consider outpatient follow-up (with or without examination and pelvic imaging) for women with confirmed endometriosis, particularly women who choose not to have surgery, if they have:
deep endometriosis involving the bowel, bladder or ureter or
1 or more endometrioma that is larger than 3 cm
Notes:
Medical treatment:
medical treatment is generally effective at treating pain e.g. secondary dyspareunia, especially if only minimal disease. However about 40% of women will have a recurrence of symptoms at some time after cessation of treatment
Surgical treatment:
if surgical treatment is adequate then the recurrence rate is less than 20%. Improvement in fertility is related to severity of disease. The conception rate after treatment for severe disease is about 35%; whilst a 65% conception rate has been reported after treatment for moderate disease. The chance of conception is greatest in the two years following surgery
if a patient has had a total abdominal hysterectomy, bilateral salpingoophrectomy and resection of other deposits of endometriosis, then hormone replacement therapy can be used with a minimal risk of growth in any residual endometriosis
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