eMedicine Specialties > Emergency Medicine > Obstetrics & Gynecology

Endometriosis: Follow-up

Author: Turandot Saul, MD, Staff Physician, Department of Emergency Medicine, Bellevue Hospital Center/New York University Medical Center
Coauthor(s): Ami K Davé, MD, Assistant Professor, Department of Emergency Medicine, New York University School of Medicine; Assistant Residency Director, Department of Emergency Medicine, New York University/Bellevue Hospital Center
Contributor Information and Disclosures

Updated: Feb 14, 2008

Follow-up

Further Outpatient Care

  • Disease is progressive and can result in chronic pain and infertility. Gynecologic follow-up is advised.

Inpatient & Outpatient Medications

  • If the presumptive diagnosis is endometriosis and follow up is arranged, pain management can include the use of NSAIDs or narcotic analgesics.

Complications

  • Infertility/subfertility
  • Chronic pelvic pain
  • Adhesions
  • Ruptured cysts

Prognosis

  • Medical management (suppression of ovulation) is effective for decreasing pelvic pain but ineffective for treatment of endometriosis-associated infertility. It does, however, preserve the potential for conception.
  • Combination estrogens/progestins relieve pain in as many as 80-85% of patients with endometriosis-related pelvic pain.
  • After 6 months of danazol therapy, as many as 90% of patients with moderate endometriosis experience adequate pain relief.
  • Total abdominal hysterectomy and bilateral salpingo-oophorectomy is reported to be up to 90% effective in relieving pain.
  • Pregnancy is possible but depends on the severity of disease.
  • Signs and symptoms generally regress with the onset of menopause and during pregnancy.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Prior to ascribing a patient's abdominal or pelvic pain to endometriosis, the clinician should consider other important causes of such pain, including ectopic pregnancy, pelvic infection, and ovarian torsion.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Kyle Hsu, MD, to the development and writing of this article.



More on Endometriosis

Overview: Endometriosis
Differential Diagnoses & Workup: Endometriosis
Treatment & Medication: Endometriosis
Follow-up: Endometriosis
References
[ CLOSE WINDOW ]

References

  1. Adamson, GD, Nelson, HP. Surgical treatment of endometriosis. Obstet Gynecol Clin North Am. 1997;24:375-409. [Medline].

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

  3. Brosens IA. New principles in the management of endometriosis. Acta Obstet Gynecol Scand Suppl. 1994;159:18-21. [Medline].

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

  5. Busacca M, Chiaffarino F, Candiani M, Vignali M, Bertulessi C, Oggioni G. Determinants of long-term clinically detected recurrence rates of deep, ovarian, and pelvic endometriosis. Am J Obstet Gynecol. Aug 2006;195(2):426-32. [Medline].

  6. Carlson KJ, Nichols DH, Schiff I. Indications for hysterectomy. N Engl J Med. Mar 25 1993;328(12):856-60. [Medline].

  7. Espindola D, Kennedy KA, Fischer EG. Management of abnormal uterine bleeding and the pathology of endometrial hyperplasia. Obstet Gynecol Clin North Am. Dec 2007;34(4):717-37, ix. [Medline].

  8. Eskenazi, B, Warner, ML. Epidemiology of Endometriosis. Obstet Gynecol Clin North Am. 1997;24:235-258. [Medline].

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

  10. Mukund J. Sonography of adnexal masses. Ultrasound Clinics. January 2007;2.

  11. Jubanyik KJ, Comite F. Extrapelvic Endometriosis. Obstet Gynecol Clin North Am. 1997;24:411-440. [Medline].

  12. Kennedy S, Bergqvist A, Chapron C, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. Oct 2005;20(10):2698-704. [Medline].

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

  14. Lu PY, Ory SJ. Endometriosis: Current Management. Mayo Clin Proc. 1995;170:453-463. [Medline].

  15. Mahmood TA, Templeton A. Prevalence and genesis of endometriosis. Hum Reprod. Apr 1991;6(4):544-9. [Medline].

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

  17. Prentice A. Regular review: Endometriosis. BMJ. Jul 14 2001;323(7304):93-5. [Medline].

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

  19. Shepard MK, Mancini MC, Campbell GD. Right-sided hemothorax and recurrent abdominal pain in a 34 year-old woman. Chest. 1993;103:1239. [Medline].

  20. Wilson AL. Endometriosis. A common cause of infertility and pelvic pain. JAAPA. Dec 2003;16(12):20-3. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

endometriosis, pelvic pain, infertility, endometrial implants, endometriosis externa, endometrioma, gynecologic disorder, gynecologic pain, retrograde menstruation, oral contraception, women's health

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Turandot Saul, MD, Staff Physician, Department of Emergency Medicine, Bellevue Hospital Center/New York University Medical Center
Turandot Saul, MD is a member of the following medical societies: American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Ami K Davé, MD, Assistant Professor, Department of Emergency Medicine, New York University School of Medicine; Assistant Residency Director, Department of Emergency Medicine, New York University/Bellevue Hospital Center
Ami K Davé, MD is a member of the following medical societies: American Association of Physicians of Indian Origin
Disclosure: Nothing to disclose.

Medical Editor

Robert M McNamara, MD, FAAEM, Professor of Emergency Medicine, Temple University; Chief, Department of Internal Medicine, Section of Emergency Medicine, Temple University Hospital
Robert M McNamara, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, Pennsylvania Medical Society, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Mark Zwanger, MD, MBA, Assistant Professor, Department of Emergency Medicine, Thomas Jefferson University
Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD, Associate Professor, Program Director, Department of Medicine, Division of Emergency Medicine, University of California at Los Angeles School of Medicine
Pamela L Dyne, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.