General treatment issues

Patient participation in the decision-making process is essential as multiple options exist and endometriosis is

Table 44.2 Factors influencing choice of treatment

Woman's age Fertility status Nature of symptoms Severity of disease Previous treatments Priorities and attitudes Resource implications Costs + side-effect profile Risks of treatment Other subfertility factors Intended duration of treatment Best available evidence

Table 44.3 Treatment aims

What are you treating (disease, symptoms or both)? Why are you treating? Possible reasons to treat Improve natural fertility Enhance chances of success at ART Pain relief as an alternative to surgery Pain relief while awaiting surgery Adjunct to surgery

Prophylaxis against disease occurrence Symptom recurrence potentially a chronic problem. Choosing which treatment to have will depend upon a number of factors (Table 44.2).

Summarizing how these factors influence decision making is difficult because each patient is different and the decisions are often complex. However, some general principles apply. For example, a woman in her late 40s with debilitating pain and severe disease who has completed her family can be offered a hysterectomy and bilateral salpingo-oophorectomy provided that all the endometri-otic tissue is removed at the same time. On the other hand, a young nulliparous woman with a similar presentation will want as much normal tissue as possible conserved if she opts for surgery.

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