**5. Critical analysis of treatments for endometriosis**

The therapeutic approach to endometriosis varies, depending on the patient's complaint, pelvic pain or infertility, although such complaints are often associated. Gonadotropin-releasing hormone (GnRH) analogues, GnRHa, may be indicated for three months and then continue with oral contraceptives. If the patient has

**3**

studies.

able [13, 14].

both [13, 15].

its pathogenesis.

*Introductory Chapter: Changes in the Approach of the Patient with Endometriosis…*

recurrence of pain, or an image suggestive of endometrioma greater than 3 cm or

Surgical treatment of endometriosis involves procedures of low complexity, such as the treatment of superficial foci and the release of tendon adhesions, to complex interventions in the ovaries, Douglas sacs, intestines, bladder, and ureters, requiring, in some cases, a multidisciplinary team. For several years, the surgical treatment of endometriosis was based on the oncological principles of radical removal of the lesions. This principle is still used when it comes to cases of intestinal or ureteral stenosis or ovarian masses of doubtful characteristics. However, we currently know that there is no correlation between the disease with the severity of the symptoms, as well as the reproductive prognosis and long-term recurrence of pain [11]. In addition, many patients present infertility associated with pain, requiring that the surgical procedure be conservative. Based on these considerations, some authors recommend surgical treatment only for patients who do not respond to drug treatment, as well as for those who wish to become pregnant spontaneously [12]. There are few published randomized clinical trials evaluating the outcome of surgical treatment of symptomatic endometriosis. A review by Vercellini et al. [12] describes symptomatic improvement after conservative treatment of around 60–80%, with recurrence of symptoms and reoperation rate ranging from 12 to 58% between

For the patient with infertility, follicle ablation and adhesiolysis appear to improve fertility in the minimal and mild degrees of disease [1]. In cases of moderate or severe degrees, there are no randomized clinical trials or meta-analyses

Endometriosis exhibits similarity with cancer since endometrial cell implants require neovascularization to establish, grow, and invade tissues. In addition, the etiopathogenic theories of endometriosis involve growth factors and cytokines associated with regulation of cell multiplication and neoangiogenesis that may act on carcinogenesis. It is estimated that 1% of cases of endometriosis is related to cancer, and for some types of endometriosis, its benign nature has been question-

Although the definitive diagnosis of endometriosis necessitates a surgical intervention, called video-laparoscopy, several findings in the physical, imaging and laboratory examinations can already predict, with a high degree of reliability, that the patient has this disease. During this surgical procedure, it is possible to visualize lesions suggestive of the disease and to obtain a tissue specimen for anatomopathological analysis and confirmation of the diagnosis of endometriosis [15]. The classification used for endometriosis is that of the American Society of Reproductive Medicine (ASRM), revised in 1996, which rates this disease in minimal (stage I), mild (stage II), moderate (stage III), or severe (stage IV) [16]. Currently, the most common treatments are surgery, ovarian suppression therapy, or the association of

The cause of endometriosis remains unknown. However, there is evidence of immunological [17, 18], environmental [19], and genetic [18, 20] factors involved in

available to answer if resection of foci would increase gestation rates.

**7. Molecular genetics and endometriosis**

*DOI: http://dx.doi.org/10.5772/intechopen.85608*

**6. Surgical treatment of endometriosis**

suspected of adherence, surgery should be indicated.

*Introductory Chapter: Changes in the Approach of the Patient with Endometriosis… DOI: http://dx.doi.org/10.5772/intechopen.85608*

recurrence of pain, or an image suggestive of endometrioma greater than 3 cm or suspected of adherence, surgery should be indicated.
