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Endometriosis is defined as the presence of endometrial like tissue outside the uterus , which includes a chronic , inflammatory reaction ( Kennedy et al 2005 )
Thought to affect 6 to 10 % of the general population.
PathophysiologyChronic estrogen or progestogen responsive inflammatory disease associated with pain symptoms and infertility 
( Barra F et al 2018 ) Other theories
○ retrograde menstruation
○ metaplasia
○ implantation theory
○ induction theory
○ immune dysfunction
○ stem cell 
○ genetics
○ apoptosis suppression and alteration of endometrial cell fate
When to suspectchronic pelvic pain period related pain ( dysmenorrhoea ) affecting daily activities and QOL deep pain during or after sexual intercourse period-related or cyclical gastro-intestinal symptoms , in particular , painful bowel movements period related or cyclical urinary symptoms , in particular , blood in urine or passing urine infertility in association with 1 or more of above
Referral they have severe , persistent or recurrent symptoms of endometriosis pelvic signs of endometriosis OR initial management is not effective , not tolerated or in contraindicated if they have suspected or confirmed deep endometriosis involving the bowel , bladder or uterus consider referring young women ( aged 17 & under ) with suspected or confirmed endometriosis
Management Analgesia e.g paracetamol or NSAID or both Hormonal manipulation – suppress menstruation and suppress pain
contraceptive preparations e.g COCP
GnRH agonists – suppress ovarian activity and induce a hypo-oestrogenic state Laparoscopic surgery Emotional and psychological support


PIL from Royal College of Obstetricians and Gynaecologists
American College of Obstetricians and Gynecologists on endometriosis
Endometriosis UK a large charity provides information and support for patients with endometriosis – advise patients to look at the publications section which has some very useful leaflets
A global forum for news and information about endometriosis
Pelvic Pain Support Network on Endometriosis
Endometriosis Foundation of America
NICE guideline

ACOG Updates Guideline on Diagnosis and Treatment of Endometriosis 2011

Diagnosis and management of endometriosis: a
systematic review of international and national
guidelines M Hirsch,a,b MR Begum,a E Paniz,  a C Barker,c CJ Davis,a JMN Duffyd,e
A vast collection of all guidelines from Geneva Foundation for Medical EducationResearch

  1. Endometriosis : diagnosis and management NICE Guideline 73 September 2017
  2. ESHRE Management of women with endometriosis : Guideline of the European Society of Human Reproduction and Embryology Sept 2013

  3. Endometriosis: implications of new guidelines for general practice Dr Jessica Garner British Journal of Family Medicine, 6 (1), January, 2018 BMJ 2017358 doi: (Published 06 September 2017)
  4.  Theories on the Pathogenesis of Endometriosis International Journal of Reproductive Medicine
    Volume 2014, Article ID 179515, 9 pages
  5.  2018 Apr;14(4):399-415. doi: 10.1080/17425255.2018.1461840. Epub 2018 Apr 10.Current understanding on pharmacokinetics, clinical efficacy and safety of progestins for treating pain associated to endometriosis.



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