From the Guidelines
No, endometriosis does not always require surgery. Treatment for endometriosis typically follows a stepwise approach, starting with conservative options before considering surgery, as supported by the most recent guidelines 1. Many patients manage their symptoms effectively with medications like nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen for pain relief.
Key Considerations
- Hormonal treatments are often the next step, including combined hormonal contraceptives, progestins, or GnRH agonists, which work by suppressing estrogen or inducing amenorrhea to reduce painful periods 1.
- Surgery becomes an option when medication fails to control symptoms, when fertility is a concern, or when there are large endometriomas or severe adhesions.
- The decision for surgery should be individualized based on symptom severity, fertility desires, and response to medical management, as emphasized in recent studies 1.
- Even after surgery, many patients continue medical therapy to prevent recurrence, as endometriosis is a chronic condition that often requires ongoing management.
Diagnostic Approaches
- Preoperative imaging, including expanded protocol transvaginal ultrasound (TVUS) and MRI, can help inform patient decision making, surgical planning, and management 1.
- These diagnostic approaches can reduce morbidity and mortality by reducing the need for repeat surgeries and incomplete surgeries.
Treatment Outcomes
- The goal of treatment is to improve quality of life by reducing symptoms and improving fertility outcomes, if desired.
- A multidisciplinary approach, including medical and surgical options, can help achieve these goals and improve patient outcomes, as supported by recent evidence 1.
From the Research
Treatment Options for Endometriosis
- Endometriosis can be managed through both medical and surgical means 2, 3, 4, 5, 6
- Medical management includes the use of nonsteroidal anti-inflammatory drugs, hormonal therapies such as combined oral contraceptives and progestins, and gonadotropin-releasing hormone agonists/antagonists 2, 3, 5, 6
- Surgical management options include laparoscopic uterosacral nerve ablation/resection, presacral neurectomy, excision/ablation of lesions, nerve ablation, neurectomy, hysterectomy, and oophorectomy 2, 4, 5, 6
Necessity of Surgery
- Surgery is not always necessary for the treatment of endometriosis, as medical management can be effective in relieving symptoms 3, 5, 6
- However, surgery may be considered for patients who do not respond to medical management or have severe symptoms 2, 4, 5
- The decision to undergo surgery should be made on a case-by-case basis, taking into account the individual patient's symptoms, medical history, and treatment goals 4, 5, 6