Empirical therapy with leuprorelin acetate for endometriosis in the United States.

Trends in the use of laparoscopy as a diagnostic and treatment tool for endometriosis are changing in the United States and the use of empirical treatment for chronic pelvic pain is on the rise. Although it is regarded as the gold standard for the diagnosis of endometriosis, laparoscopy has a positive predictive value of only 43-45%. Furthermore, chronic pelvic pain can be treated medically without a diagnosis confirmed by laparoscopy and histology. Therapy with the gonadotropin-releasing hormone (GnRH) agonist leuprorelin acetate is effective in relieving pelvic pain regardless of the presence of endometriosis. The current treatment algorithm for chronic pelvic pain in the United States comprises physical examination, medical history and ultrasound, and if the cause of the pain is not identified, treatment with oral contraceptives and nonsteroidal antiinflammatory drugs is undertaken. On lack of response to these treatments, GnRH agonist therapy is initiated. The American College of Obstetrics and Gynecology supports therapy with GnRH agonists in the management of women with chronic pelvic pain, even in the absence of confirmation of endometriosis, provided that a detailed investigation reveals no other cause of the pain. Laparoscopy is the final option if pain is not relieved by medical treatments.