Pain and infertility--a rationale for different treatment approaches

Endometriosis may result in pain and/or infertility in some patients, while others may remain asymptomatic. The disease appears to progress and regress somewhat unpredictably, making it difficult to determine the appropriate treatment. Progression of the disease can be altered by medical and surgical treatments used according to general guidelines but selected for the individual. Coagulation, medical suppression and observation are frequently the first approaches to infertility or pain resulting from endometriosis. Deep dissection and excision may be indicated with deep disease, persistent pain or persistent tenderness.