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OB/GYN
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Endometriosis Management
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NSAIDs + OCPs vs laparoscopy for definitive diagnosis.
Decision
Outcome
Decision
Chronic pelvic pain, dysmenorrhea, deep dyspareunia, dyschezia. First step?
✓
Assess for need for definitive diagnosis (infertility, medical-therapy contraindication, malignancy/adnexal mass concern)
Decision
Any of those concerns?
✓
Yes → laparoscopy for diagnosis ± excision/ablation
✓
No → empirically treat with NSAIDs + oral contraceptives
Outcome
Laparoscopy is gold standard; ablation/excision improves pain
Outcome
NSAIDs + combined OCPs (or progestin-only); GnRH agonists/antagonists second-line
Add-back therapy (low-dose hormones) with GnRH agonists to limit menopausal symptoms.