ABSTRACT
This chapter examines the epidemiology, pathogenesis and clinical features of endometriosis. It deals mainly with the management of pain in endometriosis, which has attracted a large literature and for which evidence-based management is relatively well developed. Endometriosis is an oestrogen-dependent inflammatory condition and is a disease which affects women of reproductive age with regression after the menopause. The commonest presenting symptoms of endometriosis are dysmenorrhoea, chronic cyclical or non-cyclical pelvic pain, deep dyspareunia and infertility. Laparoscopy, backed up by biopsy, is regarded as the 'gold standard' investigation for diagnosis of endometriosis. There is a large evidence base supporting the use of medical therapy in the management of endometriosis-associated pain. Progestogens given continuously inhibit ovulation, depending on dosage, and have direct antiproliferative effects on endometriotic implants, causing decidualisation and eventual atrophy. Hormonal therapies are effective for relief of endometriosis-associated pain. Chronic pelvic pain in endometriosis may be resistant to hormonal suppression.
