BMJ 2014; 348:g1752 (Published 19 March 2014)
Martha Hickey, Karen Ballard, Cindy Farquhar


Short description:
• Medical treatment is not recommended for women with endometriosis who are trying to conceive as it does not improve pregnancy rates and delays fertility
• The combined oral contraceptive, oral or depot MPA (medroxyprogesterone acetate), and Mirena (levonorgestrel releasing intrauterine system) are as effective as the GnRH (gonadotrophin releasing hormone) analogues and can be used long term
• When surgical treatment is being considered, attempt laparoscopic excision or ablation at the time of diagnostic laparoscopy when possible
• The cyst wall of endometriomas should ideally be removed instead of drainage and ablation but treatment can lead to reduced ovarian reserve
• In the five years after surgery or medical treatment, 20-50% of women will experience recurrence of symptoms
• Long term medical treatment (with or without surgery) might reduce recurrence but more data are needed to define the optimum medical treatment
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