Deep endometriosis: medical or surgical treatment?

Fernanda Arcoverde, Fernanda Vieira Lins Arcoverde, Marina P Andres, Marina Paula Andres, Carolina C Souza, Carolina C.C. Souza, Joao S Neto, João Siufi Neto, Mauricio S Abrão, Maurício Simões Abrão
Minerva obstetrics and gynecology · 2021 · vol. 73(3) , pp. 341–346 · doi:10.23736/s2724-606x.21.04705-5 · PMID:34008388 · W3163573736
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This review compared medical and surgical treatments for deep endometriosis, finding hormonal therapy satisfactory for most and surgery effective for quality of life, with medical treatment recommended first for uncomplicated cases not seeking conception.

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Abstract

Deep endometriosis (DE) is classically defined as disease that infiltrates structures by more than 5 mm, such as bowel, ureters, bladder and vagina. The two major symptoms related to DE are pain and infertility. A lot of debate goes on upon the best treatment choice for DE. Treatments include medical therapy with oral progestins or combined contraceptives, and surgery for resection of DE nodules. In this review we focus on the best option treatment for the symptomatic patients with DE not seeking conception. We performed a narrative review of literature searching for the latest evidence on efficacy and outcomes of medical and surgical treatment of DE patients. Results showed that 2/3 of patients with DE will be satisfied with hormonal treatment, and surgery will be effective in improving QoL in most patients with DE. Most studies published regarding surgical outcomes involve bowel endometriosis, and their complication rates should not be extrapolated to all DE. DE that does not infiltrate pelvic viscera accounts for most cases of DE. Together with DE affecting the urinary tract, a much lower rate of severe complications is reported when compared to bowel endometriosis. This distinction should influence decision making. Medical treatment should be first option for non-complicated DE patients not seeking conception. Surgery should be indicated for those who do not tolerate nor improve with medical treatment, as well as those cases complicated by visceral impairment.

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Condition tags

endometriosisbowel_endometriosisinfertility

MeSH descriptors

Endometriosis Endometriosis Female Humans Pelvis Progestins Progestins Quality of Life

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.

References (32)

Cited by (3)

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