Surgical management of endometriosis

Surgical management of endometriosis has assumed a prominent role in treating endometriosis-associated infertility and pain. Given the relative lack of prospective, randomized, controlled studies, firm conclusions regarding optimal treatment are difficult. With respect to infertility, the available data generally support surgical management as effective for all stages of disease. Ovarian suppression is usually ineffective and should not be used for endometriosis-associated infertility except in highly selected cases. The management of endometriosis-associated pain usually needs to be multifaceted with surgery being an important, but not the only, component. Except for selected young women responding to ovarian suppression, most patients should have diagnostic laparoscopy with concurrent surgical therapy. The decision to operate depends on clinical judgment, surgeon skill, and individual patient needs. A comprehensive long-term management plan incorporating various treatment modalities should be developed to optimize each patient's management with respect to pain, pelvic masses, and reproductive goals. More studies using sophisticated designs and statistical methods and basic science initiatives in endocrinology, immunology, and genetics are increasingly giving us better insight into endometriosis. With improved knowledge of this complex medical condition, more refined conclusions regarding optimal treatment approaches will become possible and enable clinicians to obtain better outcomes for their patients.