Personalized endometriosis therapy: efficacy of surgical treatment and long-term medical control

Introduction. Endometriosis is a chronic multisystem disease associated with decreased quality of life, chronic pelvic pain, infertility, and a wide range of comorbid conditions. Despite the fact that laparoscopy has traditionally held a central place in the diagnosis and treatment of endometriosis, the current role of surgical intervention requires a differentiated assessment, taking into account disease phenotype, the severity of pain, reproductive plans, the risk of damage to ovarian reserve and the likelihood of recurrence.

Aim: to critically compare surgical, medical, and combined approaches to endometriosis treatment and to substantiate a stratified model of long-term patient management accounting for disease phenotype, pain profile, ovarian reserve, comorbidity, and reproductive plans.

Materials and Methods. A narrative literature review was performed by retieving relevant publixcxations found in PubMed/MEDLINE, Embase, Scopus, Web of Science, ScienceDirect, eLibrary.ru, CyberLeninka, and Google Scholar. The primary search window covered 2017–2025; earlier publications were included base on their methodological, historical, or clinical relevance. Eligible sources comprised systematic reviews, meta-analyses, randomized controlled trials, large cohort studies, and clinically relecant observational studies reporting surgical, medical, or combined endometriosis treatment, pain control, recurrence prevention, effects on fertility and ovarian reserve, as well as long-term therapy safety. The review was prepared in accordance to the SANRA criteria (Scale for the Assessment of Narrative Review Articles).

Results. Synthesis of current evidence indicates that surgery is effective for selected indications (large or symptomatic endometriomas, deep infiltrating endometriosis with obstructive manifestations, distorted pelvic anatomy, and certain infertility phenotypes) but guarantees no durable pain control or recurrence prevention. Long-term medical therapy (progestins, combined oral contraceptives, oral gonadotropin-releasing hormone antagonists with add-back therapy, and the levonorgestrel-releasing intrauterine system) provides clinically relevant pain reduction and lowers postoperative recurrence risk; progestogen regimens are associated with a lower need for reoperation and second-line therapy. Unlike repeated ovarian surgery, medical strategies do not involve direct surgical trauma to ovarian tissue; however, their effectiveness and safety depend on disease phenotype, treatment duration, contraindications, tolerability, and reproductive goals.

Conclusion. Surgical treatment remains important in cases of large or symptomatic endometriomas, pelvic anatomy disorders, obstructive complications, suspected malignancy, and certain infertility forms. The most reasonable approach is not to replace surgery with drug treatment, but rather a stratified model in which the sequence and scope of interventions are determined by patient's clinical profile and long-term goals of therapy.

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