Obstetricians and Gynaecologists. The investigation and management of endometriosis. Green-top Guideline No. 24. http://www.pelvicpain.org.uk. 2006. Accessed 21 May 2010.
  41. Dunselman GA, Vermeulen N, Becker C, et al. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014 Mar;29(3):400-412. doi: 10.1093/humrep/det457. Accessed 28 Apr 2014. PMID: 24435778
  42. Gerlinger C, Faustmann T, Hassall JJ, Seitz C. Treatment of endometriosis in different ethnic populations: a meta-analysis of two clinical trials. BMC Womens Health. 2012 Apr 19;12:9. doi: 10.1186/1472-6874-12-9. PMID: 22515510
  43. Haas D, Shebl O, Shamiyeh A, Oppelt P. The rASRM score and the Enzian classification for endometriosis: their strengths and weaknesses. Acta Obstet Gynecol Scand. 2013 Jan;92(1):3-7. doi: 10.1111/aogs.12026. PMID: 23061819
  44. Subramaniam R, Sinthamoney E, Damodaran P, et al. Clinical guidelines for the management of endometriosis 2016. Obstetrical and Gynaecological Society of Malaysia (OGSM). http://www.ogsm.org.my. 2016. Accessed 24 Jan 2017.
  45. Hirsch M, Begum MR, Paniz É, et al. Diagnosis and management of endometriosis: a systematic review of international and national guidelines. BJOG. 2018 Apr;125(5):556-564. doi: 10.1111/1471-0528.14838. PMID: 28755422
  46. Orilissa highlights of prescribing information. U.S. Food & Drug Administration. https://www.accessdata.fda.gov. 2018.
  47. Taylor HS. Use of elagolix in gynaecology. J Obstet Gynaecol Can. 2018 Jul;40(7):931-934. doi: 10.1016/j.jogc.2018.01.004. PMID: 29921430
  48. ClinicalKey. Clinical overview: endometriosis. ClinicalKey. https://www.clinicalkey.com. 24 May 2021.
  49. Kuhlmann Z. Endometriosis. In: Kellerman RD, Rakel D, eds. Conn's Current Therapy 2021. Philadelphia: Elsevier; 2021. https://www.clinicalkey.com. Accessed 25 May 2021:1181-1183.
  50. McGuirk B. Endometriosis. Ferri's Clinical Advisor 2021. Philadelphia: Elsevier; 2021. https://www.clinicalkey.com. Accessed 25 May 2021:519-521e1.
  51. Ministry of Health New Zealand. Diagnosis and management of endometriosis in New Zealand. Ministry of Health New Zealand. http://www.health.govt.nz/. 02 Mar 2020. Accessed 26 May 2021.
  52. Schenken RS. Endometriosis: pathogenesis, clinical features, and diagnosis. UpToDate. https://www.uptodate.com. 27 Apr 2021.
  53. Taylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet. 2021 Feb;397(10276):839-852. doi: 10.1016/S0140-6736(21)00389-5. PMID: 33640070
Editor's Recommendations
Special Reports