Current guidelines for treatment of endometriosis without laparoscopy.

The role of laparoscopy in the diagnosis and medical treatment of endometriosis is changing. Diagnosis based on laparoscopic visualization of endometriotic implants alone is unreliable. However, clinical diagnosis based on noninvasive techniques such as history, symptoms and physical examination is correct in 78-87% of cases. The current approach to treatment of chronic pelvic pain in Italy involves first-line treatment with oral contraceptives or nonsteroidal antiinflammatory drugs. Second-line treatment involves gonadotropin-releasing hormone (GnRH) agonists administered with or without add-back therapy. Current guidelines suggest that in the absence of adnexal masses, estrogen-progesterone combinations can be administered without the need for preliminary laparoscopy.