Ep 214 Bridging the Gap in Endometriosis Care: Recognition, Risk Stratification, and ED-Initiated Management
Feb 25, 2026
Jennifer McCall, emergency medicine clinician scientist focused on endometriosis in acute care. Catherine Varner, minimally invasive gynecologic surgeon and endometriosis subspecialist. They discuss when endometriosis should top the differential for pelvic pain. They cover distinguishing flares from dangerous complications and common imaging pitfalls. They explain practical ED-initiated hormonal options and safe discharge strategies.
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Don't Send Home Persistent 10/10 Pelvic Pain
- Do not discharge someone with persistent 10/10 pelvic pain without reassessment for torsion and other emergencies.
- Catherine Varner and Anton Hellman stressed ovarian torsion is a clinical diagnosis and ultrasound can miss it, so manage pain and re-evaluate bedside findings.
Flares Are Common While Emergencies Are Rare
- Most ED presentations for suspected endometriosis are inflammatory flares; true emergent complications are uncommon (1–5%).
- Studies show 60–80% are flares, 20–40% delayed/misdiagnoses, and 1–5% are true complications like hemoperitoneum or ureteric obstruction.
Normal Ultrasound Does Not Exclude Endometriosis
- Remember normal ED pelvic ultrasound does not rule out endometriosis.
- Jennifer McCall explained standard ED imaging lacks endometriosis mapping sensitivity and specialty scans detect disease many ED ultrasounds miss.