A cost-effective approach to the management of endometriosis.

Endometriosis is a common disease that affects a large number of women throughout the world. Whereas in the past laparoscopy was commonly used for the diagnosis and treatment of women with endometriosis and pelvic pain, recent studies have demonstrated that surgical therapy offers no better results in terms of pain relief than medical therapy with a gonadotrophin-releasing hormone agonist. Surgical therapy requires considerable experience and expertise on the part of the surgeon and the results are likely to be operator dependent. The results of the very best surgeons, as published in the medical literature, often cannot be replicated by the average gynecologist. Medical treatment, on the other hand, is not operator dependent. The efficacy of clinical diagnosis given a thorough evaluation has been proved, and the outcomes of empiric medical therapy with a gonadotrophin-releasing hormone agonist are substantial. Given the similar results obtained with a gonadotrophin-releasing hormone agonist and surgical intervention and the fact that medical treatment is less expensive, primary therapy with a gonadotrophin-releasing hormone agonist appears to be the most cost-effective approach to the management of endometriosis and pelvic pain. Because of the limited information currently available, a statement regarding endometriosis and infertility would probably be inappropriate at this time.