It has low sensitivity for detecting focal endometriotic lesions. MRI has a higher sensitivity for detecting pelvic masses than ultrasound but is limited in identifying diffuse pelvic endometriosis. Hysterosalpingography may reveal tubal occlusion or periadnexal adhesions. Laparoscopy is the criterion standard for definitive diagnosis of endometriosis. Hallmark findings are the classic powder burn, blue-black lesions.
Unstable patients require resuscitation and urgent surgical consultation.
Stable patients with the presumptive diagnosis of endometriosis require gynecologic referral for long-term management. Medical management in the ED generally is restricted to pain control. Long-term medical therapy usually is suppressive and rarely curative of endometriosis because the recurrence rate is high after cessation of medications. Do not place patients on danazol or GnRH agonists unless they are monitored by a physician and have a laparoscopically confirmed diagnosis of endometriosis. Ovulation suppression occurs with medical management.