Best investigation to establish the diagnosis of endometriosis is

Ans. is a i.e. Laparoscopy Diagnostic laparoscopy is the gold standard for diagnosing endometriosis. Typical lesion : Powder burn / gun shot lesions (black, dark brown or bluish cysts with old hemorrhage surrounded by variable degree of fibrosis). Other non typical findings could be : - Red implantsdeg - Serous or clear vesicles White plaques / scarring] - Yellowish brown discolouration of peritoneumdeg Sub ovarian adhesionsdeg. Histological confirmation of laparoscopic impression is essential for diagnosis of endometriosis. Danazol By its multiple effects, produces a high androgen & low estrogen environment that does not suppo the growth of endometriosis. It inhibits pituitary gonadotropins & produces pseudo menopause like state. Danazol is not more effective than other available medications to treat endometriosis. Due to its androgenic propey has significant side effect like weight gain, fluid retention, acne oily skin, hirsutism, hot flashes, atrophic vaginitis, reduced breast-size. reduced libido, fatigue, muscle cramps. Deepening of voice is an rreversible side effect. Gestrinone It is a 19 noesto sterone derivative. It acts centrally & peripherally to increase free testosterone, reduce SHBG. serum estradiol & LH which inturn obliterates LH & FSH surge. Its actions are similar to Danazol but is longer acting. So, can be given twice weekly. Side effects - similar to Danazol but less intense. Gonadotropin releasing hormone agonist When given continously suppress pituitary gonadotropin. They are inactive orally; & have to be given intramuscular, intra nasal or subcutaneous. Side effects due to hypo estrogen are hot-flashes, vaginal dryness, reduced libido and osteoporosis. GnRH should not be prescribed to girls who have not yet attained their maximum bone density (i.e., in age < 16 years).