Women who suffer from endometriosis-related pain should be treated first with conservative, nonsurgical approaches and then with more invasive options if pain does not resolve, and with hysterectomy only as a last resort, according to a practice bulletin issued by the American College of Obstetricians and Gynecologists (ACOG) and published in the July issue of Obstetrics & Gynecology, reported HealthDay News.

Tommaso Falcone, MD, of the Cleveland Clinic, led the ACOG Committee on Practice Bulletins in assembling an updated guide on the incidence of endometriosis and recommendations for diagnosis and management of the condition.

The authors reported that endometriosis occurs in 6% to 10% of reproductive-age women, appearing in 38% of infertile women, and 71% to 87% of women reporting chronic pelvic pain. They recommended vaginal ultrasound as the best method for diagnosing the presence of endometriosis, but wrote that laparoscopic surgery is the only way to definitely diagnose the condition. According to the bulletin, medications such as oral contraceptives and nonsteroidal anti-inflammatory drugs should be a first line of treatment, followed by gonadotropin-releasing hormone agonists, and then surgery if less invasive methods fail, with hysterectomy used only as a last resort.

“If a woman has completed having children and all other conservative treatments haven't worked to stop the pain, she may consider having her uterus removed,” Dr. Falcone said in a press release. “If both ovaries are normal and all of the visible endometriosis is removed, then consideration should be given to conserving them.”