Optimal Management of Endometriosis and Pain

Abstract

The pathophysiology of endometriosis-associated pain involves inflammatory and hormonal alterations and changes in brain signaling pathways. Although medical treatment can provide temporary relief, most patients can achieve long-term sustained pain relief when it is combined with surgical intervention. Owing to its complexity, there is an ongoing debate about how to optimally manage endometriosis-associated pain. We believe optimal management for this condition requires (1) possible egg preservation in affected young patients with and without endometriomas, (2) preoperative medical suppression to inhibit ovulation and to avoid removal of functional cysts that might look like endometriomas, and (3) postoperative hormonal suppression to decrease recurrence, but this treatment should be modified according to disease severity, symptoms, and fertility goals.