Safety of medical and surgical management of chronic pelvic pain and endometriosis

Objective: About 400,000 laparoscopies are performed each year for chronic pelvic pain (CPP) and endometriosis, and an estimated 2.3 million women take prescription drugs for CPP or endometriosis. Although the safety of medical interventions is relatively well established, fewer data are available on complications of surgery. This study evaluates the relative safety of both treatment modalities. Methods: A comprehensive review of available data on medications and surgery was performed. Results: Complications from surgical or medical interventions are unusual. Although few data are available on surgical complications, it has been reported that about 6% of women with deep endometriosis require bowel surgery following endoscopic excision with a CO2 laser. Moderate or severe constipation is common following laparoscopic presacral neurectomy. More data exist on safety profiles of medications, for which statistically and clinically significant adverse events are variable in frequency and severity. Oral contraceptives alone were associated with ocular effects, while only danazol stimulated androgenlike effects. Conclusion: Although complications from medical or surgical treatment of CPP and endometriosis generally are rare, no intervention is without risk. To evaluate the risks and benefits of each modality, physicians and patients can consider whether the risks are acceptable for the degree of efficacy anticipated.