Treat endometriosis pain as a chronic condition.(Gynecology)

SANTA FE, N.M. -- No treatment option for endometriosis is likely to provide permanent relief from pelvic pain, and patients should be warned accordingly before undergoing surgery for the condition, Stephen M. Cohen, M.D., advised.

"When we are going to do surgery on a patient who has this disease, we have to tell her, 'This is a chronic disease. I am there to make you feel better but not to cure you,'" he suggested at a conference on gynecologic surgery sponsored by Omnia Education.

"If they expect a cure, you will be the 14th doctor on the hit parade that the patient has gone to and been dissatisfied with," warned Dr. Cohen, chief of the division of gynecology and director of women's minimal access surgery at Albany (N.Y.) Medical College.

Pain will recur in about a third of patients within 2 years of surgery. Pain and stage are unrelated, however, and the causes of endometriosis are unclear. "Stage I hurts as much as stage IV," he said, reporting that the least pain is associated with black lesions, the worst with red lesions.

When a patient complains of pelvic pain, Dr. Cohen said that empiric therapy--"treating without looking"--is an option. A thorough work-up is essential, however, to rule out all other possible causes, including fibromyalgia and depression.

"In point of fact, you will be right in diagnosing endometriosis 75% of the time without putting the laparoscope in," he said. "If you include infertility and pain, you will be right 85% of the time."

The preferred medical treatment of endometriosis is leuprolide, but surgery can help some patients, according to Dr. Cohen. Conservative treatment with excision, ablation, or both can be ...