A review of current management of endometriosis in 2006: an evidence-based approach

Endometriosis, a common cause of morbidity in reproductive age females, results in pelvic pain and infertility. Effective, evidence-based treatments of endometriosis-associated infertility include conservative surgical therapy and assisted reproductive technologies. In early stage endometriosis ovulation induction, with or without intrauterine insemination, improves pregnancy rates. In early stage disease in vitro fertilization reduces time to pregnancy as compared to controls, but does not increase the chance of pregnancy after three years. Endometriosis-associated pain can be approached with surgical or medical therapies. Conservative surgery maintains the reproductive organs and is an effective mode of treatment for endometriosis-associated pain. A more radical surgical approach of hysterectomy with bilateral salpingo-oophorectomy, not investigated in randomized controlled trials, remains a mainstay of therapy for endometriosis-associated pain in patients who have completed child-bearing. Current medical therapies rely upon interruption of normal cyclic, ovarian hormone production resulting in an environment not conducive to the growth of endometriosis. The current accepted therapies for endometriosis include danazol, progestational agents, oral contraceptive agents, and gonadotropin-releasing hormone analogues which all function similarly in relieving pain. The new era of genomics promises to help characterize endometriosis and allow one to tailor therapies based on a woman's symptoms and reproductive goals.