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Evaluation and Management of Women With Endometriosis

Winkel, Craig A. MD, MBA

Clinical Gynecologic Series: An Expert's View

Endometriosis is a condition that often leads to a variety of symptoms that range from pain complaints to infertility. Endometriosis is also found in women who are asymptomatic. The diagnosis of endometriosis can be made clinically with reliability similar to that of one made surgically. Medical treatment options are effective, as are surgical treatment options. Complications associated with surgery, however, push the balance in favor of medical therapy whenever possible. Based on the body of evidence available at present, women with endometriosis-related complaints should be treated with a first-line medical therapy. If that fails, a second-line medical therapy is warranted under most conditions. Laparoscopic surgery should be reserved for patients in whom second-line medical therapy has failed or is contraindicated by desire to conceive immediately or as soon as possible.

The diagnosis of endometriosis can be made most of the time asaccurately by clinical evaluation as by surgical intervention, and management, in most cases, should commence with medical rather than surgical therapy.

Department of Obstetrics and Gynecology, Georgetown University, Washington, DC.

Address reprint requests to: Craig A. Winkel, MD, MBA, Department of Obstetrics and Gynecology, Georgetown University, 3800 Reservoir Road NW, #3PHC, Washington, DC 20007; E-mail:

We thank the following individuals who, in addition to members of our Editorial Board, will serve as referees for this series: Dwight P. Cruikshank, MD, Ronald S. Gibbs, MD, Gary D. V. Hankins, MD, Philip B. Mead, MD, Kenneth L. Noller, MD, Catherine Y. Spong, MD, and Edward E. Wallach, MD.

Received May 2, 2002. Received in revised form December 18, 2002. Accepted December 26, 2002.

We have invited select authorities to present background information on challenging clinical problems and practical information on diagnosis and treatment for use by practitioners.

© 2003 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.