E‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍ndometriosis is a common cause of gynecologic associated ch

E‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍ndometriosis is a common cause of gynecologic associated chronic pelvic pain. “Endometriosis is characterized by endometrial glands and stroma outside the endometrial cavity that respond to the cyclical hormonal fluctuations of the menstrual cycle resulting in swelling and local inflammation” (Schadewald et al., 2020, p. 346). Lesions caused by endometriosis are found primarily on the rectovaginal septum, ovaries, and pelvic peritoneum (Schadewald et al., 2020). Symptoms associated with endometriosis include chronic pelvic pain, infertility, dysmenorrhea, and deep dyspareunia (Schadewald et al., 2020). Endometriosis should be suspected in women who experience dysmenorrhea that is not responsive to NSAIDs or oral contraceptives (Schadewald et al., 2020). There is also an association between endometriosis and infertility. It is estimated that 30 to 50% of women struggling with infertility have either known or undiagnosed endometriosis (Schadewald et al., 2020). Symptom severity varies and often there is no direct relationship with the stage of endometriosis present (Schadewald et al., 2020). Some women with minimal disease have debilitating pain whereas some women with more severe disease exper‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍ience very little pain or other symptoms (Schadewald et al., 2020). Treatment includes birth control pills, NSAIDS, mirena, progestins, Gonadotropin-releasing hormone, and danazol (Schadewald et al., 2020). Referral is indicated for laparoscopic diagnosis or when conservative medical management is not effective (Dunphy et al., 2019). Laparoscopy is the first line treatment standard for surgical intervention related to endometriosis (Zanelotti and Decherney, 2017). “Laparotomy conversion procedures are still performed in rare cases of difficult visualization with extensive disease and the need for multiple complex procedures involving other organ structures” (Zanelotti and Decherney, 2017, p. 1). Nurse practitioners are responsible for ensuring that a patient has a follow up referral sent out to a provider. Point of contact information should be given to both the patient and outside provider so an appointment can be scheduled. A follow up phone call should be made to the patient to ensure contact with the outside specialist. Nurse practitioners are also responsible to know the outcome of the referral appointment to appropriately follow the treatment plan and guidelines. please add 1 ‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍reference