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Cited by 134Endometriosis Research and TreatmentGynecological conditions and treatmentsEctopic Pregnancy Diagnosis and Management

Surgical management of endometriosis

Donnez, Jacques, Pirard, Céline, Smets, Mireille, Jadoul, Pascale, Squifflet, Jean·2004·Best Practice & Research Clinical Obstetrics & Gynaecology
DOI 10.1016/j.bpobgyn.2004.03.004
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Abstract

The efficacy of medical and surgical treatment of endometriosis-associated infertility and pelvic pain is a source of ongoing controversy. Complete resolution of endometriosis is not yet possible and current therapy has three main objectives: (1) to reduce pain; (2) to increase the possibility of pregnancy; and (3) to delay recurrence for as long as possible. It is possible that a consensus will never be reached on the optimal treatment of minimal and mild endometriosis. In case of moderate and severe endometriosis-associated infertility, the combined approach (operative laparoscopy with a gonadotropin-releasing hormone (GnRH) agonist) should be considered as 'first-line' treatment. The mean pregnancy rate of 50% reported in the literature following surgery provides scientific proof that operative treatment should first be undertaken to give our patients the best chance of conceiving naturally. In case of rectovaginal adenomyotic nodules, surgery must be considered as first-line therapy, medical therapy being relatively in-efficacious.

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Crossref · 10.1016/j.bpobgyn.2004.03.004

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113 of 113 references verified0 citation errors · 0 not checkable

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This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

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  • GnRH agonists excessively suppress E2 to less than 20 pg/mL, with related unfavorable side effects.

    “GnRH agonists are effective at treating endometriosis symptoms, but they have numerous limitations, including a delayed therapeutic impact because of the flare-up effect, excessive suppression of E2 to less than 20 pg/mL (with related unfavorable side effects), inability to titrate E2 levels, and unpredictable reversibility of treatment when injectable depot forms of GnRH agonists are used [95,96,”

    From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [97]

  • GnRH agonists have a delayed therapeutic impact because of the flare-up effect.

    “GnRH agonists are effective at treating endometriosis symptoms, but they have numerous limitations, including a delayed therapeutic impact because of the flare-up effect, excessive suppression of E2 to less than 20 pg/mL (with related unfavorable side effects), inability to titrate E2 levels, and unpredictable reversibility of treatment when injectable depot forms of GnRH agonists are used [95,96,”

    From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [97]

  • GnRH agonists cannot titrate E2 levels.

    “GnRH agonists are effective at treating endometriosis symptoms, but they have numerous limitations, including a delayed therapeutic impact because of the flare-up effect, excessive suppression of E2 to less than 20 pg/mL (with related unfavorable side effects), inability to titrate E2 levels, and unpredictable reversibility of treatment when injectable depot forms of GnRH agonists are used [95,96,”

    From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [97]

  • The mechanism of GnRH antagonists differs from that of GnRH agonists, which after a first phase of stimulation desensitize GnRH receptors, leading to full suppression of LH and FSH production and complete suppression of E2 to levels similar to those after bilateral oophorectomy.

    “The mechanism is different from that of the GnRH agonist which, after a first phase of stimulation, desensitizes GnRH receptors, leading to full suppression of LH and FSH production and subsequently to complete suppression of E2 to levels similar to those observed after bilateral oophorectomy [95,96,97,98].”

    From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [97]

  • GnRH agonists are effective at treating endometriosis symptoms.

    “GnRH agonists are effective at treating endometriosis symptoms, but they have numerous limitations, including a delayed therapeutic impact because of the flare-up effect, excessive suppression of E2 to less than 20 pg/mL (with related unfavorable side effects), inability to titrate E2 levels, and unpredictable reversibility of treatment when injectable depot forms of GnRH agonists are used [95,96,”

    From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [97]

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Authors
Donnez, J., Pirard, C., Smets, M., Jadoul, P., & Squifflet, J.
Affiliations
Cliniques Universitaires Saint-Luc (BE)
Corresponding author
Donnez, Jacques
ORCID
Venue
Best Practice & Research Clinical Obstetrics & Gynaecology
Publisher
Elsevier BV
Published
2004-04
Volume
18
Issue
2
Pages
329-348
ISSN
1521-6934 (ISSN-L)
DOI
10.1016/j.bpobgyn.2004.03.004
OpenAlex
W2106304510
Cited by
134
References
114
Citations by year
2026: 3 · 2025: 3 · 2024: 1 · 2023: 2 · 2022: 5 · 2021: 9 · 2020: 5 · 2019: 5 · 2018: 6 · 2017: 3 · 2016: 4 · 2015: 11 · 2014: 3 · 2013: 7 · 2012: 9
FWCI
1.15
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Best Practice & Research Clinical Obstetrics & Gynaecology (publishedVersion)
  • PubMed (publishedVersion)
  • Digital Access to Libraries (submittedVersion)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
Keywords
endometriosis, surgical management, endometriosis-associated infertility, pelvic pain, laparoscopic surgery, GnRH agonist, pregnancy rate, recurrence
MeSH terms
Endometriosis, Female, Humans, Infertility, Female, Ovarian Diseases, Peritoneal Diseases, Laparoscopy, Retroperitoneal Space, Evidence-Based Medicine

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