Introduction: From pathogenesis to therapy, deep endometriosis remains a source of controversy

This issue’s Views and Reviews discuss medical and surgical strategies for deep endometriosis and emphasizes that treatment should be designed according to a patient’s symptoms and individual needs.

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Volume 108, Issue 6, Pages 872–885.e1


Jacques Donnez, M.D., Ph.D.


Deep endometriosis remains a source of controversy. A number of theories may explain its pathogenesis and many arguments support the hypothesis that genetic or epigenetic changes are a prerequisite for development of lesions into deep endometriosis. Deep endometriosis is frequently responsible for pelvic pain, dysmenorrhea, and/or deep dyspareunia, but can also cause obstetrical complications. Diagnosis may be improved by high-quality imaging. Therapeutic approaches are a source of contention as well. In this issue's Views and Reviews, medical and surgical strategies are discussed, and it is emphasized that treatment should be designed according to a patient's symptoms and individual needs. It is also vital that referral centers have the knowledge and experience to treat deep endometriosis medically and/or surgically. The debate must continue because emerging trends in therapy need to be followed and investigated for optimal management.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. 


Go to the profile of Nancy Petersen
almost 4 years ago

Sadly, superficial endometriosis or peritoneal endometriosis is also a source of disabling pain, which does not resolve with medical therapy, yet gets little respect.  The majority of it responds well to expert surgery, with low recurrence rates and substantial improved quality of life

Go to the profile of Nancy Petersen
almost 4 years ago

Likewise, hormonal therapy does not treat endo, nor stop progression or recurrence of it (ACOG practice bulletins), and most patients find hormonal manipulation unacceptable but gynecology is not listening.  We know what works, excision when done with great expertise, and to question the only tools that restore quality of life is, pardon me, misogynist and subject to questioning.  Our 30,000 member patient group is still growing at the rate of 300 a week having failed all gynecology has to offer except expert surgery.  The disconnect is stunning.
Nancy Petersen RN retired

Endometriosis Patient Advocate since 1985