Deep ovarian endometriosis: controversial and unresolved issues

Endometriosis is one of the most controversial diseases in contemporary medicine. This especially concerns ovarian endometriosis. With the introduction of new World Health Organization (WHO) classifications, both clinical (ICD-11) and pathological, adopted in 2020, the classification and terminology of ovarian endometriosis have not been clarified, and many questions have arisen due to fundamental contradictions within one classification and when assessing their compliance. This article discusses aspects of the toxicity of ovarian endometriosis and the impact of cystectomy on the fertility of patients with this pathology. Together, molecular and morphogenetic features allow to substantiate the indications for surgical treatment of ovarian endometriosis, and histo-structural features enable to make the choice in favor of ablative techniques rather than cystectomy. In the conclusion of the article, the problem of choosing hormone therapy is considered. In this regard, data on the resistance of endometrioid tissue to progesterone are presented. Ethinylestradiol can not only neutralize this resistance, but also enhance the anti-proliferative effect of progestogen, as well as accelerate the processes of apoptosis of endometrioid cells.