To compare the clinical outcomes of medical versus surgical treatment in women with moderate-to-severe endometriosis, focusing on symptom relief, recurrence rates, and quality of life. This randomized controlled trial involved 200 women diagnosed with moderate-to-severe endometriosis, who were randomly assigned to either medical management (GnRH agonists and oral contraceptives) or surgical treatment (laparoscopic excision of endometriotic lesions). Outcome measures included symptom resolution, recurrence rates, quality of life (measured by the Endometriosis Health Profile-30), and adverse effects. Both medical and surgical treatments resulted in significant symptom relief (p < 0.05). Surgical treatment demonstrated superior long-term outcomes with a lower recurrence rate (15% vs. 30%, p = 0.02). However, medical treatment had a shorter recovery time and fewer complications. Both medical and surgical treatments are effective for managing endometriosis, but laparoscopic surgery offers superior long-term results, including lower recurrence rates. However, medical treatment may be preferred in women seeking less invasive options with quicker recovery times.
Endometriosis is a common gynaecological disorder characterized by the presence of endometrial-like tissue outside the uterus. It affects approximately 10-15% of women of reproductive age and is associated with chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility [1,2]. The management of endometriosis is challenging, as it often requires a , ,personalized approach depending on symptom severity, the extent of disease, and the patient's fertility desires [3]. Treatment options typically include medical therapies (e.g., hormonal treatments such as GnRH agonists, oral contraceptives) and surgical approaches (e.g., laparoscopic excision of endometriotic lesions).
Medical treatments aim to suppress the hormonal milieu contributing to endometriotic growth, but they often come with side effects, including bone density loss, mood changes, and potential long-term effects [4]. Surgical treatment, particularly laparoscopic excision of endometriotic tissue, has been shown to provide significant symptomatic relief, improve fertility, and reduce recurrence rates [5, 6]. However, surgery is invasive, carries risks such as adhesion formation, and requires longer recovery times [7]
There is a lack of randomized controlled trials directly comparing the long-term efficacy and safety of medical versus surgical management in endometriosis. This study aims to address this gap by comparing clinical outcomes, recurrence rates, quality of life, and patient satisfaction between medical and surgical treatments for endometriosis.
Study design:
This was a multicenter, randomized controlled trial conducted at three tertiary care centers. Women aged 18-40 years with moderate-to-severe endometriosis, confirmed by laparoscopy or imaging, and who had not undergone prior treatment for endometriosis were eligible for inclusion. Women with contraindications to medical therapy (e.g., liver disease, thromboembolic disorders) or surgery were excluded.
Study groups:
Eligible participants were randomly assigned to one of two treatment groups:
Group 1: Medical Treatment (n = 100): This group received 6 months of GnRH agonist therapy (leuprorelin 3.75 mg monthly) followed by oral contraceptives for maintenance.
Group 2: Surgical Treatment (n = 100): This group underwent laparoscopic excision of visible endometriotic lesions, with the goal of complete removal of endometriosis.
Study plain
Primary Outcome: Symptom resolution, assessed using the Visual Analog Scale (VAS) for pain, measuring pelvic pain, dysmenorrhea, and dyspareunia at baseline, 6 months, and 12 months.
Secondary Outcomes:
Statistical Analysis:
Data were analyzed using SPSS software (version 26). Descriptive statistics were used to summarize demographic data. Between-group comparisons of continuous variables were performed using independent t-tests, and categorical variables were analysed with chi-square tests. A p-value of < 0.05 was considered statistically significant.
The present study was carried out after taking permission from institutional ethical committee. The patients ready to give inform consent there data was recorded and analysed. Table 1 presents the baseline demographic and clinical characteristics of the study participants. There were no significant differences between the two groups regarding age, BMI, disease severity, or baseline pain scores.
Characteristic |
Medical Treatment (n=100) |
Surgical Treatment (n=100) |
p-value |
Age (years) |
31.5 ± 5.3 |
32.0 ± 4.9 |
0.34 |
BMI (kg/m²) |
24.2 ± 3.0 |
24.4 ± 3.2 |
0.61 |
Disease Severity (rAFS score) |
28.4 ± 7.2 |
29.1 ± 7.5 |
0.65 |
Baseline Pelvic Pain (VAS score) |
8.2 ± 1.1 |
8.3 ± 1.2 |
0.75 |
At 12 months, both groups showed significant improvement in pain scores. However, the surgical group experienced a greater reduction in pelvic pain and dysmenorrhea compared to the medical group (p < 0.05).
Outcome |
Medical Treatment (n=100) |
Surgical Treatment (n=100) |
p-value |
Pelvic Pain (VAS score) |
2.3 ± 1.0 |
1.2 ± 0.8 |
0.03 |
Dysmenorrhea (VAS score) |
2.6 ± 1.2 |
1.4 ± 0.9 |
0.01 |
Dyspareunia (VAS score) |
3.0 ± 1.4 |
1.8 ± 1.1 |
0.04 |
The recurrence rate of symptoms was significantly lower in the surgical group (15%) compared to the medical group (30%) (p = 0.02). Quality of life, measured by the EHP-30, improved more in the surgical group, particularly in terms of pain, sexual health, and emotional well-being (p < 0.05).
Outcome |
Medical Treatment (n=100) |
Surgical Treatment (n=100) |
p-value |
Recurrence Rate (%) |
30 |
15 |
0.02 |
Quality of Life (EHP-30 score) |
65.4 ± 12.5 |
85.2 ± 10.3 |
0.04 |
The incidence of side effects was higher in the medical treatment group (45% vs. 12%) due to the hormonal therapy, which included mood swings, hot flashes, and headaches. No major complications occurred in either group, but the surgical group had a slightly higher rate of postoperative pain and longer recovery time.
The table provides an overview of the baseline demographic and clinical characteristics of two groups: the Medical Treatment group and the Surgical Treatment group, each consisting of 100 participants. The mean age of participants in the medical treatment group was 31.5 ± 5.3 years, while the surgical treatment group had a mean age of 32.0 ± 4.9 years (p = 0.34). This shows that the groups were comparable in terms of age, ensuring that age-related factors do not confound the study results. The average BMI for the medical treatment group was 24.2 ± 3.0, and for the surgical treatment group, it was 24.4 ± 3.2 (p = 0.61). The similar BMI scores between groups suggest that body weight and obesity-related factors are not likely to influence treatment outcomes. The rAFS (revised American Fertility Society) score, which is commonly used to classify the severity of endometriosis, showed a mean score of 28.4 ± 7.2 in the medical treatment group and 29.1 ± 7.5 in the surgical treatment group (p = 0.65). This indicates that both groups had similar levels of disease severity at baseline. The average baseline pelvic pain score, measured on a Visual Analog Scale (VAS), was 8.2 ± 1.1 in the medical treatment group and 8.3 ± 1.2 in the surgical group (p = 0.75). Both groups had similar pain levels at baseline, which ensures comparability in the initial severity of symptoms.
The lack of significant differences between the two groups in these key demographic and clinical factors strengthens the internal validity of the study, suggesting that observed differences in outcomes can be more confidently attributed to the treatment types rather than confounding variables.
At the 12-month follow-up, both treatment groups showed improvements in pelvic pain, dysmenorrhea, and dyspareunia, but the surgical group exhibited significantly greater improvements compared to the medical group. These findings are consistent with several other studies comparing surgical and medical interventions for endometriosis.
The surgical group experienced a greater reduction in pelvic pain (VAS score: 1.2 ± 0.8) compared to the medical group (VAS score: 2.3 ± 1.0) (p = 0.03). These results are in line with those of Miller et al. (2016) [5], who found that surgical excision was more effective than medical treatments (such as GnRH agonists) in reducing pelvic pain in endometriosis patients. Similarly, Abbott et al. (2017) [3] reported that laparoscopic surgery led to better pain relief outcomes than medical therapy.
The surgical group also showed greater improvement in dysmenorrhea (VAS score: 1.4 ± 0.9) compared to the medical group (VAS score: 2.6 ± 1.2) (p = 0.01). This finding aligns with Giudice and Kao (2004) [2], who noted that surgical treatment typically offers better symptom relief for dysmenorrhea compared to medical management, such as hormonal therapy. Similarly, the surgical group experienced a greater reduction in dyspareunia (pain during intercourse), with a VAS score of 1.8 ± 1.1 compared to the medical group’s score of 3.0 ± 1.4 (p = 0.04). These results support findings from Nisenblat et al. (2016) [7], who reported that surgical treatment was more effective in alleviating dyspareunia compared to medical options.
The recurrence of symptoms was lower in the surgical group (15%) compared to the medical group (30%) (p = 0.02). This is an important finding, as it indicates that surgery may provide longer-term relief. Other studies, such as Shakir et al. (2019) [6], have also found that surgical excision of endometriosis lesions has a lower recurrence rate compared to medical treatments, which often have to be continued over a prolonged period. Quality of life, as measured by the Endometriosis Health Profile-30 (EHP-30), improved more in the surgical group (score: 85.2 ± 10.3) compared to the medical group (score: 65.4 ± 12.5) (p = 0.04). The improvement in quality of life, particularly in areas related to pain, sexual health, and emotional well-being, highlights the overall benefit of surgery. Giudice and Kao (2004) [2] emphasized that surgical treatment not only improves pain but also has a positive effect on the patient's emotional well-being and sexual function, which is consistent with the findings here.
The incidence of side effects was notably higher in the medical treatment group (45%) compared to the surgical group (12%). The side effects in the medical group were primarily related to hormonal therapy, which included mood swings, hot flashes, and headaches. This is consistent with other studies, such as Rossi et al. (2018) [4], which discussed the common side effects of GnRH agonists and other hormonal therapies. In contrast, the surgical group had fewer side effects, but a slightly higher rate of postoperative pain and longer recovery time, which is a common drawback of invasive procedures. However, these side effects were not severe and did not result in major complications, which is consistent with findings from Abbott et al. (2017) [3].
The results of this study indicate that both medical and surgical treatments for endometriosis lead to significant improvements in pain scores over a 12-month period. However, the surgical group demonstrated greater reductions in pelvic pain, dysmenorrhea, and dyspareunia compared to the medical treatment group, with statistically significant differences observed in all three outcomes (p < 0.05). Additionally, the surgical group exhibited a lower recurrence rate of symptoms (15% vs. 30%, p = 0.02) and a significant improvement in quality of life, particularly in terms of pain, sexual health, and emotional well-being.
While both treatments had side effects, the medical treatment group experienced a higher incidence of side effects (45% vs. 12%) primarily due to hormonal therapy, which included mood swings, hot flashes, and headaches. On the other hand, the surgical group had a slightly higher rate of postoperative pain and longer recovery time, though no major complications were reported in either group.
In conclusion, although both medical and surgical treatments are effective in managing endometriosis symptoms, surgical treatment appears to offer superior long-term benefits, particularly in terms of pain relief, recurrence reduction, and quality of life improvement. However, the choice of treatment should be individualized, considering the potential trade-offs in terms of recovery time and side effects.