Endometriosis and Pelvic Pain for the Gastroenterologist

Gastroenterol Clin North Am. 2022 Mar;51(1):195-211. doi: 10.1016/j.gtc.2021.10.012. Epub 2022 Jan 8.

Abstract

Endometriosis, affecting 5-10% of reproductive-age women, is a common contributor to dysmenorrhea and chronic pelvic pain. Diagnosis requires laparoscopic tissue biopsy, but careful pelvic examination, and/or imaging with either ultrasound or MRI, may identify patients who should receive empiric first-line therapy. The presence of dyschezia, particularly with cyclical exacerbation, should raise suspicion for bowel or rectovaginal septum involvement, and a greater need for surgical management. Treatment of dysmenorrhea includes hormonal suppression of the menstrual cycle, and/or analgesics; more severe cases with strong pain and disability may require earlier surgical intervention to excise disease while preserving fertility desires.

Keywords: Dyschezia; Endometriosis; Hormonal therapy; Laparoscopy.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Dysmenorrhea / diagnosis
  • Dysmenorrhea / etiology
  • Dysmenorrhea / therapy
  • Dyspareunia*
  • Endometriosis* / complications
  • Endometriosis* / diagnosis
  • Endometriosis* / surgery
  • Female
  • Gastroenterologists*
  • Humans
  • Laparoscopy* / methods
  • Pelvic Pain / diagnosis
  • Pelvic Pain / etiology
  • Pelvic Pain / therapy