Diagnosis and treatment of endometriosis.

Endometriosis is a progressive disease affecting 5 to 10 percent of women. It can cause dyspareunia, dysmenorrhea, low back pain and infertility. A definitive diagnosis can be made only by means of laparoscopy. Medical treatment designed to interfere with ovulation generally provides effective pain relief, but the recurrence rate following cessation of therapy is high, and this type of treatment will not resolve infertility. Surgical treatment improves pregnancy rates and is the preferred initial treatment for infertility caused by endometriosis. Surgery also appears to provide better long-term pain relief than medical treatment. Bilateral oophorectomy and hysterectomy are treatment options for patients with intractable pain, if childbearing is no longer desired.