Clinical Management of Endometriosis

Falcone T, Tommaso Falcone, Dan I. Lebovic
Obstetrics and gynecology · 2011 · vol. 118(3) , pp. 691–705 · doi:10.1097/aog.0b013e31822adfd1 · PMID:21860303 · W2332643287
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-07 ⓘ

This article reviews surgical and medical management strategies for endometriosis, addressing diagnosis, infertility, chronic pain, cancer risk, and postmenopausal hormone therapy.

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This review article examines the clinical management of endometriosis, a chronic gynecologic disorder characterized by pelvic pain and infertility. It highlights that definitive diagnosis requires surgery, while noting that medical therapy offers only short-term pain relief and does not improve fertility outside of assisted reproductive technology. The authors discuss the complexities of treating endometriomas due to potential reductions in ovarian reserve and emphasize the importance of complete surgical excision to minimize recurrence rates. This paper is centrally about endometriosis — specifically focusing on the diagnostic challenges, surgical techniques for lesion removal, and long-term management strategies for pain and disease recurrence.

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Abstract

Endometriosis is a common and challenging condition of reproductive-aged women that carries a high individual and societal cost. The many molecular dissimilarities between endometriosis lesions and eutopic endometrium create difficulties in the development of new drug therapies and treatments. Surgery remains the gold standard for definitive diagnosis, but it must be weighed against the risks of surgical morbidity and potential decreases in ovarian reserve, especially in the case of endometriomas. Safe and effective surgical techniques are discussed within this article for various presentations of endometriosis. Medical therapy is suppressive rather than curative, and regimens that are long-term and affordable with minimal side effects are recommended. Recurrences are common and often rapid when medical therapy is discontinued. Endometriosis in the setting of infertility is reviewed and appropriate management is discussed, including when and whether surgery is warranted in this at-risk population. In patients with chronic pain, central sensitization and myofascial pain are integral components of a multidisciplinary approach. Endometriosis is associated with an increased risk of epithelial ovarian cancer; however, the risk is low and currently no preventive screening is recommended. Hormone therapy for symptomatic women with postsurgical menopause should not be delayed as a result of concerns for malignancy or recurrence of endometriosis.
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Clinical Management of Endometriosis - Tommaso Falcone - Dan I. Lebovic Endometriosis is a relatively common chronic gynecologic disorder that usually presents with chronic pelvic pain or infertility. The societal effect of this disorder is enormous both in monetary costs and in quality of life. The diagnosis of the disease can only be definitively made with surgical intervention. Fertility may be enhanced with surgical intervention, but medical suppressive therapy has no role apart from in vitro fertilization. Assisted reproductive technology is associated with excellent outcomes. Management of endometriomas is particularly complex because surgical intervention may reduce ovarian reserve. Both medical and surgical treatment of endometriosis-associated chronic pelvic pain are effective in the short-term. Recurrence is common with both modalities. Recurrence after surgical intervention can be decreased with the use of postoperative suppressive medical therapy such as hormonal contraceptives. This article presents the different types of peritoneal disease found in endometriosis patients. The technique used to safely and completely remove the disease is discussed. The specific areas of involvement include the pelvic side wall, the cul-de-sac, and bladder peritoneum.

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Condition tags

endometriosischronic_pelvic_paininfertility

MeSH descriptors

Endometriosis Adult Drug Therapy, Combination Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Female Fertilization in Vitro Gonadotropin-Releasing Hormone Gonadotropin-Releasing Hormone Humans Infertility, Female Infertility, Female Laparoscopy Pelvic Pain Pelvic Pain Pelvic Pain

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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