A randomized trial of excision versus ablation for mild endometriosis. Continuous low‐dose oral contraceptive in the treatment of colorectal endometriosis evaluated by rectal endoscopic ultrasonography Endometriosis is associated with central sensitization: a psychophysical controlled study. Quantification of endometriosis-associated pain and quality of life during the stimulatory phase of gonadotropin-releasing hormone agonist therapy: a double-blind, randomized, placebo-controlled trial. Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Persistence of dysmenorrhea and nonmenstrual pain after optimal endometriosis surgery may indicate adenomyosis. Hormonal suppression treatment or dietary therapy versus placebo in the control of painful symptoms after conservative surgery for endometriosis stage III-IV. A randomized comparative trial. Depression in women with endometriosis with and without chronic pelvic pain Continuous versus cyclic use of oral contraceptives after surgery for symptomatic endometriosis: a prospective cohort study. A gonadotrophin‐releasing hormone agonist compared with expectant management after conservative surgery for symptomatic endometriosis Postoperative medical treatment of chronic pelvic pain related to severe endometriosis: levonorgestrel-releasing intrauterine system versus gonadotropin-releasing hormone analogue. Return of Chronic Pelvic Pain From Endometriosis After Raloxifene Treatment: A Randomized Controlled Trial Add-back therapy in the treatment of endometriosis-associated pain. Pain and ovarian endometrioma recurrence after laparoscopic treatment of endometriosis: a long-term prospective study. Investigation of diagnostic potentials of nine different biomarkers in endometriosis. Surgical treatment of endometriosis: a prospective randomized double-blinded trial comparing excision and ablation. Surgical versus medical treatment for endometriosis-associated severe deep dyspareunia: I. Effect on pain during intercourse and patient satisfaction.
OBJECTIVE To compare excisional and ablative treatment modalities for mild ( revised American Fertility score 1 - 2 ) endometriosis in the management of  chronic pelvic pain .  DESIGN A r and omized study of excision or ablation for mild endometriosis , participants and investigators alike blinded to the treatment modality at the follow-up visit . SETTING District general hospital with a specialist pelvic pain clinic in the United Kingdom . PATIENT(S ) Women presenting with chronic pelvic pain . INTERVENTION(S ) Participants were asked to complete a question naire detailing symptoms related to chronic pelvic pain and rating their pain on a ranked ordinal scale . Areas of pelvic tenderness were identified and similarly ranked . At laparoscopy they were r and omly assigned to excision or ablation of any endometriotic lesions , and the question naire was repeated at 6 months . MAIN OUTCOME MEASURE(S ) Changes in pain score on a ranked ordinal scale after surgical treatment for mild endometriosis . RESULT ( S ) Both treatment modalities produced good symptomatic relief and reduction of pelvic tenderness ( 67 % ) . There was no difference in morbidity ; one woman in each group became pregnant during the study period . Only two participants reported no relief or a worsening of symptoms or signs . CONCLUSION ( S ) This small study showed good symptom relief at 6 months from pelvic pain for the majority of participants irrespective of the treatment modality , but two participants did not improve or got worse . A high pain score before treatment was a predictor of appreciable improvement . Further work is needed to identify women in whom surgical intervention is likely to produce a good response Objective . Limited attention has been focused on the medical treatment of bowel endometriosis . This study evaluates the efficacy of administration of a continuous low‐dose oral contraceptive in treating pain and other symptoms associated with colorectal endometriotic nodules , as evaluated by rectal endoscopic ultrasonography . Design . Prospect i ve observational study . Setting . Academic Department of San Raffaele Scientific Institute , Obstetrics and Gynecology Unit . Population . Symptomatic women of reproductive age ( n=26 ) with colorectal nodules infiltrating at least the bowel muscularis propria and without a stenosis > 50 % . In 31 % of the patients , endoscopic ultrasonography permitted diagnosis of nodules located more than 10 cm from the anal rim . Methods . Patients received a continuous low‐dose oral contraceptive containing 15 μg ethinylestradiol and 60 μg gestodene for 12 months . Subjective symptoms were prospect ively evaluated , and nodule volumes were monitored using endoscopic ultrasonography . Main outcome measures . Nodule measurements were performed at baseline and after 12 months of treatment . Symptoms at the start and after 12 months were evaluated . Results . A significant improvement in the intensity of all the considered symptoms ( dysmenorrhea , non‐menstrual pelvic pain , deep dyspareunia and painful defecation ) was seen when evaluated by a visual analog scale . A reduction in terms of both diameter ( mean reduction 26 % ) and volume of the nodules ( mean reduction 62 % ) was observed after a 12 month period . Conclusions . A continuous low‐dose oral contraceptive therapy may reduce bowel endometriosis‐associated symptoms . In addition , this therapy induces a significant volumetric reduction of colorectal plaques when evaluated by endoscopic ultrasonography Endometriosis is a pain syndrome representing a major cause of pelvic pain in women of reproductive age . The aim of this study was to test the hypothesis that persistent nociceptive input from endometriotic tissues leads to central sensitization manifested by somatic hyperalgesia and increased referred pain areas to experimental saline-induced muscle pain in patients with endometriosis , compared to healthy control subjects . Ten women with laparoscopically confirmed endometriosis and 10 healthy , age-matched women participated in the study .  Hypertonic saline ( 0.5 mL , 5.8 % ) was injected intramuscularly , in r and om succession , into 1 site of menstrual pain referral ( the multifidus muscle at the low back ) and into 1 non-pain control site ( first dorsal interosseous muscle [ FDI ] of the h and ) . The post-saline pain intensity and pain areas at the FDI were significantly greater in patients with endometriosis than in control subjects ( P < .05 ) but were not different between the groups for the back . An absence of enhancement of post-saline pain responses at the back in the endometriosis group suggests that saline-induced pain at the back appears to activate segmental inhibitory systems in patients with endometriosis . Manifestation of central sensitization in women with endometriosis is demonstrated by increased muscle nociceptor input in the form of increased post-saline pain intensity , pain areas at the FDI , and hypersensitivity to pressure stimulation . These findings provide new insights into the complex pain mechanisms associated with endometriosis OBJECTIVE The purpose of this study was a quantification of changes in endometriosis-associated  pain and quality of life during the stimulatory phase of gonadotropin-releasing hormone agonist therapy . STUDY DESIGN One hundred twenty women with significant endometriosis-associated pain participated in a 1-month double-blind , r and omized , placebo-controlled trial . Pain was measured at baseline and at 2 and 4 weeks with  visual analog scales  and the Endometriosis Symptom Severity score . Quality of life was measured with the SF-36 instrument . Group means and SEMs were calculated . Paired t tests were used after determination of data normality . RESULTS Compared with placebo-treated control subjects women treated with gonadotropin-releasing hormone agonist had a statistically ( P < . 0001 ) and clinical ly significant temporary increase in pain and a concomitant decrease in quality of life . CONCLUSION The stimulatory phase of gonadotropin-releasing hormone agonist therapy is associated with an increase in endometriosis-associated pain and a decrease in quality of life In a 3-year prospect i ve study of 643 consecutive laparoscopies for infertility , pelvic pain , or infertility and pain , the pelvic area , the depth of infiltration , and the volume of endometriotic lesions were evaluated . The incidence , area , and volume of subtle lesions decreased with age , whereas for typical lesions these parameters and the depth of infiltration increased with age . Deeply infiltrating endometriosis was strongly associated with pelvic pain , women with pain having larger and deeper lesions . Because deep endometriosis has little emphasis in the revised American Fertility Society classification and after analyzing the diagnoses made in each class , considerations for a simplifying revision with inclusion of deep lesions are suggested . In conclusion , suggestive evidence is presented to support the concept that endometriosis is a progressive disorder , and it is demonstrated that deep endometriosis is strongly associated with pelvic pain OBJECTIVE To evaluate whether persistence of pelvic pain after excision of endometriosis was associated with adenomyosis as defined by a thickened uterine junctional zone ( JZ ) on magnetic resonance ( MR ) imaging . DESIGN Prospect i ve clinical trial . SETTING Government research hospital . PATIENT(S ) Fifty-three women with chronic pelvic pain . INTERVENTION(S ) Preoperative MR imaging to measure uterine JZ thickness , surgical excision , and pathologic diagnosis of endometriosis . Those with biopsy-proven endometriosis were r and omized to raloxifene or placebo .  Visual analog scale ( VAS ) was used to rate dysmenorrhea and nonmenstrual pain severity before surgery and 3 months later . MAIN OUTCOME MEASURE(S ) Comparison of JZ thickness and pain severity before and 3 months after surgery in women with endometriosis controlling for medical treatment . RESULT ( S ) Forty of the 53 patients had biopsy-proven endometriosis , and 6 of these 40 women with endometriosis had a thickened JZ . Overall , dysmenorrhea at 3 months was positively correlated with preoperative JZ thickness ( r = 0.47 , P=.01 ) . Dysmenorrhea pain severity showed no significant decrease in those patients whose JZ measured > or=11 mm compared with those with JZ < 8 mm ( P<.0001 ; VAS decreased 4.3 + /- 0.6 ) , or > or=8 and < 11 mm ( P<.02 ; VAS decreased 4.8 + /- 1.3 ) . Nonmenstrual pain severity was correlated with JZ thickness ( r = 0.51 , P=.004 ) at 3 months with a significant decrease in nonmenstrual pain only in women with a JZ < 8 mm ( VAS decreased 4.0 + /- 0.7 , P<.0001 ) . The association between dysmenorrhea and nonmenstrual pain reduction and thinner JZ remained after controlling for medical treatment . CONCLUSION ( S ) Following surgical excision of endometriosis , chronic pelvic pain was significantly more likely to persist with JZ thickness > 11 mm on preoperative MR imaging . This suggests that myometrial JZ abnormalities or adenomyosis may contribute to chronic pelvic pain in women with endometriosis OBJECTIVE To evaluate the effectiveness for the outcomes of endometriosis-related pain and quality of life of conservative surgery plus placebo compared with conservative surgery plus hormonal suppression treatment or dietary therapy . DESIGN R and omized comparative trial . SETTING University hospital . PATIENT(S ) Two hundred twenty-two consecutive women who underwent conservative pelvic surgery for symptomatic endometriosis stage III-IV ( r-AFS ) . INTERVENTION(S ) Six months of placebo ( n = 110 ) versus GnRH-a ( tryptorelin or leuprorelin , 3.75 mg every 28 days ) ( n = 39 ) or continuous estroprogestin ( ethynilestradiol , 0.03 mg plus gestoden , 0.75 mg ) ( n = 38 ) versus dietary therapy ( vitamins , minerals salts , lactic ferments , fish oil ) ( n = 35 ) . MAIN OUTCOME MEASURE(S ) Painful symptoms ( visual analogue scale score ) and quality -of-life endometriosis-related symptoms ( SF-36 score ) at 12 months ' follow-up . RESULT ( S ) Patients treated with postoperative hormonal suppression therapy showed less visual analogue scale scores for dysmenorrhoea than patients of the other groups . Hormonal suppression therapy and dietary supplementation were equally effective in reducing nonmenstrual pelvic pain . Surgery plus placebo showed significative decrease in dyspareunia scores . Postoperative medical and dietary therapy allowed a better quality of life than placebo . CONCLUSION ( S ) Postoperative hormonal suppression treatment or dietary therapy are more effective than surgery plus placebo to obtain relief of pain associated with endometriosis stage III-IV and improvement of quality of life Aim . The aim of the study is to compare the prevalence of depression in women surgically diagnosed with endometriosis according to the presence or absence of pelvic pain . Methods . This cross‐sectional prospect i ve study evaluated 100 women receiving care at the Out patients ’ Clinic for Endometriosis , Department of Obstetrics and Gynecology , Universidade Estadual de Campinas ( UNICAMP ) , Campinas , São Paulo , Brazil , equally divided into two groups : one suffering from chronic pelvic pain and the other pain‐free .  The Beck Depression Inventory  was used in order to measure depression . Results . Depression was detected in 86 and 38 % of the women with and without chronic pelvic pain , respectively . Complaints of depression , such as somatic concerns , work inhibition , dissatisfaction , and sadness , were observed at a significantly higher rate in the group with pain . A sensation of failure was the only variable observed more frequently in the pain‐free group . Conclusions . Depression is highly prevalent in women with endometriosis , especially those with pelvic pain . Careful evaluation can identify women with depression who may benefit from treatment OBJECTIVE To evaluate the efficacy of continuous oral contraceptive ( OC ) use versus the usual cyclic fashion in the recurrence of endometriosis-related symptoms after surgery . DESIGN Prospect i ve cohort trial involving patients in two tertiary care units . SETTING Academic institution in collaboration with a private hospital . PATIENT(S ) 356 patients underwent surgical treatment by laparoscopy for symptomatic endometriosis . INTERVENTION(S ) After surgical treatment for endometriosis , patients offered 6-month course of cyclic OC ( including a 7-day pill-free period ) or continuous OC . MAIN OUTCOME MEASURE(S ) Recurrence rate of endometriosis-related symptoms and endometriomas after fertility-sparing surgery . RESULT ( S ) Out of 356 patients , 167 were placed on the usual cyclic OC course  and 85 on  continuous OC for a minimum of 6 months . The continuous OC group experienced a statistically significant reduction in recurrence rates for endometrioma , dysmenorrhea , and non-menstrual pelvic pain as compared with the cyclic OC group . There was no reduction in the recurrence of dyspareunia between the two groups . CONCLUSION ( S ) After surgical treatment of endometriosis , the use of both cyclic and continuous OC improves pain symptoms when compared with preoperative scores . Continuous OC appears to be associated with a reduced recurrence rate for dysmenorrhea , non-menstrual pelvic pain , and endometrioma but not for dyspareunia as compared with cyclic OC Objective To ascertain whether the frequency of pelvic pain recurrence is reduced and time to symptoms recurrence is prolonged in women with symptomatic endometriosis undergoing conservative surgery and post‐operative hormonal therapy  compared with women treated with  surgery  only . Pregnancy rates and time to conception in women wanting children were also evaluated OBJECTIVE To compare efficacy of the levonorgestrel-releasing intrauterine system ( LNG-IUS ; Mirena ) with depot GnRH analogue ( GnRH-a ; gosareline acetate ; Zoladex ) on endometriosis-related chronic pelvic pain ( CPP ) in patients with severe endometriosis during 12 months . DESIGN Prospect i ve , r and omized , controlled study . SETTING The reproductive endocrinology unit of a tertiary , research and education hospital . PATIENT(S ) Forty women with severe endometriosis ( revised The American Fertility Society [ AFS ] classification > 40 ) and endometriosis-related CPP and control groups were enrolled in the study . INTERVENTION(S ) The patients were treated with either LNG-IUS ( n = 20 ) or GnRH-a ( n = 20 ) . The GnRH-a dose was repeated every 4 weeks for 24 weeks . MAIN OUTCOME MEASURE(S ) Scores of CPP were evaluated using a visual analogue scale ( VAS ) and total endometriosis severity profile ( TESP ) . RESULT ( S ) The TESP score decreased in the LNG-IUS group at first , third , and sixth month follow-up visits , whereas at the 12th month follow-up visit , the TESP scores were increased to values similar to pretreatment values . Although the VAS score had no significant alteration during the follow-up period in the LNG-IUS group , the GnRH-a group showed a significant decrease in the VAS score and TESP score at the end of 1 year . The LNG-IUS treatment showed a lower patient satisfaction . CONCLUSION ( S ) Both treatment modalities showed comparable effectiveness in the treatment of CPP-related endometriosis OBJECTIVE : To evaluate whether 6 months of raloxifene was effective in treatment of  chronic pelvic pain in women with endometriosis . METHODS : Women with chronic pelvic pain and no endometriosis treatment for 6 months underwent laparoscopy for excision of all lesions . Those with biopsy-proven endometriosis were r and omly allocated to raloxifene ( 180 mg ) or placebo daily . A second laparoscopy was performed at 2 years , or earlier , if pain returned . Return of pain was defined as 2 months of pain equal to or more severe than that at study entry . Menstrual cycles and adverse events were recorded . The log rank test was used to compare the time to return of pain by drug group . Analyses were done as intent-to-treat . RESULTS : A total of 127 of 158 women underwent surgery . Of these , 93 had biopsy-confirmed endometriosis and were r and omly assigned to study treatment . Menstrual cycle length , pelvic pain severity , quality of life , bone mineral density , and adverse events did not differ between treatment groups . The Data Safety Monitoring Committee terminated the study early when the raloxifene group experienced pain ( P=.03 ) and had second surgery ( P=.016 ) significantly sooner than the placebo group . Interestingly , biopsy-proven endometriosis was not associated with return of pain ( P=.6 ) . CONCLUSION : Raloxifene significantly shortened the time to return of chronic pelvic pain . Because recurrence of endometriosis lesions did not correlate with return of pain , other factors are implicated in pelvic pain . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www.cliicaltrials.gov , NCT00001848 LEVEL OF EVIDENCE : OBJECTIVE To determine the efficacy of GnRH analogue plus add-back therapy compared with GnRH analogue alone and estroprogestin in patients with relapse of endometriosis-associated pain . DESIGN R and omized , controlled study . SETTING University hospital . PATIENT(S ) One hundred thirty-three women with relapse of endometriosis-related pain after previous endometriosis surgery . INTERVENTION(S ) Forty-six women were treated with GnRH analogue plus add-back therapy , 44 women were given GnRH analogue alone , and 43 women received estroprogestin , for 12 months . MAIN OUTCOME MEASURE(S ) Pain evaluation by a visual analogue scale , quality of life in treated patients according to the SF-36 question naire , and occurrence of adverse effects , including bone mass density loss , at pretreatment , after 6 months of treatment , at the end of treatment ( 12 months ) , and 6 months after discontinuation of treatment . RESULT ( S ) Patients treated either with GnRH analogue alone or GnRH analogue plus add-back therapy showed a higher reduction of pelvic pain , dysmenorrhea , and dyspareunia than patients treated with oral contraceptive , whereas patients treated with add-back therapy showed a better quality of life , as assessed with the SF-36 question naire , and adverse effects rate than the other two groups . CONCLUSION ( S ) Add-back therapy allows the treatment of women with relapse of endometriosis-associated pain for a longer period , with reduced bone mineral density loss , good control of pain symptoms , and better patient quality of life compared with GnRH analogue alone or oral contraceptive OBJECTIVE To identify prognostic factors for pain and endometrioma recurrence after complete laparoscopic excision of endometrioma(s ) . DESIGN Prospect i ve observational study . SETTING Tertiary care university hospital . PATIENT(S ) One-hundred sixty-six consecutive women affected by uni- or bilateral ovarian endometrioma(s ) . INTERVENTION(S ) Laparoscopic conservative treatment of endometriosis . MAIN OUTCOME MEASURE(S ) Patient demographic characteristics , surgical findings , and surgical results were prospect ively recorded . Postoperative follow-ups were carried out every 3 months to identify pain and /or endometrioma recurrence for a minimum of 3 years . RESULT ( S ) Dysmenorrheal , dyspareunia , and chronic pelvic pain recurred in 14.5 % , 6 % , and 5.4 % of women , respectively . Prior surgery for endometriosis , adhesion extension , and use of ovarian stimulation drugs ( OSD ) were unfavorable prognostic factors for pain symptoms . Ovarian endometrioma recurred in 9.6 % of cases ; negative factors were prior surgery for endometriosis , OSD , pelvic adhesions , and high American Society for Reproductive Medicine disease scores . Postoperative pregnancy showed a significant protective effect on pain and disease recurrences . CONCLUSION ( S ) Prior surgery , presence of adhesions , and ovulation drugs are negative prognostic factors . Pregnancy has a protective effect on disease and pain recurrence OBJECTIVE To investigate the diagnostic potentials of the serum levels of nine different biomarkers in endometriosis . STUDY DESIGN In this case-controlled , prospect i ve clinical study , 80 women underwent laparoscopy or laparotomy with a preliminary diagnosis of chronic pelvic pain , severe secondary dysmenorrhea , infertility , pelvic endometriosis or pelvic mass . The 60 women with confirmed pelvic endometriosis constituted the endometriosis group , and the other 20 women without endometriosis constituted the control group . Preoperative blood sample s were obtained for serum biomarker measurements . Serum levels of nine different serum biomarkers including α-enolase , macrophage migration inhibitory factor , leptin , interleukin-8 , anti-endometrial antibody , phosphoinositide dependent protein kinase 1 , CA125 , syntaxin-5 , and laminin-1 were measured concurrently and compared between the control and endometriosis groups , and among control group and endometriosis subgroups including stage I , stage II , stage III and stage IV endometriosis . RESULTS The serum levels of α-enolase , macrophage migration inhibitory factor , leptin , interleukin-8 and antiendometrial antibodies showed a statistically significant difference neither between control and endometriosis groups nor among control group and endometriosis subgroups . The serum levels of CA125 , syntaxin-5 and laminin-1 showed a statistically significant difference both between the control and endometriosis groups ( p<0.01 ) and among control group and endometriosis subgroups ( p<0.01 ) . Serum levels of laminin-1 in stage II and IV endometriosis ; syntaxin-5 in stage I and II endometriosis ; and CA125 in stage III and IV endometriosis were found to have the different levels compared to control group . CONCLUSIONS These findings show that the concurrent measurement of CA125 , syntaxin-5 and laminin-1 might be a useful non-invasive test in strengthening the diagnosis of endometriosis and in predicting its severity OBJECTIVE To compare reduction of pain following laparoscopy after ablation or excision of endometriosis . DESIGN A prospect i ve , r and omized , double-blind study . SETTING Endometriosis and pelvic pain clinic at a university teaching hospital . PATIENT(S ) Women of reproductive age presenting with pelvic pain and visually proved endometriosis . INTERVENTION(S ) Subjects completed a question naire rating their various pains using visual analogue scales ( VASs ) . After visual identification subjects were assigned r and omly to treatment with ablation or excision by supervised training gynecologists as primary surgeon . Follow-up question naires at 3 , 6 , 9 , and 12 months documented pain levels . MAIN OUTCOME MEASURE(S ) Change in overall pain VAS score at 12 months after operation . RESULT ( S ) There was no significant difference in reduction in overall pain VAS scores at 12 months when comparing ablation and excision . CONCLUSION ( S ) This study has not been able to demonstrate a significant difference in pain reduction between ablation and excisional treatments . Nonsignificant trends suggest that a larger study may find a difference in outcomes looking at dyspareunia or dyschezia STUDY QUESTION Does surgical or medical treatment for endometriosis-associated severe deep dyspareunia achieve better results in terms of patients ' satisfaction ( main study outcome ) , variation of coital pain and frequency of intercourse ? SUMMARY ANSWER Surgery and progestin therapy were equally effective in the treatment of deep dyspareunia in women with rectovaginal endometriosis , whereas medical therapy performed significantly better than excisional treatment in those without deeply infiltrating lesions . WHAT IS KNOWN AND WHAT THIS PAPER ADDS Conservative surgery and hormonal therapies have been used independently for endometriosis-associated deep dyspareunia with inconsistent results . This study reports a direct comparison between the two treatment options in women with severe pain during intercourse . DESIGN Patient preference , parallel cohort study with a 12-month follow-up . The effect of conservative surgery at laparoscopy was compared with treatment with a low-dose of norethisterone acetate per os ( 2.5 mg/day ) in women with persistent/recurrent severe deep dyspareunia after first-line surgery . PARTICIPANTS AND SETTING A total of 51 patients chose repeat surgery and 103 progestin treatment .  Patient satisfaction was grade d according to a five-category scale . Variations in pain during intercourse were measured by means of a 100-mm visual analogue scale . MAIN RESULTS AND THE ROLE OF CHANCE In the surgery group , a marked and rapid short-term dyspareunia score reduction was observed , followed by partial recurrence of pain . The pain relief effect of the progestin was more gradual , but progressive throughout the study period . At a 12-month follow-up , the frequency of intercourse per month ( mean ± SD ) was 4.6 ± 1.8 in the surgery group and 5.3 ± 1.5 in the norethisterone acetate group ( P = 0.02 ) . A total of 22/51 ( 43 % ) women were satisfied in the surgery group compared with 61/103 ( 59 % ) in the progestin group [ adjusted odds ratios ( OR ) , 0.36 ; 95 % confidence interval ( CI ) , 0.16 - 0.82 ; P = 0.015 ] . Corresponding figures in women with and without rectovaginal endometriotic lesions were , respectively , 13/24 ( 54 % ) versus 18/35 ( 51 % ; adjusted OR , 0.77 ; 95 % CI , 0.22 - 2.67 ; P = 0.68 ) , and 9/27 ( 33 % ) versus 43/68 ( 63 % ; adjusted OR , 0.23 ; 95 % CI , 0.07 - 0.76 , P = 0.02 ) . BIAS , CONFOUNDING , AND OTHER REASONS FOR CAUTION : Treatments were not r and omly assigned , and distribution of participants as well as of dropouts between study arms was unbalanced . However , the possibility of choosing the treatment allowed assessment of the maximum potential effect size of the interventions . GENERALIZABILITY TO OTHER POPULATION S Caucasian patients able to choose their treatment . STUDY FUNDING /COMPETING INTEREST(S ) This study was supported by a research grant from the University of Milan School of Medicine ( PUR number 2009-ATE-0570 ) . None of the authors have a conflict of interest
Surgery and the use of drugs provided reduced pain scores in patients with endometriosis but nevertheless exhibit disadvantages , such as risk of recurrence and side effects , respectively .
However , improved quality of life in these patients has been obtained with the use of conventional treatment
Endometriosis is a chronic gynecological disease characterized by sustained painful symptoms that are responsible for a decline in the quality of life of sufferers .
Conventional treatment includes surgical and pharmacological therapy aim ing at reducing painful symptoms .
This study aim ed to evaluate pain levels in women with endometriosis , focusing on the influence of conventional treatment in controlling this variable .
Treatment of endometriosis is , therefore , a challenge for gynecologists and patients , as they must select the best therapeutic approach for this disease .