Comparative analysis of surgical versus medical management in alleviating pain in endometriosis patients

Background: Endometriosis is a prevalent gynecological disorder associated with chronic pelvic pain and infertility. Management typically involves surgical or medical interventions. Aim of this study was to compare the effectiveness of these approaches in alleviating pain and improving fertility outcomes. Methods: This comparative study was conducted with patients who received treatment at the department of obstetrics and gynecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from February 2022 to January 2023. Seventy-six women with endometriosis were randomly assigned to either the surgical group (n=38) or the medical group (n=38). Pain relief, recurrence rates, side effects, and fertility outcomes were assessed over 12 months. Results: The surgical group showed significantly greater pain relief, with 78.9% achieving ≥50% pain reduction compared to 47.4% in the medical group (p=0.003). Recurrence of pain was lower in the surgical group (21.1%) compared to the medical group (52.6%) (p=0.003). Surgical complications occurred in 7.9% of patients, while 36.8% of the medical group experienced hormonal side effects. Regarding fertility, 50.0% of patients in the surgical group achieved pregnancy, compared to 31.3% in the medical group, though this difference was not statistically significant (p=0.262). Conclusions: Surgical management of endometriosis provides more effective and sustained pain relief and lower recurrence rates compared to medical management.