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Endometriosis - Management
Basis for recommendation
Relapse rate
- Relapse is common once hormonal treatment is discontinued. In trials of treatment with a gonadotrophin-releasing hormone (GnRH) analogue or danazol, approximately 10–20% of women required further treatment within 12 months. Uncontrolled cohort studies report relapse in about half of women at 5 years [Farquhar and Sutton, 1998].
- Relapse is also common after surgical procedures, and up to 50% of women may require analgesics or hormonal treatment 1 year later [Vercellini et al, 2009].
Further medical treatment
- There is a lack of trial evidence regarding the safety and effectiveness of repeat courses of hormonal treatment for endometriosis. Specialist advice is therefore recommended. Several CKS expert reviewers advised that it would be reasonable to prescribe medical treatment such as combined oral contraception if this had been effective in the past, if subfertility was not an issue, and in the absence of findings that the disease had significantly worsened (such as ovarian endometriomas or deeply infiltrating nodules).
Surgery
- Repeat surgery may also be considered.
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