Introduction

Abstract

Endometriosis is a protean disease, and its manifestations, associated clinical problems, and possible treatments are numerous. Deep endometriosis that infiltrates multiple pelvic organs should be considered the most severe endometriotic form that poses the most difficult therapeutic uncertainties in both infertility and pelvic pain symptoms limiting quality of life. The available evidence demonstrates that endometriosis is not only a gynecologic disorder but, contrary to previous belief, its impact extends into pregnancy, delivery, and the post-partum period. The old clinical tenet that pregnancy is a cure for endometriosis may be revealed as fallacious. Safe and effective modalities to reduce the risk of the recurrence of symptoms and lesions after conservative surgery for endometriosis are now available. These treatment options should be offered post-operatively to women not immediately seeking conception. Endometriosis is associated with a moderate increase in ovarian cancer risk. However, as there are no definitive demonstrations that endometriosis constitutes per se a pre-neoplastic condition, it seems currently unwise to set-up a screening program to detect undiagnosed endometriosis in asymptomatic women. Endometriosis is not a cancer; therefore a paradigm shift from treatment of lesions to treatment of symptoms is warranted. Management should be shaped on the main clinical problem, taking into consideration a woman's preferences and priorities. Quantitative information should be provided to describe the potential benefits, potential harms, and costs of each treatment alternative. Counseling should be complete and transparent, and the duty of the caring gynecologist is to inform the woman on the pros and cons of each option and support her in the shared decision-making process. The physician should be able to explain in detail all the available treatments, and not only those that the physician prefers or is able to offer.

Interrelationships among endometriosis-related pain symptoms and their effects on health-related quality of life: a sectional observational study

“…Deep infiltrating endometriosis (DIE) infiltrates multiple pelvic organs to levels deeper than 5 mm [ 5 ]. It is considered the most severe form of endometriosis and poses the most difficult therapeutic problems since the most effective measures must be identified to resolve the specific issues that are most important to patients [ 6 ]. In these cases, although effective medical therapies for controlling DIE exist, radical surgical excision of the lesions is usually necessary to improve patient symptoms and quality of life [ 7 8 ].…”

“…Quantitative approaches should ideally help physicians and patients discuss the potential benefits, risks, and costs of each treatment alternative [ 6 ]. Different tools have been used to assess and quantify HRQoL in women with endometriosis [ 15 ].…”

To operate or not to operate on women with deep infiltrating endometriosis (DIE) before in vitro fertilization (IVF)

“…Surgery cannot be recommended when the main goal is to treat infertility, as the evidence to support such approach is still scant. Decisions should be tailored according to the individual needs of each woman after they are provided with information on the potential benefits, harm, and costs of each treatment alternative (Vercellini, 2015). …”

Endometriosis: current challenges in modeling a multifactorial disease of unknown etiology

“…Curiously, lesion regression has never been chosen as an end-point of clinical studies. Clinical studies were aimed at finding ways to mitigate symptoms, which seems to be the utmost point to be addressed for endometriosis [ 8 , 74 , 75 ]. An International Consensus Workshop proposed a list of priorities for endometriosis research and under the “treatment and outcome” section, lesion regression was not mentioned at all, as opposed to diminishing symptoms [ 76 ].…”

“…An International Consensus Workshop proposed a list of priorities for endometriosis research and under the “treatment and outcome” section, lesion regression was not mentioned at all, as opposed to diminishing symptoms [ 76 ]. According to Paolo Vercellini´s view, the treatment should not target the lesions but the clinical signs, as researchers should aim at providing patients comfort and address their main complaints [ 74 ] instead of masking advances with endpoints of questionable use for the progression of new drugs discovery. Thus, it is still debatable what would be the most adequate approach to study endometriosis.…”