What is included in emergency department (ED) care of endometriosis?

Updated: Nov 06, 2018
  • Author: Turandot Saul, MD; Chief Editor: Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE  more...
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Answer

Answer

The goal of the emergency physician is to provide pain relief and exclude life-threatening causes of pelvic/abdominal pain. Unstable patients require resuscitation and possibly urgent surgical consult.

Medical management in the ED generally is restricted to pain control. Long-term medical therapy usually is suppressive and rarely curative.

Medical treatments for endometriosis act in a variety of ways to abolish the trophic effect of estradiol on the eutopic and ectopic endometrium. Therefore, the patient develops amenorrhea, because all endometrial tissue becomes inactive.

Although medical treatment can relieve symptoms, the recurrence rate is high after cessation of medications. [7]  All medical treatments are equally effective in managing endometriosis; about 80-85% of patients note improvement in their symptoms. The main difference between medical treatments is their side-effect profile.

Medical treatments include nonsteroidal anti-inflammatory drugs (NSAIDs), progestins (ie, medroxyprogesterone), combination estrogens and progestins, synthetic androgens (ie, danazol), and gonadotropin-releasing hormone analogues with or without hormone replacement therapy. Alternative therapies such as transcutaneous electrical nerve stimulation (TENS) (acupuncture-like TENS, self-applied TENS) may be effective complementary treatments for women with deep endometriosis who have persistent pelvic pain and/or deep dyspareunia despite undergoing hormone therapy. [8]

Urgent acute complications of endometriosis during pregnancy include spontaneous hemoperitoneum and bowel and ovarian complications that often require operative intervention. [3]

Surgical management can be either conservative (ie, laparoscopy with lysis of adhesions) or definitive (ie, total abdominal hysterectomy with bilateral salpingo-oophorectomy [TAH/BSO]).

The fact that TAH/BSO relieves the symptoms of endometriosis is well established. In some cases, however, not all of the endometrial tissue implanted outside the uterus can be removed, and symptoms may persist.

Patients may require surgery involving dissection of the urinary tract, bowel, and/or rectovaginal septum.

There is some degree of recurrence even after surgical therapy. [7]

Stable patients with the presumptive diagnosis of endometriosis require gynecologic referral for long-term management. [9, 10]


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