Although endometriosis can’t “definitively” be diagnosed unless it’s visualized during laparoscopic surgery (and then confirmed on the pathology report), this doesn’t mean that all patients suggestive of endometriosis: eg. pelvic pain; painful periods; or pain with intercourse require surgery. A large proportion of patients can be confidently diagnosed with endometriosis based on their symptoms and even ultrasound findings (eg. endometriomas seen within the ovaries are essentially diagnostic). Once endometriosis has been diagnosed, the big question remains as to the best method to treat this condition – through a medical or surgical approach? On the one hand surgery allows the physician to potentially burn all the visible endometriosis implants from the pelvis, remove the endometrioma cysts from the ovaries and cut away any scars that have formed from the chronic inflammation. On the other hand, surgery can have significant risks (eg. injuries to the bowel and bladder) and can have a very negative impact on the ovarian reserve by damaging the ovaries. Furthermore, since endometriosis is a chronic and hormonally responsive condition, surgery is likely only a temporary solution with short term benefits.
The rationale for medical management is based on counteracting the hormonal stimulation responsible for proliferating endometriosis. In general, to treat endometriosis one must either decrease the available estrogen or increase the daily progestin exposure. Of course there are also complimentary options and nutritional considerations to treat endometriosis.
Whatever the “medication” of choice, ideally it will adequately manage the endometriosis as a long term solution, and thereby avoiding the risk of surgery. Sometimes a combination of surgery followed by postoperative hormonal suppression is the optimal formula.
Although each case of endometriosis is unique, and I highly recommend a full discussion with your physician, below is a summarized list of the disadvantages and advantages for both a medical and surgical option.