Managing Endometriosis-Associated Pain: A Two-Step Approach

Alena Sofieva
In: European Medical Journal · 2026 · doi:10.33590/emj/zec0ny0z · W7164887425
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-07-09 ⓘ

Vitaly F. Bezhenar reviewed the current two-step approach for managing endometriosis-associated pain, comparing postoperative hormonal therapies and discussing long-term medical management's role in reducing recurrence and improving quality of life.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-09 · read from full text ⓘ

This congress feature reviews a two-step strategy for managing endometriosis-associated pain, describing when surgery is used and summarizing evidence on postoperative hormonal modulation and long-term recurrence prevention. It reports that recurrence can reach 50% after surgery and that microscopic endometriotic foci in macroscopically intact peritoneum support continuing postoperative hormonal therapy for at least 6 months, with treatment individualized and laparoscopic surgery preferred for deep endometriosis; it also notes a key limitation that many recurrences follow discontinuation of therapy and that conservative strategies often show limited symptom improvement. In comparative evidence discussed, recurrence and pain outcomes are presented as worse with cyclic combined oral contraceptives (including dienogest) and better with options such as GnRH agonists and dienogest, with additional data from the ENVISION study and a systematic review/meta-analysis suggesting improved quality of life and lower recurrence risk with dienogest. This paper is centrally about endometriosis — it discusses a two-step approach to endometriosis-associated pain, emphasizing postoperative progestogen-based long-term management to reduce recurrence.

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Abstract

AT THIS year’s International Society of Gynaecological Endocrinology (ISGE) Congress 2026, held in Rome, Italy, Vitaly F. Bezhenar, Head of the Department of Obstetrics, Gynaecology, and Neonatology at First Pavlov State Medical University of St. Petersburg, Russia, reviewed the current approach to the management of endometriosis-associated pain. He explored the recommended two-step treatment strategy, compared different postoperative hormonal therapies, and discussed the role of long-term medical management in reducing recurrence and improving quality of life in women with endometriosis.
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Conclusion

Bezhenar concluded that endometriosis is a chronic, inflammatory, hormone-dependent condition that requires long-term, comprehensive management, including postoperative therapy. Progestogens remain the first-line treatment, and continuity between inpatient and outpatient care is essential to optimise outcomes and reduce recurrence risk. He emphasised that postoperative therapy should continue for at least 6 months, and that there is no such thing as ‘mild’ endometriosis.

References

1. Gordts S et al. Pathogenesis of deep endometriosis. Fertil Steril. 2017;108(6):872-85. 2. Dunselman GA et al. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29(3):400-12. 3. Ministry of Health of the Russian Federation. Clinical guidelines: endometriosis. 2024. Available at: https://drive.google.com/file/d/14XuaZ zgwocmmXOXVzeVT60QK4WokgbpH/ view. Last accessed: 13 May 2026. 4. Chapron C et al. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. 2019;15(11):666-82. 5. Gusev DV et al. Endometriosis- associated infertility: various aspects of pathogenesis. Gynecology. 2020;22(3):34-8. 6. Ouchi N et al. Recurrence of ovarian endometrioma after laparoscopic excision: risk factors and effect of postoperative hormonal treatment. J Obstet Gynaecol Res. 2014;40(1):230-6. 7. Harada M et al. High incidence of endometriosis in infertile women with a history of surgically treated benign ovarian tumors. Gynecol Endocrinol. 2011;27(9):717-20. 8. Shah A et al. Catamenial pneumothorax: a rare case of thoracic endometriosis. Abstract A6687. ATS International Conference, 18-23 May, 2018. 9. Adamyan LV et al. Endometriosis: diagnosis, treatment, and rehabilitation. Clinical guidelines. 2013. Available at: https://minzdrav.alania. gov.ru/sites/minzdrav/files/media/ documents/files/2019-07/00002_ Эндометриоз%202013.pdf. Last accessed: 13 May 2026. 10. Bezhenar VF. Hormonal therapy in the treatment of endometriosis. Innovative Pharmacotherapy. 2022;2(6):9-12. 11. Bezhenar VF et al. The rationale for long-term hormonal therapy of endometriosis after surgical treatment. Obstetrics and Gynecology (Russia). 2021;4:134-42. 12. European Society of Human Reproduction and Embryology (ESHRE). Endometriosis guideline. 2022. Available at: https://www.eshre. eu/Guideline/Endometriosis. Last accessed: 13 May 2026. 13. Bezhenar et al. Analysis of the effectiveness of various management approaches in patients with endometriosis and rationale for long-term personalized dydrogesterone therapy within a combined treatment strategy. Prob Reprod. 2024;30(2):102-11. 14. Sukhikh GT et al. Algorithms for the management of the patients with endometriosis: a consensus statement of experts from the Russian Society of Obstetricians and Gynecologists. Akush Ginekol. 2023;5:159-76. Congress Feature CC BY-NC 4.0 Licence ● Copyright © 2026 EMJ ● June 2026 ● Flagship 13 15. Rybakova MG et al. Morphological characteristics of surgical specimens in nerve-sparing and conventional techniques for deep infiltrating endometriosis. J Obstet Women's Dis. 2019;3-4:26-31. 16. Busacca M et al. Guidelines for diagnosis and treatment of endometriosis. Ital J Gynaecol Obstet. 2018;30(2):7-21. 17. Bezhenar VF et al. Comparison of the effectiveness of various immunomodulatory therapy regimens after surgical treatment of external genital endometriosis. Prob Reprod. 2015;4:89-98. 18. Murji A et al. Use of dienogest in endometriosis: a narrative literature review and expert commentary. Curr Med Res Opin. 2020;36(5):895-907. 19. Techatraisak K et al. Effectiveness of dienogest in improving quality of life in Asian women with endometriosis (ENVISIOeN): interim results from a prospective cohort study under real-life clinical practice. BMC Womens Health. 2019;19:68. 20. Zakhari A et al. Dienogest and the risk of endometriosis recurrence following surgery: a systematic review and meta- analysis. J Minim Invasive Gynecol. 2020;27(7):1503-13. Congress Feature

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