Objective: To establish guidelines for the medical and surgical management of painful endometriosis.
Material and methods: An exhaustive review on Medline and Cochrane Database between 1980 and 2006 was performed.
Results: GnRH agonists, progestins, continuous monophasic oral contraceptives and danazol have a suppressive effect on dysmenorrhoea, nonmenstrual pain and dyspareunia (grade A). Surgical treatment is effective in painful endometriosis (grade B). Complete surgical excision of deep endometriotic lesions with conservation of uterus and ovaries has a limited term efficacy on pain relief (grade C). A multidisciplinary approach is recommended (grade C). The use of the psychotherapy improves the management of chronic pain (grade A). There is a lack of information concerning the therapeutic strategy able to prevent recurrences. Whether endometriosis recurrences occur, medical treatment should be the first line approach (expert opinion). A hysterectomy with salpingo-oophorectomy and complete excision of the lesions is efficient in women with pain recurrence who no longer desire pregnancy (grade C).
Conclusions: Medical and surgical treatments have a limited term efficacy on painful endometriosis (grade A). The benefit/risk ratio, depending on side-effects, should be assessed on a case to case basis.