Endometriosis: recurrence and retreatment

Endometriosis, a condition in which endometrial tissue sheds and becomes attached to extrauterine sites, appears to be a progressive or recurrent disease. Although there are a variety of treatment options, the only cure for endometriosis is total abdominal hysterectomy with bilateral oophorectomy. For women who wish to preserve fertility, however, this is not a desirable choice. Because the symptoms of endometriosis suggest a hormonal relationship, pharmacologic management entails inducing anovulation. A concern of both physicians and patients is recurrence of endometriosis after initial response to therapy. Whether symptoms represent recurrent disease or progression of preexisting implants is still unknown. A repeat course of therapy with danazol, a synthetic androgen, may be tried for retreatment of endometriosis. Another option is the progestins. Conservative surgery (ie, laparoscopy) is also an option, but often must be repeated for pain control; combination pharmacologic/surgical therapy, although in widespread use, is not without disadvantages and requires further investigation.