Proper counseling of patients with endometriosis requires attention to several aspects of the disorder. Of primary importance is the initial operative staging of the disease to obtain adequate information on which to base future decisions about therapy. The patient’s symptoms and desire for childbearing dictate appropriate therapy. Most patients can be told that they will be able to obtain significant relief from pelvic pain and that treatment will assist them in achieving pregnancy.
Long-term concerns must be more guarded in that all current therapies offer relief but not cure. Even after definitive surgery, endometriosis may recur, but the risk is very low (about 3%). The risk of recurrence is not significantly increased by estrogen replacement therapy. After conservative surgery, reported recurrence rates vary greatly but usually exceed 10% in 3 years and 35% in 5 years. Pregnancy delays but does not preclude recurrence. Recurrence rates after medical treatment also vary and are similar to or higher than those reported following surgical treatment.
Although many patients are concerned that endometriosis will progress inexorably, experience has been that conservative surgery avoids the necessity for hysterectomy in the great majority of cases. The course of endometriosis in any individual is impossible to predict at present, and future treatment options should greatly improve what can now be offered.