eMedicine Specialties > Pediatrics: Surgery > Gynecology

Endometriosis: Follow-up

Author: Tod C Aeby, MD, Generalist Division Director, Assistant Professor, Department of Obstetrics, Gynecology and Women's Health, University of Hawaii, John A Burns School of Medicine
Coauthor(s): Mark K Y Hiraoka, MD, Assistant Professor of Obstetrics and Gynecology, University of Hawaii; Consulting Staff, Department of Obstetrics and Gynecology, Queen's Medical Center
Contributor Information and Disclosures

Updated: May 15, 2006

Follow-up

Further Inpatient Care

• Management of this disease is largely outpatient.
• In patients who underwent surgery for endometriosis (or had endometriosis discovered during surgery for another indication), consider adjuvant medical treatment (see Medical Care). At a minimum, place these patients on oral contraceptive pills until they are ready to conceive.

Further Outpatient Care

• Start patients with classic symptoms of endometriosis and no reason to suspect another cause on medical therapy.
• Surgical diagnosis is not always required.
• Lack of rapid response (within 1-2 cycles) to medical therapy should prompt a search for other causes of the patient's symptoms.
• Consider diagnostic laparoscopy if it has not been performed previously.

Transfer

• Treat these patients in consultation with a physician experienced in the diagnosis and management of endometriosis and its complications.

Deterrence/Prevention

• No current methods of prevention are known.
• Some evidence suggests that rapid and aggressive medical or surgical therapy can arrest progression, especially when the disease is caught in the early (minimal-to-mild) stages.
• Early and prolonged use of oral contraceptive pills, pregnancy, and breast-feeding seem to afford some degree of protection against this disease.

Complications

• Complications of this disease fall into the following 3 categories:
  • Pain and subsequent disability
  • Anatomic disruption of involved organ systems
  • Infertility or subfertility

Prognosis

• Endometriosis is generally a progressive disease.
• The extent of progression and subsequent morbidity is unpredictable.
• While most patients (up to 95% in some studies) respond to medical therapy, as many as 50% have a return of symptoms within 5 years.
• Minimally invasive surgical therapy affords better fertility rates but is not as effective at eliminating pain.
• Definitive surgical therapy (total hysterectomy with bilateral salpingo-oophorectomy and peritoneal stripping) offers the best chance for long-term resolution of pain. Obviously, reserve this option as a last resort in patients with completely incapacitating disability or no desire for future childbearing.

Patient Education

• Stress the importance of continuing medical therapy for the full 6-month course.
• Medical therapy often relieves pain but induces uncomfortable adverse effects, and the patient needs encouragement to complete the course of treatment.
• Recurrence of symptoms after therapy should prompt the patient to return for further evaluation.
• Teach patients with severe disease about the symptoms of bowel and ureteral obstruction.
• The National Institutes of Health (NIH) is currently conducting a clinical trial to research new treatments for endometriosis. Patients who are interested in participating in this study may visit http://endometriosis.nichd.nih.gov/ for more information.
• For excellent patient education resources, visit eMedicine's Women's Health Center. Also, see eMedicine's patient education articles Female Sexual Problems, and Endometriosis.

Miscellaneous

Medicolegal Pitfalls

• Any postpubertal patient going to the operating room for acute or chronic pelvic/abdominal pain could have endometriosis. Consultation with a physician having the experience to recognize, diagnose, and treat this disease is prudent. Conservation of future fertility may be dependent on the conservative and meticulous surgical approach of an expert reproductive surgeon.
• Consider performing a pregnancy screening test.

Special Concerns

• While most pediatric patients are not currently interested in becoming pregnant, subsequent fertility is likely a major concern. Evidence is mounting that early and aggressive therapy may alter the course of this disease. Investigate moderate-to-severe dysmenorrhea that is unresponsive to NSAIDs and pelvic pain persisting longer than 3 months.

• Search for CME/CE on This Topic »

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