Endometriosis Treatment — Individualised Care Decisions

Our approach to treatment

At Balaji Horizon, treatment planning begins where diagnosis ends. The same diagnostic imaging that confirms disease also informs the operative plan — so surgery, when needed, is single-stage and definitive rather than repeated diagnostic-then-therapeutic procedures. Surgical decisions favour fertility preservation, ovarian reserve protection, and avoidance of repeat surgery wherever clinically possible. Medical options are sequenced from the safest and most evidence-based forward; older approaches are not used simply because they are familiar.

Medical management

First-line options for pain include non-steroidal anti-inflammatories and combined hormonal contraception (continuous regimens). Second-line options include progestogens (dienogest, norethisterone, levonorgestrel-IUS). GnRH analogues — with add-back hormone replacement — remain an option for selected cases. The evidence base (ESHRE 2022) supports a stepwise approach, calibrated to side-effect tolerance and fertility plans.

Surgical management

When surgery is indicated, 3D laparoscopic excision is the technique of choice for most patients. Karl Storz IMAGE1 S 3D imaging improves depth perception and dissection precision in the deep pelvis. Excision (not ablation) of visible disease is preferred where feasible. For DIE involving bowel or bladder, multidisciplinary planning is essential — and increasingly, the entire surgery is staged with colorectal or urological colleagues present from incision.

Fertility-integrated treatment decisions

For patients with fertility goals, the decision is rarely surgery-or-IVF in isolation. Endometrioma surgery before IVF can reduce ovarian reserve. Repeated surgery for deep disease can have cumulative impact on the pelvis. The integrated decision — when to operate, when to proceed to IVF, when to do both in sequence — is the most important conversation in modern endometriosis care.

Treatment topics covered

Guidelines we follow

• ESHRE 2022 Guideline on Endometriosis — treatment recommendations
• ESGE consensus on operative pathways for deep infiltrating disease
• AAGL practice guidelines on the management of endometriosis
• Cochrane reviews on medical and surgical management

Where this fits

Treatment decisions follow diagnosis and depend on disease type. For fertility-integrated planning, see endometriosis and fertility. For day-to-day life around treatment, see living with endometriosis.