Medscape is available in 5 Language Editions – Choose your Edition here.


Endometriosis Medication

  • Author: G Willy Davila, MD; Chief Editor: Michel E Rivlin, MD  more...
Updated: Apr 25, 2016

Medication Summary

Medical therapy for treating endometriosis involves hormonal therapy. Progestins, combination estrogens/progestins, danazol, and gonadotropin-releasing hormone (GnRH) agonists with or without hormone replacement therapy are some of the medications used. Patients should not begin a regimen of danazol or GnRH agonists unless they are monitored by a gynecologist and have a laparoscopically confirmed diagnosis of endometriosis. Evidence for the use of aromatase inhibitors is currently limited.

Suppression of ovulation and menses often occurs with medical management.


Oral contraceptives

Class Summary

Combination oral contraceptive pills (COCPs) act by ovarian suppression and continuous progestin administration. Initially, a trial of continuous or cyclic COCPs should be given for 3 months. If the patient pain is relieved, this treatment is continued for 6-12 months. Subsequent pregnancy rates are 40-50% upon discontinuation of the contraceptive pill.

Although individual formulations offer few variations, note that the long-term efficacy of multiphasic preparations remains unproven. In addition, continuous noncyclical administration of COCPs, omitting the placebo menstrual tablets, for 3-4 months helps avoid any menstruation and associated pain.

These agents are generally progestin dominant and work to suppress the hypothalamic-ovarian axis and, thus, endometriosis implants. Clinically, they probably work better for suppression of the disease rather than actual therapy. Some patients gain significant pain relief with this class of medication, especially when the pills are taken continuously (ie, the patient skips the placebo week of each 28-d pack, going directly to the next pack's first active pill).

Desogestrel and ethinyl estradiol (Desogen, Ortho-Cept, Velivet, Azurette, Cyclessa)


The combination of desogestrel and ethinyl estradiol reduces the secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary by decreasing the amount of gonadotropin-releasing hormones (GnRHs). This is one example of an oral contraceptive pill (OCP). All the modern formulations are equally efficacious, although some of the newer (so-called third-generation) pills have a larger progestin effect and may offer greater efficacy.

Norgestimate/ethinyl estradiol (Ortho-Cyclen, Tri-Sprintec, Ortho Tri-Cyclen)


The combination of norgestimate and ethinyl estradiol reduces the secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary by decreasing the amount of gonadotropin-releasing hormones (GnRHs).


Progestational agents

Class Summary

All progestational agents act by decidualization and atrophy of the endometrium. Use of this category of drugs relies on high-dose hormones to suppress the hypothalamus through negative feedback. This results in a hypoestrogenic state. Evidence for direct inhibition of endometrial implants by progestins also exists. These medications provide pain relief equivalent to the gonadotropin-releasing hormone (GnRH) analogues and seem to have a slightly lower recurrence rate.

Norethindrone acetate (Aygestin, Camila, Errin)


Norethindrone is a common progestin used in many of the oral (PO) contraceptive pills currently available; the dose administered for endometriosis is significantly higher.

Medroxyprogesterone (Provera, Depo-Provera)


Progestins stop endometrial cell proliferation, allowing organized sloughing of cells after withdrawal. These agents typically do not stop acute bleeding episode, but they produce normal bleeding episodes following withdrawal.

Medroxyprogesterone is a common progestin available in both an oral (PO) and an intramuscular (IM) depo form. The efficacy and adverse effects of this drug are similar to those of norethindrone.

Megestrol (Megace)


Megestrol produces results similar to those of medroxyprogesterone.


Gonadotropin-releasing hormone analogs

Class Summary

Gonadotropin-releasing hormone (GnRH) analogues produce a hypogonadotrophic-hypogonadic state by downregulation of the pituitary gland. Goserelin and leuprolide acetate are commonly used agonists.

Normal menstrual cycles rely on pulsatile delivery of GnRH to the pituitary. The GnRH analogues (agonists) supply constant stimulation of the pituitary receptors, leading to downregulation and eventual suspension of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) secretion. This suspension results in a profound hypoestrogenic state, similar to menopause. Because endometrial implants are dependent on estrogen stimulation, they subsequently regress. Owing to hypoestrogenic adverse effects, the use of these drugs is limited to 6-months duration.

The use of so-called add-back therapy, addition of low-dose estrogen with or without a progestin, for prolonged therapy has been investigated. The results are mixed, and, thus, a sound recommendation cannot be made currently.

The expense of GnRH analogues is a significant limitation to their long-term use. GnRH agonists should be used with caution in adolescents younger than 16 years because of adverse effects on bone density.

Goserelin (Zoladex)


Goserelin suppresses ovarian and testicular steroidogenesis by decreasing luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels. This agent is administered monthly as a subcutaneous (SC) implant in the upper abdominal wall; it is otherwise similar to the drugs in this class.

Leuprolide (Lupron Depot, Eligard)


Leuprolide suppresses ovarian and testicular steroidogenesis by decreasing luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels. This agent is available in a daily subcutaneous (SC) dosing regimen and the much more convenient monthly intramuscular (IM) depo formulation. A 3-month depo dosing formulation is also available, but experience with its use is limited for endometriosis.

Nafarelin (Synarel)


Nafarelin is an analogue of gonadotropin-releasing hormone (GnRH) that is approximately 200 times more potent than natural endogenous GnRH. Upon long-term administration, this agent suppresses gonadotrope responsiveness to endogenous GnRH, thereby reducing secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which in turn reduces ovarian and testicular steroid production.

Nafarelin is available as a nasal solution (2 mg/mL). Administration of this agent is delivered via a nasal spray, which requires twice daily (bid) dosing; it is otherwise similar to the other drugs in this category.


Antigonadotropic agents

Class Summary

Antigonadotropic agents work to suppress both the hypothalamic-ovarian axis and endometriosis at a local level and act by inhibiting the midcycle follicle-stimulating hormone (FSH) and luteinizing hormone (LH) surge and preventing steroidogenesis in the corpus luteum. These are the most extensively studied agents for endometriosis. Danazol has been shown to be as effective as any of the newer agents, but it has a higher incidence of adverse effects.



Danazol is a synthetic steroid analogue with strong antigonadotropic activity (inhibits luteinizing hormone [LH] and follicle-stimulating hormone [FSH]) and weak androgenic action.

However, although efficacious, androgens have fallen out of favor because of their unpleasant adverse effects, and because newer medications work as well or better. These drugs may represent a less expensive alternative, or better choice, for certain patients and remain part of the armamentarium. Danazol requires at least 3-6 months to determine its effectiveness.


Aromatase Inhibitors

Class Summary

Aromatase inhibitors work by blocking the aromatase activity in extraovarian sites that suppress the conversion of androstenedione and testosterone to estrogen. This action may result in suppression of endometriosis at a local level.

Letrozole (Femara)


Letrozole is a competitive inhibitor of the aromatase enzyme system that leads to a reduction in plasma estrogen levels in postmenopausal women. Although this agent has been used extensively in breast cancer treatment, experience to date in endometriosis management is limited. Letrozole may decrease pain in patients whose conditions have previously failed other treatments. Although initial results appear promising, further studies are required to establish the role of aromatase inhibitors in the management of endometriosis.

Contributor Information and Disclosures

G Willy Davila, MD Chairman, Department of Gynecology, Section of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida

G Willy Davila, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Colorado Medical Society, Florida Medical Association

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: AMS/Astora; Astellas, Uroplasty/Cogentix<br/>Received research grant from: Pfizer; A-Cell; Coloplast; Cook Myocyte.


Elizabeth Alderman, MD Director, Pediatric Residency Program, Director of Fellowship Training Program, Adolescent Medicine, Professor of Clinical Pediatrics, Department of Pediatrics, Division of Adolescent Medicine, Albert Einstein College of Medicine and Children's Hospital at Montefiore

Elizabeth Alderman, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, North American Society for Pediatric and Adolescent Gynecology, Society for Adolescent Health and Medicine

Disclosure: Nothing to disclose.

Gamal Mostafa Ghoniem, MD, FACS Professor and Vice Chair of Urology, Chief, Division of Female Urology, Pelvic Reconstructive Surgery, and Voiding Dysfunction, Department of Urology, University of California, Irvine, School of Medicine

Gamal Mostafa Ghoniem, MD, FACS is a member of the following medical societies: American Urogynecologic Society, International Continence Society, International Urogynaecology Association, Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, American College of Surgeons, American Urological Association

Disclosure: Received honoraria from Astellas for speaking and teaching; Received grant/research funds from Uroplasty for none; Partner received honoraria from Allergan for speaking and teaching.

Dharmesh Kapoor, MD, MBBS, MRCOG Consultant Gynecologist, Royal Bournemouth Hospital

Disclosure: Nothing to disclose.

Mark K Y Hiraoka, MD Assistant Professor of Obstetrics and Gynecology, University of Hawaii, John A Burns School of Medicine; Consulting Staff, Department of Obstetrics and Gynecology, Queen's Medical Center

Mark K Y Hiraoka, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Association of Professors of Gynecology and Obstetrics

Disclosure: Nothing to disclose.

Barry D Peskin, MD, MBA Head, Section of Ambulatory Gynecology, Department of Gynecology, Cleveland Clinic, Florida

Barry D Peskin, MD, MBA is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, Cleveland Society of Obstetricians and Gynecologists, North American Menopause Society, Ohio State Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Frances E Casey, MD, MPH Director of Family Planning Services, Department of Obstetrics and Gynecology, VCU Medical Center

Frances E Casey, MD, MPH is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Reproductive Health Professionals, Society of Family Planning, National Abortion Federation, Physicians for Reproductive Health

Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD Former Professor, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine

Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, Royal College of Surgeons of Edinburgh, Royal College of Obstetricians and Gynaecologists

Disclosure: Nothing to disclose.

Additional Contributors

Thomas Michael Price, MD Associate Professor, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Director of Reproductive Endocrinology and Infertility Fellowship Program, Duke University Medical Center

Thomas Michael Price, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Obstetricians and Gynecologists, Phi Beta Kappa, Society for Reproductive Investigation, Society for Reproductive Endocrinology and Infertility, American Society for Reproductive Medicine

Disclosure: Received research grant from: Insigtec Inc<br/>Received consulting fee from Clinical Advisors Group for consulting; Received consulting fee from MEDA Corp Consulting for consulting; Received consulting fee from Gerson Lehrman Group Advisor for consulting; Received honoraria from ABOG for board membership.


The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Tod C Aeby, MD,to the development and writing of a source article.

  1. Buchweitz O, Poel T, Diedrich K, Malik E. The diagnostic dilemma of minimal and mild endometriosis under routine conditions. J Am Assoc Gynecol Laparosc. 2003 Feb. 10(1):85-9. [Medline].

  2. Shepard MK, Mancini MC, Campbell GD Jr, George R. Right-sided hemothorax and recurrent abdominal pain in a 34-year-old woman. Chest. 1993 Apr. 103(4):1239-40. [Medline].

  3. Mounsey AL, Wilgus A, Slawson DC. Diagnosis and management of endometriosis. Am Fam Physician. 2006 Aug 15. 74(4):594-600. [Medline].

  4. Kennedy S, Bergqvist A, Chapron C, D'Hooghe T, Dunselman G, Greb R, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005 Oct. 20(10):2698-704. [Medline].

  5. Kingsberg SA, Janata JW. Female sexual disorders: assessment, diagnosis, and treatment. Urol Clin North Am. 2007 Nov. 34(4):497-506, v-vi. [Medline].

  6. Namnoum AB, Hickman TN, Goodman SB, Gehlbach DL, Rock JA. Incidence of symptom recurrence after hysterectomy for endometriosis. Fertil Steril. 1995 Nov. 64(5):898-902. [Medline].

  7. Liu DT, Hitchcock A. Endometriosis: its association with retrograde menstruation, dysmenorrhoea and tubal pathology. Br J Obstet Gynaecol. 1986 Aug. 93(8):859-62. [Medline].

  8. Kruitwagen RF, Poels LG, Willemsen WN, de Ronde IJ, Jap PH, Rolland R. Endometrial epithelial cells in peritoneal fluid during the early follicular phase. Fertil Steril. 1991 Feb. 55(2):297-303. [Medline].

  9. Scott RB, Te Linde RW, Wharton LR Jr. Further studies on experimental endometriosis. Am J Obstet Gynecol. 1953;66:1082:

  10. D'Hooghe TM, Bambra CS, Raeymaekers BM, Koninckx PR. Increased prevalence and recurrence of retrograde menstruation in baboons with spontaneous endometriosis. Hum Reprod. 1996 Sep. 11(9):2022-5. [Medline].

  11. Mathur S, Peress MR, Williamson HO, Youmans CD, Maney SA, Garvin AJ, et al. Autoimmunity to endometrium and ovary in endometriosis. Clin Exp Immunol. 1982 Nov. 50(2):259-66. [Medline]. [Full Text].

  12. Acién P, Velasco I, Gutiérrez M, Martínez-Beltrán M. Aromatase expression in endometriotic tissues and its relationship to clinical and analytical findings. Fertil Steril. 2007 Jul. 88(1):32-8. [Medline].

  13. Matsuzaki S, Canis M, Pouly JL, Wattiez A, Okamura K, Mage G. Cyclooxygenase-2 expression in deep endometriosis and matched eutopic endometrium. Fertil Steril. 2004 Nov. 82(5):1309-15. [Medline].

  14. Wölfler MM, Nagele F, Kolbus A, Seidl S, Schneider B, Huber JC, et al. A predictive model for endometriosis. Hum Reprod. 2005 Jun. 20(6):1702-8. [Medline].

  15. Zeitoun KM, Bulun SE. Aromatase: a key molecule in the pathophysiology of endometriosis and a therapeutic target. Fertil Steril. 1999 Dec. 72(6):961-9. [Medline].

  16. Shippen ER, West WJ Jr. Successful treatment of severe endometriosis in two premenopausal women with an aromatase inhibitor. Fertil Steril. 2004 May. 81(5):1395-8. [Medline].

  17. Ailawadi RK, Jobanputra S, Kataria M, Gurates B, Bulun SE. Treatment of endometriosis and chronic pelvic pain with letrozole and norethindrone acetate: a pilot study. Fertil Steril. 2004 Feb. 81(2):290-6. [Medline].

  18. Suginami H. A reappraisal of the coelomic metaplasia theory by reviewing endometriosis occurring in unusual sites and instances. Am J Obstet Gynecol. 1991 Jul. 165(1):214-8. [Medline].

  19. Metzger DA, Lessey BA, Soper JT, McCarty KS Jr, Haney AF. Hormone-resistant endometriosis following total abdominal hysterectomy and bilateral salpingo-oophorectomy: correlation with histology and steroid receptor content. Obstet Gynecol. 1991 Nov. 78(5 Pt 2):946-50. [Medline].

  20. Schrodt GR, Alcorn MO, Ibanez J. Endometriosis of the male urinary system: a case report. J Urol. 1980 Nov. 124(5):722-3. [Medline].

  21. Ueki M. Histologic study of endometriosis and examination of lymphatic drainage in and from the uterus. Am J Obstet Gynecol. 1991 Jul. 165(1):201-9. [Medline].

  22. Kadan Y, Fiascone S, McCourt C, et al. Predictive factors for the presence of malignant transformation of pelvic endometriosis. Eur J Obstet Gynecol Reprod Biol. 2014 Dec 2. 185C:23-27. [Medline].

  23. Lobo RA. Endometriosis: etiology, pathology, diagnosis, management. Comprehensive Gynecology. Philadelphia, PA: Mosby; 5th ed. 2007:chap 19.

  24. Markham SM, Carpenter SE, Rock JA. Extrapelvic endometriosis. Obstet Gynecol Clin North Am. 1989 Mar. 16(1):193-219. [Medline].

  25. Jubanyik KJ, Comite F. Extrapelvic endometriosis. Obstet Gynecol Clin North Am. 1997 Jun. 24(2):411-40. [Medline].

  26. ACOG practice bulletin. Medical management of endometriosis. Number 11, December 1999 (replaces Technical Bulletin Number 184, September 1993). Clinical management guidelines for obstetrician-gynecologists. Int J Gynaecol Obstet. 2000 Nov. 71(2):183-96. [Medline].

  27. Wheeler JM. Epidemiology of endometriosis-associated infertility. J Reprod Med. 1989 Jan. 34(1):41-6. [Medline].

  28. Rawson JM. Prevalence of endometriosis in asymptomatic women. J Reprod Med. 1991 Jul. 36(7):513-5. [Medline].

  29. Strathy JH, Molgaard CA, Coulam CB, Melton LJ 3rd. Endometriosis and infertility: a laparoscopic study of endometriosis among fertile and infertile women. Fertil Steril. 1982 Dec. 38(6):667-72. [Medline].

  30. Verkauf BS. Incidence, symptoms, and signs of endometriosis in fertile and infertile women. J Fla Med Assoc. 1987 Sep. 74(9):671-5. [Medline].

  31. Carter JE. Combined hysteroscopic and laparoscopic findings in patients with chronic pelvic pain. J Am Assoc Gynecol Laparosc. 1994 Nov. 2(1):43-7. [Medline].

  32. Kontoravdis A, Hassan E, Hassiakos D, Botsis D, Kontoravdis N, Creatsas G. Laparoscopic evaluation and management of chronic pelvic pain during adolescence. Clin Exp Obstet Gynecol. 1999. 26(2):76-7. [Medline].

  33. Williams TJ, Pratt JH. Endometriosis in 1,000 consecutive celiotomies: incidence and management. Am J Obstet Gynecol. 1977 Oct 1. 129(3):245-50. [Medline].

  34. Cramer DW. Epidemiology of endometriosis. Wilson EA, ed. Endometriosis. New York, NY: Alan R. Liss; 1987:5-22.

  35. Hadfield RM, Mardon HJ, Barlow DH, Kennedy SH. Endometriosis in monozygotic twins. Fertil Steril. 1997 Nov. 68(5):941-2. [Medline].

  36. Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gynecol Clin North Am. 1997 Jun. 24(2):235-58. [Medline].

  37. Harrison RF, Barry-Kinsella C. Efficacy of medroxyprogesterone treatment in infertile women with endometriosis: a prospective, randomized, placebo-controlled study. Fertil Steril. 2000 Jul. 74(1):24-30. [Medline].

  38. Tu FF, Du H, Goldstein GP, Beaumont JL, Zhou Y, Brown WJ. The influence of prior oral contraceptive use on risk of endometriosis is conditional on parity. Fertil Steril. 2014 Mar 22. [Medline].

  39. Demco L. Mapping the source and character of pain due to endometriosis by patient-assisted laparoscopy. J Am Assoc Gynecol Laparosc. 1998 Aug. 5(3):241-5. [Medline].

  40. Koninckx PR, Martin DC. Deep endometriosis: a consequence of infiltration or retraction or possibly adenomyosis externa?. Fertil Steril. 1992 Nov. 58(5):924-8. [Medline].

  41. Koninckx PR, Oosterlynck D, D'Hooghe T, Meuleman C. Deeply infiltrating endometriosis is a disease whereas mild endometriosis could be considered a non-disease. Ann N Y Acad Sci. 1994 Sep 30. 734:333-41. [Medline].

  42. Ferrero S, Esposito F, Abbamonte LH, Anserini P, Remorgida V, Ragni N. Quality of sex life in women with endometriosis and deep dyspareunia. Fertil Steril. 2005 Mar. 83(3):573-9. [Medline].

  43. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril. 1997 May. 67(5):817-21. [Medline].

  44. Hornstein MD, Gleason RE, Orav J, Haas ST, Friedman AJ, Rein MS, et al. The reproducibility of the revised American Fertility Society classification of endometriosis. Fertil Steril. 1993 May. 59(5):1015-21. [Medline].

  45. Koninckx PR, Meuleman C, Demeyere S, Lesaffre E, Cornillie FJ. 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. [Medline].

  46. Barbati A, Cosmi EV, Spaziani R, Ventura R, Montanino G. Serum and peritoneal fluid CA-125 levels in patients with endometriosis. Fertil Steril. 1994 Mar. 61(3):438-42. [Medline].

  47. Chen FP, Soong YK, Lee N, Lo SK. The use of serum CA-125 as a marker for endometriosis in patients with dysmenorrhea for monitoring therapy and for recurrence of endometriosis. Acta Obstet Gynecol Scand. 1998 Jul. 77(6):665-70. [Medline].

  48. Yeaman GR, Collins JE, Lang GA. Autoantibody responses to carbohydrate epitopes in endometriosis. Ann N Y Acad Sci. 2002 Mar. 955:174-82; discussion 199-200, 396-406. [Medline].

  49. Agic A, Djalali S, Wolfler MM, Halis G, Diedrich K, Hornung D. Combination of CCR1 mRNA, MCP1, and CA125 measurements in peripheral blood as a diagnostic test for endometriosis. Reprod Sci. 2008 Nov. 15(9):906-11. [Medline].

  50. Mukund J. Sonography of adnexal masses. Ultrasound Clinics. January 2007;2(1):133-53:

  51. Kinkel K, Chapron C, Balleyguier C, Fritel X, Dubuisson JB, Moreau JF. Magnetic resonance imaging characteristics of deep endometriosis. Hum Reprod. 1999 Apr. 14(4):1080-6. [Medline].

  52. Takeuchi H, Kuwatsuru R, Kitade M, Sakurai A, Kikuchi I, Shimanuki H, et al. A novel technique using magnetic resonance imaging jelly for evaluation of rectovaginal endometriosis. Fertil Steril. 2005 Feb. 83(2):442-7. [Medline].

  53. Stewart CJ, Leung Y, Walsh MD, Walters RJ, Young JP, Buchanan DD. KRAS mutations in ovarian low-grade endometrioid adenocarcinoma: association with concurrent endometriosis. Hum Pathol. 2012 Feb 1. [Medline].

  54. Sutton CJ, Pooley AS, Ewen SP, Haines P. 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. [Medline].

  55. Waller KG, Shaw RW. Gonadotropin-releasing hormone analogues for the treatment of endometriosis: long-term follow-up. Fertil Steril. 1993 Mar. 59(3):511-5. [Medline].

  56. Reeve L, Lashen H, Pacey AA. Endometriosis affects sperm-endosalpingeal interactions. Hum Reprod. 2005 Feb. 20(2):448-51. [Medline].

  57. Badawy SZ, ElBakry MM, Samuel F, Dizer M. Cumulative pregnancy rates in infertile women with endometriosis. J Reprod Med. 1988 Sep. 33(9):757-60. [Medline].

  58. 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. [Medline].

  59. Bukulmez O, Yarali H, Gurgan T. The presence and extent of endometriosis do not effect clinical pregnancy and implantation rates in patients undergoing intracytoplasmic sperm injection. Eur J Obstet Gynecol Reprod Biol. 2001 May. 96(1):102-7. [Medline].

  60. Hughes E, Brown J, Collins JJ, Farquhar C, Fedorkow DM, Vandekerckhove P. Ovulation suppression for endometriosis. Cochrane Database Syst Rev. 2007 Jul 18. CD000155. [Medline].

  61. Benschop L, Farquhar C, van der Poel N, Heineman MJ. Interventions for women with endometrioma prior to assisted reproductive technology. Cochrane Database Syst Rev. 2010 Nov 10. CD008571. [Medline].

  62. Hamdan M, Omar SZ, Dunselman G, Cheong Y. Influence of Endometriosis on Assisted Reproductive Technology Outcomes: A Systematic Review and Meta-analysis. Obstet Gynecol. 2015 Jan. 125(1):79-88. [Medline].

  63. Vercammen EE, D'Hooghe TM. Endometriosis and recurrent pregnancy loss. Semin Reprod Med. 2000. 18(4):363-8. [Medline].

  64. Allen C, Hopewell S, Prentice A, Gregory D. Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev. 2009 Apr 15. CD004753. [Medline].

  65. Nawathe A, Patwardhan S, Yates D, Harrison GR, Khan KS. Systematic review of the effects of aromatase inhibitors on pain associated with endometriosis. BJOG. 2008 Jun. 115(7):818-22. [Medline].

  66. Guzick DS, Huang LS, Broadman BA, Nealon M, Hornstein MD. Randomized trial of leuprolide versus continuous oral contraceptives in the treatment of endometriosis-associated pelvic pain. Fertil Steril. 2011 Apr. 95(5):1568-73. [Medline].

  67. Modugno F, Ness RB, Allen GO, Schildkraut JM, Davis FG, Goodman MT. Oral contraceptive use, reproductive history, and risk of epithelial ovarian cancer in women with and without endometriosis. Am J Obstet Gynecol. 2004 Sep. 191(3):733-40. [Medline].

  68. Hull ME, Moghissi KS, Magyar DF, Hayes MF. Comparison of different treatment modalities of endometriosis in infertile women. Fertil Steril. 1987 Jan. 47(1):40-4. [Medline].

  69. Kauppila A. Changing concepts of medical treatment of endometriosis. Acta Obstet Gynecol Scand. 1993 Jul. 72(5):324-36. [Medline].

  70. Schlaff WD, Dugoff L, Damewood MD, Rock JA. Megestrol acetate for treatment of endometriosis. Obstet Gynecol. 1990 Apr. 75(4):646-8. [Medline].

  71. Varma R, Sinha D, Gupta JK. Non-contraceptive uses of levonorgestrel-releasing hormone system (LNG-IUS)--a systematic enquiry and overview. Eur J Obstet Gynecol Reprod Biol. 2006 Mar 1. 125(1):9-28. [Medline].

  72. Anpalagan A, Condous G. Is there a role for use of levonorgestrel intrauterine system in women with chronic pelvic pain?. J Minim Invasive Gynecol. 2008 Nov-Dec. 15(6):663-6. [Medline].

  73. Hughes E, Fedorkow D, Collins J, Vandekerckhove P. Ovulation suppression for endometriosis. Cochrane Database Syst Rev. 2000. CD000155. [Medline].

  74. Winkel CA, Scialli AR. Medical and surgical therapies for pain associated with endometriosis. J Womens Health Gend Based Med. 2001 Mar. 10(2):137-62. [Medline].

  75. Paoletti AM, Serra GG, Cagnacci A, Vacca AM, Guerriero S, Solla E, et al. Spontaneous reversibility of bone loss induced by gonadotropin-releasing hormone analog treatment. Fertil Steril. 1996 Apr. 65(4):707-10. [Medline].

  76. Friedman AJ, Hornstein MD. Gonadotropin-releasing hormone agonist plus estrogen-progestin "add-back" therapy for endometriosis-related pelvic pain. Fertil Steril. 1993 Aug. 60(2):236-41. [Medline].

  77. Taskin O, Yalcinoglu AI, Kucuk S, Uryan I, Buhur A, Burak F. Effectiveness of tibolone on hypoestrogenic symptoms induced by goserelin treatment in patients with endometriosis. Fertil Steril. 1997 Jan. 67(1):40-5. [Medline].

  78. Surrey ES, Voigt B, Fournet N, Judd HL. Prolonged gonadotropin-releasing hormone agonist treatment of symptomatic endometriosis: the role of cyclic sodium etidronate and low-dose norethindrone "add-back" therapy. Fertil Steril. 1995 Apr. 63(4):747-55. [Medline].

  79. Lane N, Baptista J, Snow-Harter C. Bone mineral density of the lumbar spine in endometriosis subjects compared to an age-similar control population. J Clin Endocrinol Metab. 1991 Feb. 72(2):510-4. [Medline].

  80. Surrey E, Hornstein M. Prolonged GnRH agonist add back therapy for symptomatic endometriosis patients: Long-term follow-up of a 12-month clinical trial. Fertil Steril. 1999;72:S80.

  81. 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. [Medline].

  82. Espaulella J, Armengol J, Bella F, Lain JM, Calaf J. Pulmonary endometriosis: conservative treatment with GnRH agonists. Obstet Gynecol. 1991 Sep. 78(3 Pt 2):535-7. [Medline].

  83. Brown J, Pan A, Hart RJ. Gonadotrophin-releasing hormone analogues for pain associated with endometriosis. Cochrane Database Syst Rev. 2010 Dec 8. CD008475. [Medline].

  84. Telimaa S, Puolakka J, Rönnberg L, Kauppila A. Placebo-controlled comparison of danazol and high-dose medroxyprogesterone acetate in the treatment of endometriosis. Gynecol Endocrinol. 1987 Mar. 1(1):13-23. [Medline].

  85. Dmowski WP, Kapetanakis E, Scommegna A. Variable effects of danazol on endometriosis at 4 low-dose levels. Obstet Gynecol. 1982 Apr. 59(4):408-15. [Medline].

  86. Razzi S, Luisi S, Calonaci F, Altomare A, Bocchi C, Petraglia F. Efficacy of vaginal danazol treatment in women with recurrent deeply infiltrating endometriosis. Fertil Steril. 2007 Oct. 88(4):789-94. [Medline].

  87. Al Kadri H, Hassan S, Al-Fozan HM, Hajeer A. Hormone therapy for endometriosis and surgical menopause. Cochrane Database Syst Rev. 2009 Jan 21. CD005997. [Medline].

  88. Cook AS, Rock JA. The role of laparoscopy in the treatment of endometriosis. Fertil Steril. 1991 Apr. 55(4):663-80. [Medline].

  89. Saidi MH, Vancaillie TG, White AJ, Sadler RK, Akright BD, Farhart SA. Complications of major operative laparoscopy. A review of 452 cases. J Reprod Med. 1996 Jul. 41(7):471-6. [Medline].

  90. Revelli A, Modotti M, Ansaldi C, Massobrio M. Recurrent endometriosis: a review of biological and clinical aspects. Obstet Gynecol Surv. 1995 Oct. 50(10):747-54. [Medline].

  91. Jones KD, Sutton C. Patient satisfaction and changes in pain scores after ablative laparoscopic surgery for stage III-IV endometriosis and endometriotic cysts. Fertil Steril. 2003 May. 79(5):1086-90. [Medline].

  92. Beretta P, Franchi M, Ghezzi F, Busacca M, Zupi E, Bolis P. Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation. Fertil Steril. 1998 Dec. 70(6):1176-80. [Medline].

  93. Alborzi S, Momtahan M, Parsanezhad ME, Dehbashi S, Zolghadri J, Alborzi S. A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas. Fertil Steril. 2004 Dec. 82(6):1633-7. [Medline].

  94. Donnez J, Nisolle M, Clerckx F. Evaluation of preoperative use of danazol, gestrinone, lynestrol, buserelin spray and buserelin implant, in the treatment of endometriosis related infertility. Chadha DR, Buttram VC Jr, eds. Current Concepts in Endometriosis. New York, NY: Alan R. Liss; 1990:427-42;

  95. Vercellini P, Crosignani PG, Abbiati A, Somigliana E, Viganò P, Fedele L. The effect of surgery for symptomatic endometriosis: the other side of the story. Hum Reprod Update. 2009 Mar-Apr. 15(2):177-88. [Medline].

  96. Johnson NP. A review of the use of lipiodol flushing for unexplained infertility. Treat Endocrinol. 2005. 4(4):233-43. [Medline].

  97. Wilson ML, Farquhar CM, Sinclair OJ, Johnson NP. Surgical interruption of pelvic nerve pathways for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev. 2000. CD001896. [Medline].

  98. Proctor ML, Latthe PM, Farquhar CM, Khan KS, Johnson NP. Surgical interruption of pelvic nerve pathways for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev. 2005 Oct 19. CD001896. [Medline].

  99. Prentice A, Deary AJ, Bland E. Progestagens and anti-progestagens for pain associated with endometriosis. Cochrane Database Syst Rev. 2000. CD002122. [Medline].

  100. Prentice A, Deary AJ, Goldbeck-Wood S, Farquhar C, Smith SK. Gonadotrophin-releasing hormone analogues for pain associated with endometriosis. Cochrane Database Syst Rev. 2000. CD000346. [Medline].

  101. Selak V, Farquhar C, Prentice A, Singla A. Danazol for pelvic pain associated with endometriosis. Cochrane Database Syst Rev. 2001. CD000068. [Medline].

  102. Moore J, Kennedy S, Prentice A. Modern combined oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev. 2000. CD001019. [Medline].

  103. Vercellini P, Cortesi I, Crosignani PG. Progestins for symptomatic endometriosis: a critical analysis of the evidence. Fertil Steril. 1997 Sep. 68(3):393-401. [Medline].

  104. Society of Obstetricians and Gynaecologists of Canada. Canadian consensus conference on endometriosis consensus statements. J SOGC. 1999;21:471-3.

  105. Redwine DB. Endometriosis persisting after castration: clinical characteristics and results of surgical management. Obstet Gynecol. 1994 Mar. 83(3):405-13. [Medline].

  106. Hickman TN, Namnoum AB, Hinton EL, Zacur HA, Rock JA. Timing of estrogen replacement therapy following hysterectomy with oophorectomy for endometriosis. Obstet Gynecol. 1998 May. 91(5 Pt 1):673-7. [Medline].

  107. Mu F, Rich-Edwards J, Rimm EB, Spiegelman D, Missmer SA. Endometriosis and Risk of Coronary Heart Disease. Circ Cardiovasc Qual Outcomes. 2016 Mar 29. [Medline].

  108. Wendling P. Study Puts Endometriosis in Cardiologists' Sights. Heartwire from Medscape. Available at March 31, 2016; Accessed: April 25, 2016.

  109. Johnson KM. Endometriosis. The case for early, aggressive treatment. J Reprod Med. 1998 Mar. 43(3 Suppl):309-15. [Medline].

  110. American College of Obstetricians and Gynecologists. Endometriosis in Adolescents. Committee Opinion. April 2005;Number 310:1-7.

  111. Busacca M, Chiaffarino F, Candiani M, Vignali M, Bertulessi C, Oggioni G, 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. [Medline].

  112. Doyle JO, Missmer SA, Laufer MR. The effect of combined surgical-medical intervention on the progression of endometriosis in an adolescent and young adult population. J Pediatr Adolesc Gynecol. 2009 Aug. 22(4):257-63. [Medline].

  113. Drosdzol A, Skrzypulec V. [Dysmenorrhea in pediatric and adolescent gynaecology]. Ginekol Pol. 2008 Jul. 79(7):499-503. [Medline].

  114. Ferrero S, Abbamonte LH, Anserini P, Remorgida V, Ragni N. Future perspectives in the medical treatment of endometriosis. Obstet Gynecol Surv. 2005 Dec. 60(12):817-26. [Medline].

  115. Good Outcomes With Radical Surgery for Moderate-Severe Endometriosis. Medscape. Apr 30 2013. Available at Accessed: May 1 2013.

  116. Hummelshoj L, Prentice A, Groothuis P. Update on endometriosis. Women's Health. 2006;2(1):53-56.

  117. Meuleman C, Tomassetti C, Wolthuis A, Van Cleynenbreugel B, Laenen A, Penninckx F, et al. Clinical Outcome After Radical Excision of Moderate-Severe Endometriosis With or Without Bowel Resection and Reanastomosis: A Prospective Cohort Study. Ann Surg. 2013 Apr 10. [Medline].

  118. Wayne PM, Kerr CE, Schnyer RN, Legedza AT, Savetsky-German J, Shields MH, et al. Japanese-style acupuncture for endometriosis-related pelvic pain in adolescents and young women: results of a randomized sham-controlled trial. J Pediatr Adolesc Gynecol. 2008 Oct. 21(5):247-57. [Medline]. [Full Text].

Powder-burn lesions of endometriosis.
Endometriosis. Chocolate cyst of the ovary.
Endometriosis. Red lesions on the sigmoid colon and cul-de-sac.
Adhesions due to endometriosis.
Endometriosis. Red lesions on various organs.
Active endometriosis with red and powder-burn lesions and adhesions from old scarring.
Scarring due to old disease and active endometriosis.
Endometriosis. Moderate-to-severe disease.
Typical appearance of minimal endometriosis on the uterosacral ligaments. Note that some are pigmented (contain hemosiderin), whereas others are not.
Peritoneal erosions and adhesions in the posterior cul-de-sac. These are typical of more severe endometriosis.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.