# Endometriosis

> Citation bundle for Endometriosis on The Treatment Registry.
> URL: https://thetreatmentregistry.com/conditions/endometriosis
> Bundle URL: https://thetreatmentregistry.com/api/citations/conditions/endometriosis

## Description

A chronic gynaecological condition in which endometrial-like tissue grows outside the uterus, causing pelvic pain, painful periods, painful intercourse, and infertility. Severity ranges from minimal disease (microscopic deposits) to severe deep-infiltrating endometriosis affecting bowel or bladder. Treatment is staged from hormonal medical management through laparoscopic excision and may include fertility treatment when conception is the priority.

## Treatment ladder

### conservative

- **Combined hormonal contraception** — First-line medical therapy for symptomatic endometriosis when pregnancy is not currently desired. Suppresses ovulation and menstrual flow, often substantially reducing pain.
- **Progestin-only therapy (oral or IUS)** — Alternative or second-line option; particularly useful when oestrogen is contraindicated. The levonorgestrel intrauterine system is well-evidenced for symptom control.
- **GnRH analogues** — Hormonal suppression producing a temporary menopausal state. Effective for severe symptoms but limited in duration by bone-density and other oestrogen-deficiency effects unless add-back therapy is used.

### procedural

- **Diagnostic and operative laparoscopy** — Direct visualisation and biopsy of suspected lesions remains the diagnostic gold standard for endometriosis. Visible disease can be ablated or excised in the same procedure.
- **IVF / ICSI** — Indicated for fertility preservation or treatment in patients with endometriosis-related infertility, often after or instead of further surgical management.

### surgical

- **Laparoscopic excision of endometriosis** — Specialist surgical excision of endometriotic deposits with preservation of fertility where possible. Outcomes substantially better with surgeons specifically trained in advanced endometriosis surgery.
- **Hysterectomy with bilateral salpingo-oophorectomy** — Considered in patients who have completed family planning and have severe refractory symptoms. Hysterectomy alone does not always cure endometriosis if extra-uterine disease remains.

## Related procedures

- https://thetreatmentregistry.com/procedures/ivf

## Sources

- [ESHRE — Guidelines for Good Practice in IVF Laboratories](https://www.eshre.eu/Guidelines-and-Legal/Guidelines) — European Society of Human Reproduction and Embryology (accessed 2026-05-09)