Hormonal treatment and non invasive investigations usefulness in endometriosis surgical treatment

Endometriosis is mainly cured by surgery. It is nevertheless a disease difficult to treat in spite of the remarkable progress accomplished specially in the field of laparoscopic surgery. Other methods deserve to be investigated. The endometriosis estrogen-dependence leads one to think that suppression of ovarian function could be an interesting tool in the management of this disease, which could be used more often. Endometriosis has also a double specificity : it provokes severe adhesions either spontaneously or after surgery and its recurence rates are high. An international investigation coordinated by L Hummelshoj has shown that for 5 000 women questionned, half of them were not satisfied either by medical treatment or by surgery except if the doctor was an expert in the field of endometriosis. The aim of this review is to show that endometriosis medical treatment is much more complex than generally admitted ant that there are traps which must be avoided so as to obtain the best results for the patient. Correctly followed, it is able to notably improve surgery results. Studies, published in 2010, demonstrated in particular the utility of continuous and prolonged ovarian suppression to delay or prevent recurrences which were until recently subject to multiple surgeries, sometimes at the origin of severe complications. The second objective is to insist on explorations using ultrasounds, MRI and biochemical markers, which give a better understanding of the disease and its relationships with adenomyosis, making surgery easier and more efficacious. In the third place, the psychological aspect of complaints related with endometriosis, up to here often neglected, are beginning to be considered by numerous specialists. Last point: endometriosis associated infertility requires, before any therapeutic decision, a complete assessment of fertility factors of the couple which can lead either to surgery or to IVF. Thus, therapeutic choices are very wide and it is in a constructive dialogue that the surgeons can help their patients make the best decision. We understand that this complex situation will be managed at best in a multidisciplinary frame.