Endometriosis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

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 subfertility.
Clinical suspicion is generally sufficient to initiate therapy, but the diagnosis can only be confirmed by direct visualization and focused biopsies during laparoscopy.
Treatment options include nonsteroidal anti-inflammatories (NSAIDs), combined oral contraceptive pills, progestin-containing compounds, gonadotropin-releasing hormone (GnRH) agonists and antagonists, danazol (or related androgens), and surgical destruction or excision of lesions. Controlled ovarian hyperstimulation and IVF may be considered for women with subfertility.
Individualized care for women with pelvic pain should incorporate a multidisciplinary evaluation and treatment plan that focuses on limiting the risk of recurrence and improving quality of life.

Laparoscopic image of ovarian endometrioma

From the collection of Dr Jonathon Solnik; used with permission

Quick Reference

History & Exam
- Key Factors
- Other Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Ultrasound of ovarian endometrioma
MRI - fibrotic nodules involving the uterosacral ligaments and rectal wall
Laparoscopic image of ovarian endometrioma
Laparoscopic image of endometriotic nodule
Laparoscopic image of peritoneal window
Laparoscopic image of retroverted uterus

Citations

Key Articles

Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020 Mar 26;382(13):1244-56.[Abstract]
Falcone T, Flyckt R. Clinical management of endometriosis. Obstet Gynecol. 2018 Mar;131(3):557-71.[Abstract]
Hughes E, Brown J, Collins JJ, et al. Ovulation suppression for endometriosis for women with subfertility. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD000155.[Abstract][Full Text]
Sutton CJ, Pooley AS, Ewen SP, et al. Follow-up report on a randomized controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal to moderate endometriosis. Fertil Steril. 1997 Dec;68(6):1070-4.[Abstract]
Abbott JA, Hawe J, Clayton RD, et al. The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2-5 year follow-up. Hum Reprod. 2003 Sep;18(9):1922-7.[Abstract][Full Text]
Marcoux S, Maheux R, Bérubé S. Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. N Engl J Med. 1997 Jul 24;337(4):217-22.[Abstract][Full Text]

Other Online Resources

Society for Assisted Reproductive Technology
endometriosis.org

Referenced Articles

1. American College of Obstetricians and Gynecologists. Dysmenorrhea and endometriosis in the adolescent. ACOG committee opinion no. 760. Obstet Gynecol. 2018 Dec;132(6):e249-58 (reaffirmed 2021).[Abstract][Full Text]
2. Al Kadri H, Hassan S, Al-Fozan HM, et al. Hormone therapy for endometriosis and surgical menopause. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD005997.[Abstract]
3. Sangi-Haghpeykar H, Poindexter AN. Epidemiology of endometriosis among parous women. Obstet Gynecol. 1995 Jun;85(6):983-92.[Abstract]
4. Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020 Mar 26;382(13):1244-56.[Abstract]
5. Fuldeore MJ, Soliman AM. Prevalence and symptomatic burden of diagnosed endometriosis in the United States: national estimates from a cross-sectional survey of 59,411 women. Gynecol Obstet Invest. 2017;82(5):453-61.[Abstract]
6. Falcone T, Flyckt R. Clinical management of endometriosis. Obstet Gynecol. 2018 Mar;131(3):557-71.[Abstract]
7. Malinak LR, Buttram VC Jr, Elias S, et al. Heritage aspects of endometriosis. II. Clinical characteristics of familial endometriosis. Am J Obstet Gynecol. 1980 Jun 1;137(3):332-7.[Abstract]
8. Simpson J, Elias S, Malinak LR, et al. Heritable aspects of endometriosis. I. Genetic studies. Am J Obstet Gynecol. 1980;137:327-31.[Abstract]
9. Bischoff F, Simpson JL. Genetic basis of endometriosis. Ann N Y Acad Sci. 2004 Dec;1034:284-99.[Abstract]
10. Wheeler JM. Epidemiology of endometriosis-associated infertility J Reprod Med. 1989 Jan;34(1):41-6.[Abstract]
11. Missmer SA, Hankinson SE, Spiegelman D, et al. Reproductive history and endometriosis among premenopausal women. Obstet Gynecol. 2004 Nov;104(5 Pt 1):965-74.[Abstract]
12. Guo SW, Wang Y. Sources of heterogeneities in estimating the prevalence of endometriosis in infertile and previously fertile women. Fertil Steril. 2006 Dec;86(6):1584-95.[Abstract]
13. Laufer MR, Goitein L, Bush M, et al. Prevalence of endometriosis in adolescent girls with chronic pelvic pain not responding to conventional therapy. J Pediatr Adolesc Gynecol. 1997 Nov;10(4):199-202.[Abstract]
14. Latthe P, Mignini L, Gray R, et al. Factors predisposing women to chronic pelvic pain: systematic review. BMJ. 2006 Apr 1;332(7544):749-55.[Abstract][Full Text]
15. Peterson CM, Johnstone EB, Hammoud AO, et al. Risk factors associated with endometriosis: importance of study population for characterizing disease in the ENDO Study. Am J Obstet Gynecol. 2013 Jun;208(6):451;e1-11.[Abstract][Full Text]
16. Marsh EE, Laufer MR. Endometriosis in premenarcheal girls who do not have an associated obstructive anomaly. Fertil Steril. 2005 Mar;83(3):758-60.[Abstract]
17. European Society of Human Reproduction and Embryology Endometriosis Guideline Development Group. Guideline on the management of women with endometriosis. Feb 2022 [internet publication].[Full Text]
18. Al Kadri H, Hassan S, Al-Fozan HM, et al. Hormone therapy for endometriosis and surgical menopause. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD005997.[Abstract]
19. Bougie O, Yap MI, Sikora L, et al. Influence of race/ethnicity on prevalence and presentation of endometriosis: a systematic review and meta-analysis. BJOG. 2019 Aug;126(9):1104-15.[Abstract]
20. Sampson JA. The development of the implantation theory for the origin of peritoneal endometriosis. Am J Obstet Gynecol. 1940 Oct;40(4):549-57.
21. Halme J, Hammond MG, Hulka JF, et al. Retrograde menstruation in healthy women and in patients with endometriosis. Obstet Gynecol. 1984 Aug;64(2):151-4.[Abstract]
22. Sidell N, Han SW, Parthasarathy S, et al. Regulation and modulation of abnormal immune responses in endometriosis. Ann N Y Acad Sci. 2002 Mar;955:159-73.[Abstract]
23. Batt RE, Smith RA. Embryologic theory of histogenesis of endometriosis in peritoneal pockets. Obstet Gynecol Clin North Am. 1989 Mar;16(1):15-28.[Abstract]
24. Halme J, Becker S, Haskill S, et al. Altered maturation and function of peritoneal macrophages: possible role in pathogenesis of endometriosis. Am J Obstet Gynecol. 1987 Apr;156(4):783-9.[Abstract]
25. Arici A. Local cytokines in endometrial tissue: the role of interleukin-8 in the pathogenesis of endometriosis. Ann N Y Acad Sci. 2002 Mar;955:101-9.[Abstract]
26. Gupta S, Aqarwal A, Krajcir N, et al. Role of oxidative stress in endometriosis. Reprod Biomed Online. 2006 Jul;13(1):126-34.[Abstract]
27. Sanfilippo JS, Wakim NG, Schikler KN, et al. Endometriosis in association with uterine anomaly. Am J Obstet Gynecol. 1986 Jan;154(1):39-43.[Abstract]
28. Sinaii N, Cleary SD, Ballweg ML, et al. High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis. Hum Reprod. 2002 Oct;17(10):2715-24.[Abstract][Full Text]
29. Simpson J, Elias S, Malinak LR, et al. Heritable aspects of endometriosis. I. Genetic studies. Am J Obstet Gynecol. 1980 Jun 1;137(3):327-31.[Abstract]
30. Bischoff F, Simpson JL. Genetic basis of endometriosis. Ann N Y Acad Sci. 2004 Dec;1034:284-99.[Abstract]
31. Khan KN, Kitajima M, Fujishita A, et al. Pelvic pain in women with ovarian endometrioma is mostly associated with coexisting peritoneal lesions. Hum Reprod. 2013 Jan;28(1):109-18.[Abstract]
32. Stratton P, Khachikyan I, Sinaii N, et al. Association of chronic pelvic pain and endometriosis with signs of sensitization and myofascial pain. Obstet Gynecol. 2015 Mar;125(3):719-28.[Abstract]
33. Brawn J, Morotti M, Zondervan KT, et al. Central changes associated with chronic pelvic pain and endometriosis. Hum Reprod Update. 2014 Sep-Oct;20(5):737-47.[Abstract][Full Text]
34. Society of Obstetricians and Gynaecologists of Canada. Clinical practice guideline - endometriosis: diagnosis and management. July 2010 [internet publication].[Full Text]
35. Andolf E, Thorsell M, Källén K. Caesarean section and risk for endometriosis: a prospective cohort study of Swedish registries. BJOG. 2013 Aug;120(9):1061-5.[Abstract]
36. D'Hooghe TM, Debrock S, Hill JA, et al. Endometriosis and subfertility: is the relationship resolved? Semin Reprod Med. 2003 May;21(2):243-54.[Abstract]
37. Tanahatoe SJ, Hompes PG, Lambalk CB. Investigation of the infertile couple: should diagnostic laparoscopy be performed in the infertility work up programme in patients undergoing intrauterine insemination? Hum Reprod. 2003 Jan;18(1):8-11.[Abstract][Full Text]
38. Lorencatto C, Petta CA, Navarro MJ, et al. Depression in women with endometriosis with and without chronic pelvic pain. Acta Obstet Gynecol Scand. 2006;85(1):88-92.[Abstract]
39. van Barneveld E, Manders J, van Osch FHM, et al. Depression, anxiety, and correlating factors in endometriosis: a systematic review and meta-analysis. J Womens Health (Larchmt). 2022 Feb;31(2):219-30.[Abstract]
40. Verket NJ, Falk RS, Qvigstad E, et al. Development of a prediction model to aid primary care physicians in early identification of women at high risk of developing endometriosis: cross-sectional study. BMJ Open. 2019 Dec 4;9(12):e030346.[Abstract][Full Text]
41. National Institute for Health and Care Excellence (UK). Endometriosis: diagnosis and management. September 2017 [internet publication].[Full Text]
42. Nisenblat V, Bossuyt PM, Farquhar C, et al. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev. 2016 Feb 26;(2):CD009591. [Abstract][Full Text]
43. Guerriero S, Ajossa S, Minguez JA, et al. Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in uterosacral ligaments, rectovaginal septum, vagina and bladder: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2015 Nov;46(5):534-45. [Abstract][Full Text]
44. Gerges B, Li W, Leonardi M, et al. Meta-analysis and systematic review to determine the optimal imaging modality for the detection of bladder deep endometriosis. Eur J Obstet Gynecol Reprod Biol. 2021 Jun;261:124-33.[Abstract][Full Text]
45. Guerriero S, Martinez L, Gomez I, et al. Diagnostic accuracy of transvaginal sonography for detecting parametrial involvement in women with deep endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2021 Nov;58(5):669-76.[Abstract][Full Text]
46. Zhou Y, Su Y, Liu H, et al. Accuracy of transvaginal ultrasound for diagnosis of deep infiltrating endometriosis in the uterosacral ligaments: Systematic review and meta-analysis. J Gynecol Obstet Hum Reprod. 2021 Mar;50(3):101953.[Abstract][Full Text]
47. Gerges B, Li W, Leonardi M, et al. Optimal imaging modality for detection of rectosigmoid deep endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2021 Aug;58(2):190-200.[Abstract][Full Text]
48. Reid S, Espada M, Lu C, et al. To determine the optimal ultrasonographic screening method for rectal/rectosigmoid deep endometriosis: ultrasound "sliding sign," transvaginal ultrasound direct visualization or both? Acta Obstet Gynecol Scand. 2018 Nov;97(11):1287-92.[Abstract][Full Text]
49. Nisenblat V, Bossuyt PM, Shaikh R, et al. Blood biomarkers for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev. 2016 May 1;(5):CD012179.[Abstract][Full Text]
50. Gupta D, Hull ML, Fraser I, et al. Endometrial biomarkers for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev. 2016 Apr 20;(4):CD012165. [Abstract][Full Text]
51. Marchino GL, Gennarelli G, Enria R, et al. Diagnosis of pelvic endometriosis with use of macroscopic versus histologic findings. Fertil Steril. 2005 Jul;84(1):12-5.[Abstract]
52. Schenken RS, Guzick DS. Revised endometriosis classification: 1996. Fertil Steril. 1997 May;67(5):815-6.[Abstract]
53. Tanahatoe SJ, Hompes PG, Lambalk CB. Investigation of the infertile couple: should diagnostic laparoscopy be performed in the infertility work up programme in patients undergoing intrauterine insemination? Hum Reprod. 2003 Jan;18(1):8-11.[Abstract][Full Text]
54. Donnez J, Nisolle M, Smoes P, et al. Peritoneal endometriosis and "endometriotic" nodules of the rectovaginal septum are two different entities. Fertil Steril. 1996 Sep;66(3):362-8.[Abstract]
55. Chapron C, Vieira M, Chopin N, et al. Accuracy of rectal endoscopic ultrasonography and magnetic resonance imaging in the diagnosis of rectal involvement for patients presenting with deeply infiltrating endometriosis. Ultrasound Obstet Gynecol. 2004 Aug;24(2):175-9. [Abstract]
56. Bazot M, Darai E, Hourani R, et al. Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology. 2004 Aug;232(2):379-89. [Abstract]
57. Walter AJ, Hentz JG, Magtibay PM, et al. Endometriosis: correlation between histologic and visual findings at laparoscopy. Am J Obstet Gynecol. 2001 Jun;184(7):1407-11.[Abstract]
58. Practice Committee of the American Society for Reproductive Medicine. Treatment of pelvic pain associated with endometriosis: a committee opinion. Fertil Steril. 2014 Apr;101(4):927-35.[Abstract][Full Text]
59. Miller JD, Shaw RW, Casper RF, et al. Historical prospective cohort study of the recurrence of pain after discontinuation of treatment with danazol or a gonadotropin-releasing hormone agonist. Fertil Steril. 1998 Aug;70(2):293-6.[Abstract]
60. Jarrell JF, Vilos GA, Allaire C, et al. No. 164-Consensus guidelines for the management of chronic pelvic pain. J Obstet Gynaecol Can. 2018 Nov;40(11):e747-87.[Abstract][Full Text]
61. Bulun SE, Gurates B, Fang Z, et al. Mechanisms of excessive estrogen formation in endometriosis. J Reprod Immunol. 2002 May-Jun;55(1-2):21-33.[Abstract]
62. Marjoribanks J, Ayeleke RO, Farquhar C, et al. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev. 2015 Jul 30;(7):CD001751.[Abstract][Full Text]
63. Brown J, Crawford TJ, Allen C, et al. Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev. 2017 Jan 23;(1):CD004753. [Abstract][Full Text]
64. Brown J, Crawford TJ, Datta S, et al. Oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev. 2018 May 22;5(5):CD001019.[Abstract][Full Text]
65. Brown J, Kives S, Akhtar M. Progestagens and anti-progestagens for pain associated with endometriosis. Cochrane Database Syst Rev. 2012 Mar 14;(3):CD002122.[Abstract][Full Text]
66. Gibbons T, Georgiou EX, Cheong YC, et al. Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery. Cochrane Database Syst Rev. 2021 Dec 20;12:CD005072.[Abstract][Full Text]
67. Farquhar C, Prentice A, Singla AA, et al. Danazol for pelvic pain associated with endometriosis. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD000068.[Abstract][Full Text]
68. Brown J, Pan A, Hart RJ. Gonadotrophin-releasing hormone analogues for pain associated with endometriosis. Cochrane Database Syst Rev. 2010 Dec 8;(12):CD008475.[Abstract][Full Text]
69. Samy A, Taher A, Sileem SA, et al. Medical therapy options for endometriosis related pain, which is better? A systematic review and network meta-analysis of randomized controlled trials. J Gynecol Obstet Hum Reprod. 2021 Jan;50(1):101798.[Abstract][Full Text]
70. Miller L, Hughes JP. Continuous combination oral contraceptive pills to eliminate withdrawal bleeding: a randomized trial. Obstet Gynecol. 2003 Apr;101(4):653-61.[Abstract]
71. Seracchioli R, Mabrouk M, Manuzzi L, et al. Post-operative use of oral contraceptive pills for prevention of anatomical relapse or symptom-recurrence after conservative surgery for endometriosis. Hum Reprod. 2009 Nov;24(11):2729-35.[Abstract][Full Text]
72. Seracchioli R, Mabrouk M, Frasca C, et al. Long-term cyclic and continuous oral contraceptive therapy and endometrioma recurrence: a randomized controlled trial. Fertil Steril. 2010 Jan;93(1):52-6.[Abstract]
73. Seracchioli R, Mabrouk M, Frasca C, et al. Long-term oral contraceptive pills and postoperative pain management after laparoscopic excision of ovarian endometrioma: a randomized controlled trial. Fertil Steril. 2010 Jul;94(2):464-71.[Abstract]
74. Muzii L, Di Tucci C, Achilli C, et al. Continuous versus cyclic oral contraceptives after laparoscopic excision of ovarian endometriomas: a systematic review and metaanalysis. Am J Obstet Gynecol. 2016 Feb;214(2):203-11.[Abstract]
75. Dmitrovic R, Kunselman AR, Legro RS. Continuous compared with cyclic oral contraceptives for the treatment of primary dysmenorrhea: a randomized controlled trial. Obstet Gynecol. 2012 Jun;119(6):1143-50. [Abstract][Full Text]
76. Strowitzki T, Marr J, Gerlinger C, et al. Dienogest is as effective as leuprolide acetate in treating the painful symptoms of endometriosis: a 24-week, randomized, multicentre, open-label trial. Hum Reprod. 2010 Mar;25(3):633-41.[Abstract][Full Text]
77. Casper RF. Progestin-only pills may be a better first-line treatment for endometriosis than combined estrogen-progestin contraceptive pills. Fertil Steril. 2017 Mar;107(3):533-6.[Abstract][Full Text]
78. Bahamondes L, Petta CA, Fernandes A, et al. Use of the levonorgestrel-releasing intrauterine system in women with endometriosis, chronic pelvic pain and dysmenorrhea. Contraception. 2007 Jun;75(suppl 6):S134-9.[Abstract]
79. Petta CA, Ferriani RA, Abrao MS, et al. Randomized clinical trial of a levonorgestrel-releasing intrauterine system and a depot GnRH analogue for the treatment of chronic pelvic pain in women with endometriosis. Human Reprod. 2005 Jul;20(7):1993-8.[Abstract][Full Text]
80. Ambacher K, Secter M, Sanders AP. The use of progestin subdermal implants in the management of endometriosis-related pain symptoms and quality of life: a systematic review. Curr Med Res Opin. 2022 Mar;38(3):479-86.[Abstract]
81. Strowitzki T, Marr J, Gerlinger C, et al. Detailed analysis of a randomized, multicenter, comparative trial of dienogest versus leuprolide acetate in endometriosis. Int J Gynaecol Obstet. 2012 Jun;117(3):228-33. [Abstract]
82. Carr B, Dmowski WP, O'Brien C, et al. Elagolix, an oral GnRH antagonist, versus subcutaneous depot medroxyprogesterone acetate for the treatment of endometriosis: effects on bone mineral density. Reprod Sci. 2014 Nov;21(11):1341-51. [Abstract][Full Text]
83. Taylor HS, Giudice LC, Lessey BA, et al. Treatment of endometriosis-associated pain with elagolix, an oral GnRH antagonist. N Engl J Med. 2017 May 19;377(1):28-40.[Abstract][Full Text]
84. Giudice LC, As-Sanie S, Arjona Ferreira JC, et al. Once daily oral relugolix combination therapy versus placebo in patients with endometriosis-associated pain: two replicate phase 3, randomised, double-blind, studies (SPIRIT 1 and 2). Lancet. 2022 Jun 18;399(10343):2267-79.[Abstract][Full Text]
85. Dlugi AM, Miller JD, Knittle H. Lupron depot (leuprolide acetate for depot suspension) in the treatment of endometriosis: a randomized, placebo-controlled, double-blind study. Lupron Study Group. Fertil Steril. 1990 Sep;54(3):419-27.[Abstract]
86. 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):51-8.[Abstract]
87. Surrey ES, Hornstein MD. Prolonged GnRH agonist and add-back therapy for symptomatic endometriosis: long-term follow up. Obstet Gynecol. 2002 May;99(5 Pt 1):709-19.[Abstract]
88. Farmer JE, Prentice A, Breeze A, et al. Gonadotrophin-releasing hormone analogues for endometriosis: bone mineral density. Cochrane Database Syst Rev. 2003;(4):CD001297.[Abstract][Full Text]
89. Guzick DS, Huang LS, Broadman BA, et al. Randomized trial of leuprolide versus continuous oral contraceptives in the treatment of endometriosis-associated pelvic pain. Fertil Steril. 2011 Apr;95(5):1568-73.[Abstract]
90. Hughes E, Brown J, Collins JJ, et al. Ovulation suppression for endometriosis for women with subfertility. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD000155.[Abstract][Full Text]
91. Cottreau CM, Ness RB, Modugno F, et al. Endometriosis and its treatment with danazol or lupron in relation to ovarian cancer. Clin Cancer Res. 2003 Nov 1;9(14):5142-4.[Abstract][Full Text]
92. Grammatis AL, Georgiou EX, Becker CM. Pentoxifylline for the treatment of endometriosis-associated pain and infertility. Cochrane Database Syst Rev. 2021 Aug 25;8:CD007677.[Abstract][Full Text]
93. Koninckx PR, Ussia A, Adamyan L, et al. Deep endometriosis: definition, diagnosis, and treatment. Fertil Steril. 2012 Sep;98(3):564-71.[Abstract]
94. Chen I, Veth VB, Choudhry AJ, et al. Pre- and postsurgical medical therapy for endometriosis surgery Cochrane Database Syst Rev. 2020 Nov 18;11(11):CD003678.[Abstract][Full Text]
95. Wattanayingcharoenchai R, Rattanasiri S, Charakorn C, et al. Postoperative hormonal treatment for prevention of endometrioma recurrence after ovarian cystectomy: a systematic review and network meta-analysis. BJOG. 2021 Jan;128(1):25-35.[Abstract][Full Text]
96. Sesti F, Capozzolo T, Pietropolli A, et al. Recurrence rate of endometrioma after laparoscopic cystectomy: a comparative randomized trial between post-operative hormonal suppression treatment or dietary therapy vs. placebo. Eur J Obstet Gynecol Reprod Biol. 2009 Nov;147(1):72-7.[Abstract]
97. Sutton CJ, Pooley AS, Ewen SP, et al. Follow-up report on a randomized controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal to moderate endometriosis. Fertil Steril. 1997 Dec;68(6):1070-4.[Abstract]
98. Busacca M, Chiaffarino F, Candiani M, et al. Determinants of long-term clinically detected recurrence rates of deep, ovarian, and pelvic endometriosis. Am J Obstet Gynecol. 2006 Aug;195(2):426-32.[Abstract]
99. Koninckx PR, Meuleman C, Demeyere S, et al. Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril. 1991 Apr;55(4):759-65.[Abstract]
100. Chopin N, Vieira M, Borghese B, et al. Operative management of deeply infiltrating endometriosis: results on pelvic pain symptoms according to a surgical classification. J Minim Invasive Gynecol. 2005 Mar-Apr;12(2):106-12.[Abstract]
101. Abbott JA, Hawe J, Clayton RD, et al. The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2-5 year follow-up. Hum Reprod. 2003 Sep;18(9):1922-7.[Abstract][Full Text]
102. Fedele L, Bianchi S, Zanconato G, et al. Tailoring radicality in demolitive surgery for deeply infiltrating endometriosis. Am J Obstet Gynecol. 2005 Jul;193(1):114-7.[Abstract]
103. Zakhari A, Delpero E, McKeown S, et al. Endometriosis recurrence following post-operative hormonal suppression: a systematic review and meta-analysis. Hum Reprod Update. 2021 Jan 4;27(1):96-107.[Abstract][Full Text]
104. Berker B, Lashay N, Davarpanah R, et al. Laparoscopic appendectomy in patients with endometriosis. J Minim Invasive Gynecol. 2005 May-Jun;12(3):206-9.[Abstract]
105. Abrão MS, Petraglia F, Falcone T, et al. Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management. Hum Reprod Update. 2015 May-Jun;21(3):329-39.[Abstract]
106. Bendifallah S, Puchar A, Vesale E, et al. Surgical outcomes after colorectal surgery for endometriosis: a systematic review and meta-analysis. J Minim Invasive Gynecol. 2021 Mar;28(3):453-66.[Abstract][Full Text]
107. Roman H, Moatassim-Drissa S, Marty N, et al. Rectal shaving for deep endometriosis infiltrating the rectum: a 5-year continuous retrospective series. Fertil Steril. 2016 Nov;106(6):1438-45.e2.[Abstract][Full Text]
108. Heinz-Partington S, Costa W, Martins WP, et al. Conservative vs radical bowel surgery for endometriosis: A systematic analysis of complications. Aust N Z J Obstet Gynaecol. 2021 Apr;61(2):169-76.[Abstract]
109. Namnoum AB, Hickman TN, Goodman SB, et al. Incidence of symptom recurrence after hysterectomy for endometriosis. Fertil Steril. 1995 Nov;64(5):898-902.[Abstract]
110. Martin DC. Hysterectomy for treatment of pain associated with endometriosis. J Minim Invasive Gynecol. 2006 Nov-Dec;13(6):566-72.[Abstract]
111. Georgiou EX, Melo P, Baker PE, et al. Long-term GnRH agonist therapy before in vitro fertilisation (IVF) for improving fertility outcomes in women with endometriosis. Cochrane Database Syst Rev. 2019 Nov 20;2019(11):CD013240.[Abstract][Full Text]
112. Casals G, Carrera M, Domínguez JA, et al. Impact of surgery for deep infiltrative endometriosis before in vitro fertilization: a systematic review and meta-analysis. J Minim Invasive Gynecol. 2021 Jul;28(7):1303-12.e5.[Abstract][Full Text]
113. Surrey ES. Endometriosis and assisted reproductive technologies: maximizing outcomes. Semin Reprod Med. 2013 Mar;31(2):154-63.[Abstract]
114. Marcoux S, Maheux R, Bérubé S. Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. N Engl J Med. 1997 Jul 24;337(4):217-22.[Abstract][Full Text]
115. Vercellini P, Somigliana E, Vigano, et al. The effect of second-line surgery on reproductive performance of women with recurrent endometriosis: a systematic review. Acta Obstet Gynecol Scand. 2009;88(10):1074-82.[Abstract]
116. Dubernard G, Piketty M, Rouzier R, et al. Quality of life after laparoscopic colorectal resection for endometriosis. Hum Reprod. 2006 May;21(5):1243-7.[Abstract][Full Text]
117. Matalliotakis IM, Cakmak H, Mahutte N, et al. Women with advanced-stage endometriosis and previous surgery respond less well to gonadotropin stimulation, but have similar IVF implantation and delivery rates compared with women with tubal factor infertility. Fertil Steril. 2007 Dec;88(6):1568-72.[Abstract]
118. Shaw RW. A risk benefit assessment of drugs used in the treatment of endometriosis. Drug Saf. 1994 Aug;11(2):104-13.[Abstract]
119. Bromham DR, Booker MW, Rose GL, et al. Updating the clinical experience in endometriosis - the European perspective. Br J Obstet Gynaecol. 1995 Oct;102(suppl 12):12-6.[Abstract]
120. Fu J, Song H, Zhou M, et al. Progesterone receptor modulators for endometriosis. Cochrane Database Syst Rev. 2017 Jul 25;(7):CD009881. [Abstract][Full Text]
121. Chwalisz K, Perez MC, Demanno D, et al. Selective progesterone receptor modulator development and use in the treatment of leiomyomata and endometriosis. Endocr Rev. 2005 May;26(3):423-38.[Abstract][Full Text]
122. Kohler G, Faustmann TA, Gerlinger C, et al. A dose-ranging study to determine the efficacy and safety of 1, 2, and 4mg of dienogest daily for endometriosis. Int J Gynaecol Obstet. 2010 Jan;108(1):21-5.[Abstract]
123. Lu D, Song H, Shi G. Anti-TNF-alpha treatment for pelvic pain associated with endometriosis. Cochrane Database Syst Rev. 2013 Mar 28;(3):CD008088.[Abstract][Full Text]
124. Proctor ML, Latthe PM, Farquhar CM, et al. Surgical interruption of pelvic nerve pathways for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev. 2005 Oct 19;(4):CD001896.[Abstract][Full Text]
125. National Institute for Health and Care Excellence (UK). Laparoscopic uterine nerve ablation (LUNA) for chronic pelvic pain. Oct 2007 [internet publication].[Full Text]
126. Yeung PP Jr, Shwayder J, Pasic RP. Laparoscopic management of endometriosis: comprehensive review of best evidence. J Minim Invasive Gynecol. 2009 May-Jun;16(3):269-81.[Abstract]
127. Pattanittum P, Kunyanone N, Brown J, et al. Dietary supplements for dysmenorrhoea. Cochrane Database Syst Rev. 2016 Mar 22;(3):CD002124.[Abstract][Full Text]
128. Flower A, Liu JP, Lewith G, et al. Chinese herbal medicine for endometriosis. Cochrane Database Syst Rev. 2012 May 16;(5):CD006568.[Abstract][Full Text]
129. Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility. Fertil Steril. 2012 Sep;98(3):591-8.[Abstract][Full Text]
130. The American College of Obsteticians and Gynecologists. Practice bulletin no. 114: management of endometriosis. Obstet Gynecol. 2010 Jul;116(1):223-36.[Abstract]
131. Ballweg ML. Impact of endometriosis on women's health: comparative historical data show that the earlier the onset, the more severe the disease. Best Pract Res Clin Obstet Gynaecol. 2004 Apr;18(2):201-18.[Abstract]
132. Okoth K, Chandan JS, Marshall T, et al. Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review. BMJ. 2020 Oct 7;371:m3502. [Erratum in: Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review. BMJ. 2020 Oct 14;371:m3963.][Abstract][Full Text]
133. Mu F, Rich-Edwards J, Rimm EB, et al. Endometriosis and risk of coronary heart disease. Circ Cardiovasc Qual Outcomes. 2016 May;9(3):257-64.[Abstract][Full Text]
134. Saraswat L, Ayansina DT, Cooper KG, et al. Pregnancy outcomes in women with endometriosis: a national record linkage study. BJOG. 2017 Feb;124(3):444-52.[Abstract]
135. Busacca M, Riparini J, Somigliana E, et al. Postsurgical ovarian failure after laparoscopic excision of bilateral endometriomas. Am J Obstet Gynecol. 2006 Aug;195(2):421-5.[Abstract]
136. Kvaskoff M, Mahamat-Saleh Y, Farland LV, et al. Endometriosis and cancer: a systematic review and meta-analysis. Hum Reprod Update. 2021 Feb 19;27(2):393-420.[Abstract][Full Text]
137. Salvador S, Scott S, Glanc P, et al. Guideline no. 403: initial investigation and management of adnexal masses. J Obstet Gynaecol Can. 2020 Aug;42(8):1021-9;e3.[Abstract]