**3.2 Postoperative medical therapy**

The hypothetical advantages of short-term postoperative medical treatment, including resorption of residual visible foci and sterilisation of microscopic implants, should result in a reduction of postoperative lesions and symptoms recurrence rates (Vercellini *et al.*, 2003).

Progestins, danazol, estrogen-progestin pills, and GnRH agonists have been used in conjunction with laparotomy or laparoscopic conservative or definitive surgical treatment. Several trials have reported that these agents increase the duration of pain relief and delayed recurrence of symptoms (Kennedy *et al.*, 2005). However, a meta-analysis of eight trials, considered that postoperative hormonal suppression of endometriosis decreased recurrence rates, but there was no significant benefit for the outcomes of pain or pregnancy rates (Yap *et al.*, 2004). The main problem in interpreting the above data is the short-instead of long-term use of medications. In fact, the rationale for suggesting adjuvant therapy for a few months is far from clear. When this treatment is deemed opportune, oestrogenprogestogen combinations should be considered because of their tolerable side effects, limited costs, and antalgic efficacy similar to GnRH agonists and danazol (Kennedy *et al.*, 2005).

The lowest effective dose of hormone replacement should be used shortly after definitive surgery or as soon as menopausal symptoms arise. Avoidance of oestrogen-only treatment and the use of combined preparations or tibolone are suggested (Vercellini *et al.*, 2009). Oestrogen-only therapy has been associated with an increased risk of malignant transformation of ectopic foci (Modesitt *et al.*, 2002).
