Medical management of endometriosis-associated pain

Endometriosis-associated pain is among the most challenging conditions in gynecologic practice. It may be found in up to 60% of women with dysmenorrhea and 40% to 50% of women with pelvic pain or dyspareunia [1]. Despite this high prevalence, diagnosis is often delayed because of the need for surgical confirmation. When treatment is initiated it often achieves only partial success. Frequently, various treatments are attempted, tolerated to varying degrees, and rejected. This cycle may result in increasing frustration felt by the patient and the physician. It is not unusual for the resulting sense of despair to sever physician-patient relationships. This need not be the case. In recent years, various new insights into the medical treatment of endometriosis-associated pain have been gained. These developments should allow most women with endometriosis to find suitable relief. It is incumbent on physicians who provide gynecologic services to women of reproductive age to be intimately familiar with these treatments and the nuances of medication delivery and combination therapy.