Endometriosis, 1995--confusion or sense?

OBJECTIVE

To review current understanding of endometriosis.

METHOD

A review of etiology, pathogenesis, relationship with infertility, medical and surgical treatment.

RESULTS

It is likely that endometriosis occurs in most women at some stage in their reproductive years. Exposure to menstruation and estrogen are important etiologically. Current evidence suggests that implantation of menstrual endometrium is the commonest mechanism of pathogenesis. Clinical symptoms and signs are important in the diagnosis while laparoscopy remains the prime diagnostic technique. Treatment is not indicated for infertility but is for symptoms. Danazol and progestogens represent the best first-line therapy although gonadotropin-releasing hormone agonists are appropriate if economically justifiable. Both open and laparoscopic surgery are important especially in reconstructive work. The value of laser ablation in the treatment of infertility is unknown but it is effective in pain. The disease should be regarded as a recurrent problem and treatment strategies designed appropriately.

CONCLUSION

Endometriosis still represents an intellectual and therapeutic challenge but successful treatment is possible especially if it is individualized for each patient.