Optimising Care For Endometriosis: New Therapeutic Options and Surgical Considerations — A Systematic Literature Review (SLR)

Abstract

Endometriosis is a chronic gynaecological condition that is linked to pelvic pain, dysmenorrhea, infertility and poor quality of life (QoL) and now needs to be managed increasingly on an individual basis combining medical and surgical treatment. This systematic literature review assessed recent therapeutic and surgical considerations for the optimization of endometriosis treatment, focusing on pain control, QoL, fertility, ovarian reserve, recurrence, safety and postoperative outcomes. Original clinical studies published between 2015 to 2025 were identified through PubMed sand Google Scholar. Following duplications removal and eligibility screening, 15 studies were included and narratively synthesized based on therapeutic approaches, surgical management, reproductive outcomes, patient-reported outcomes and methodological quality. Newer oral gonadotropin-releasing hormone antagonists (elagolix, relugolix, and linzagolix) uniformly reduced dysmenorrhea and non-menstrual pelvic pain and improved functioning and QoL. Based on the surgical procedures, pain and QoL were also improved, but not in all cases the more extensive procedures were superior. It was demonstrated that the ovarian reserve was affected by surgical technique, underscoring the need for fertility preserving surgical techniques. Factors to consider for long-term results were recurrence, treatment safety, and repeat procedures. In summary, the ideal care of endometriosis must progress beyond the medical versus surgical dichotomy and exhibit a patient-centred approach that considers symptom management, safety, reproductive considerations and long-term QoL.