Medical versus Surgical Management for Endometriosis-Associated Pelvic Pain: A Systematic Review

Abstract

Introduction: Endometriosis is a chronic inflammatory condition causing significant pelvic pain. Management options include medical therapy (hormonal suppression) and surgical excision of lesions. This review compares the effectiveness of these two primary approaches.

Methods: A systematic search for RCTs was conducted, comparing medical therapy (e.g., GnRH agonists, oral contraceptives) to laparoscopic surgical excision for the treatment of endometriosis-associated pain. The primary outcome was the change in pain scores.

Results: The analysis showed that both medical and surgical therapies were effective in reducing pelvic pain compared to placebo or diagnostic laparoscopy alone. Direct comparison trials suggest that surgery may provide more significant and sustained pain relief, but is associated with surgical risks. Medical therapy often leads to recurrence of pain upon cessation.

Discussion: The management of endometriosis-associated pain should be individualized. Surgery is often preferred for definitive diagnosis and treatment, while medical therapy is crucial for long-term suppression and management of this chronic disease.

Conclusion: Both medical and surgical treatments are effective for endometriosis-associated pain, with surgery potentially offering more complete initial relief.