Consensus statement for the management of chronic pelvic pain and endometriosis: proceedings of an expert-panel consensus process

Gambone, Joseph C; Mittman, Brian S; Munro, Malcolm G; Scialli, Anthony R; Winkel, Craig A; the Chronic Pelvic Pain/Endometriosis Working Group,

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Volume 78, Issue 5 , Pages 961-972, November 2002

Consensus statement for the management of chronic pelvic pain and endometriosis: proceedings of an expert-panel consensus process

Joseph C Gambone (D.O., M.P.H.)
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Corresponding author: Joseph C. Gambone, D.O., M.P.H., Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, California 90095-1740 (FAX: 310-206-3670), USA
Brian S Mittman, Ph.D.
- Department of Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, California, USA
- RAND Health, Santa Monica, California, USA
Malcolm G Munro, M.D.
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
Anthony R Scialli, M.D.
- Georgetown University School of Medicine, Washington, D.C., USA
Craig A Winkel, M.D., M.B.A.
- Georgetown University School of Medicine, Washington, D.C., USA
the Chronic Pelvic Pain/Endometriosis Working Group

Received 2 April 2002; received in revised form 11 July 2002; accepted 11 July 2002.

Abstract

Objective: To develop recommendations for the medical and surgical care of women who present with chronic pelvic pain (CPP) and are likely to have endometriosis as the underlying cause.

Design: An expert panel comprised of practicing gynecologists from throughout the United States and experts in consensus guideline development was convened. After completion of a structured literature search and creation of draft algorithms by an executive committee, the expert panel of >50 practicing gynecologists met for a 2-day consensus conference during which the clinical recommendations and algorithms were reviewed, refined, and then ratified by unanimous or near-unanimous votes.

Patient(s): Women presenting with CPP who are likely to have endometriosis as the underlying cause.

Main Outcome Measure(s): None.

Conclusion(s): Chronic pelvic pain frequently occurs secondary to nongynecologic conditions that must be considered in the evaluation of affected women. For women in whom endometriosis is the suspected cause of the pain, laparoscopic confirmation of the diagnosis is unnecessary, and a trial of medical therapy, including second-line therapies such as danazol, GnRH agonists, and progestins, is justified provided that there are no other indications for surgery such as the presence of a suspicious adnexal mass. When surgery is necessary, laparoscopic approaches seem to offer comparable clinical outcomes to those performed via laparotomy, but with reduced morbidity. The balance of evidence supports the use of adjuvant postoperative medical therapy after conservative surgery for CPP. There is some evidence that adjuvant presacral neurectomy adds benefit for midline pain, but currently, there is inadequate evidence to support the use of uterosacral nerve ablation or uterine suspension. Hysterectomy alone has undocumented value in the surgical management of women with endometriosis-associated CPP.

Keywords: Pain, endometriosis, guidelines, consensus