Endometriosis
Clinical detail
Additional detail checked 2026-10-17 against the linked sources. This check covers the section below; the rest of the module retains its displayed verification status.
Endometriosis can produce disabling cyclical or persistent pain even when the initial examination or ultrasound is normal. Management should follow symptoms, quality of life and fertility priorities rather than stage alone.
Assessment & interpretation
- Ask about dysmenorrhoea affecting normal activities, deep dyspareunia, cyclical bowel or urinary symptoms, infertility and family history.
- Offer transvaginal ultrasound to assess endometriomas, deep disease and alternative pathology. A normal scan does not exclude endometriosis; do not use CA125 as its diagnostic test.
Decisions that change management
- Investigation and referral can run alongside initial symptom treatment. Refer when symptoms persist, impair daily life, or treatment is ineffective or unsuitable.
- Suspected endometrioma, deep disease involving bowel/bladder/ureter or disease outside the pelvis warrants specialist endometriosis care.
- When conception is the immediate goal, hormonal suppression is not a treatment to improve spontaneous pregnancy rates; involve fertility expertise.
Follow-up & safety-netting
- Review pain, function, medication effects and reproductive plans. A symptom diary can make changes clearer.
- Discuss ovarian reserve and fertility before ovarian surgery. Some deep lesions and endometriomas need outpatient monitoring even when surgery is deferred.
Admission & discharge
Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.
When admission or continued hospital care is needed
- Uncontrolled acute pain, systemic illness, heavy bleeding, bowel/urinary obstruction concern or another surgical diagnosis requires hospital assessment.
When clinic, day care or home care may be suitable
- Stable pain/fertility symptoms can be assessed and managed through a planned gynaecology/endometriosis service.
Before going home
- Pain is manageable on a feasible oral plan, no unresolved acute complication is present and the investigation/specialist review plan is agreed.
- After surgery, document what was done, any bowel/bladder involvement and the relevant postoperative criteria.
Discharge medicines and treatment changes
- Reconcile the chosen analgesic/hormonal treatment with fertility goals, pregnancy possibility and contraindications. Provide stop/review dates for short-term treatment.
Medicine doses — use only when indicated
Use the medicines selected for this patient. Listed alternatives are not instructions to prescribe all of them together. Confirm the actual remaining course, pregnancy/postnatal context and monitoring plan.
Selected short-term oral pain relief when appropriate.
- Indication: Short-term maternal postoperative/postpartum pain or other mild pain after assessment; adult ≥50 kg
- MSF oral monograph: no pregnancy or breastfeeding contraindication. The dose does not replace assessment of the cause of pain.
- Pain and functional recovery; investigate increasing pain, fever or other warning symptoms.
- Check all prescribed/OTC paracetamol, weight and hepatic risk; suspected excess dosing requires urgent assessment.
Tests, pending results and their reviewer
- Assign imaging, histology and fertility-related results; persistent symptoms need reassessment even if initial testing is reassuring.
Home care and counselling
- Give a pain/flare plan, activity guidance after surgery and a route to specialist support.
Follow-up: when and what to review
| When | Action / responsible service |
|---|---|
At the booked gynaecology/endometriosis review | Assess treatment response, adverse effects and fertility priorities. |
After surgery | Review histology and any bowel/urinary/wound recovery plan at the agreed appointments. |
Return urgently
- Worsening severe pain, fever, vomiting, inability to pass urine, heavy bleeding or postoperative breathlessness needs urgent assessment.
Treatment
① Immediate stabilization — first minutes
Acute pain -> exclude torsion/ruptured endometrioma.
③ First-line treatment & drug regimens
| Line | Therapy |
|---|---|
First (pain) | NSAIDs + CHC (cyclic/continuous) OR progestogens (LNG-IUS/DMPA/norethisterone) |
Second | Dienogest 2 mg daily (contemporary strong option) OR GnRH agonist WITH ADD-BACK limited course |
Surgery | Laparoscopic excision/ablation; cystectomy endometrioma >4 cm symptomatic |
Definitive treatment
Definitive excision ± hysterectomy/oophorectomy completed-fertility refractory (HRT nuance). Subfertility: surgery then timed attempts/ART by severity.
Monitoring
- Symptom diaries; bone density awareness repeated GnRH
⑮ Complications & their management
Deep infiltrating disease (bowel/ureter)
Tertiary multidisciplinary surgery ONLY
Rare malignant change
Postmenopausal enlarging endometrioma -> oncology pathway
Post-treatment care
- Suppression continues until conception/menopause; fertility counselling
Diagnosis & assessment
- Haemodynamic instability / severe anaemia -> acute pathway
Sources (8)
2021-07 · updated 2025-12-22 (page review; guidance itself unchanged) · checked 2026-08-23 · verified-live
Open source ↗
CDC pages + wall chart: uncomplicated gonorrhoea cervix/urethra/rectum → ceftriaxone 500 mg IM single dose (<150 kg; 1 g if ≥150 kg); pharyngeal same; conjunctivitis 1 g IM; DGI 1 g IV/IM q24h; PID outpatient → ceftriaxone 500 mg IM ×1 + doxycycline 100 BD ×14 d + metronidazole 500 BD ×14 d; chlamyd…
06 September 2017 · updated 11 November 2024 · checked 2026-10-18 · verified-live
Open source ↗
Scope: additional clinical-detail explanation for endometriosis. Checked the assessment, management-decision and follow-up statements in that section against this source. This does not certify all pre-existing regimens, calculations or recommendations in the module. Additional admission/discharge ch…
· checked 2026-10-18 · verified-live
Open source ↗
Full primary patient recovery page read: pain control, wounds, activity/VTE, urinary/bowel and infection warning signs, adult support and no driving/important decisions during the first 24 hours after general anaesthesia. Used as general recovery/handover principles, not operation-specific discharge…
· checked 2026-10-18 · verified-live
Open source ↗
Full primary oral monograph read: adult 1 g 3–4 times daily, maximum 4 g/day, ≥50 kg adult table, 500 mg tablets, duration according to response, hepatic caution and pregnancy/breastfeeding. Pain chapter also checked for 6–8-hour interval. Smaller adults require an individual weight-based prescripti…
· checked 2026-10-18 · verified-live
Open source ↗
Maternal/newborn transfer assessment, first void and effective feeding, handover, support/safeguarding, first midwife visit within 36 hours after transfer, postnatal danger symptoms. Full recommendations page read.
· checked 2026-10-18 · verified-live
Open source ↗
Normal-delivery discharge not less than 48 hours: full primary SOP PDF normal-delivery/discharge passages read. Corroborated by NHM CEmONC 2024 Part 1, chapter 8. This does not define a universal post-caesarean or complicated-case stay.
· checked 2026-10-18 · verified-live
Open source ↗
Official WHO summary read: at least 24-hour facility care after birth; additional contacts at 48–72 hours, 7–14 days and week 6; individual assessment/support. Summary facts only, not a claim that the full 242-page PDF was reviewed.
· checked 2026-10-18 · verified-live
Open source ↗
Full primary recommendations read, focusing on critical-care-to-ward transfer: structured written handover, shared plan, monitoring, rehabilitation and receiving-team capability. Step-down is distinct from home discharge; no universal organ-support discharge cutoff is asserted.