Surgical treatment and adjunct therapy of endometriosis

Conservative surgery at laparoscopy or laparotomy is effective against stage I-IV endometriosis to relieve pelvic pain and treat infertility. The subsequent average conception rate is 45-65%. Recurrence of endometriosis may occur, although pregnancy may delay this. Hysterectomy is indicated in severe disease, but the ovaries may be preserved if there is no evidence of active disease or significant periovarian adhesion. Combined surgery and pre- or postoperative medical therapy using gonadotropin releasing hormone agonists or danazol is recommended in young non-infertile women and those with extensive or severe disease.