Accurate diagnosis of endometriosis requires surgery, unless it is very severe with endometriomas in the ovary. Surgery is not only for diagnosis, but also for treatment. Many women see multiple physicians before being accurately diagnosed with endometriosis. Also women may undergo multiple laparoscopies with less aggressive and less effective treatment. The endometriosis may be cauterized, but many studies show that excision of endometriosis improves the outcome with fertility as well as reducing pain. Repetitive surgery leads to more scarring and when the surgery is incomplete it is not effective at improving fertility and offers only short-term pain relief. Endometriosis causes pelvic pain because the monthly bleeding leads to inflammation. Over many months scar tissue also leads to pain particularly between menstrual cycles or with intercourse. Medical treatment with targeted hormonal medications is the primary treatment for pelvic pain related to endometriosis, although complete excision of endometriosis by expert surgeons provides longer-lasting pain relief. 

Patients should understand that endometriosis effects women from the time of puberty until menopause (12 years old up to 51 years old.) Even after laparoscopy, endometriosis may recur due to incomplete treatment, or it may develop again. As long as patients are having periods, endometriosis may cause pain and infertility. But with the right treatments, both medical and surgical, endometriosis can be managed, pain can be controlled, and fertility can be improved. Because of the importance of medical treatment, Dr. Coussons can manage endometriosis many times with remote testing, and ongoing medical treatment. His knowledge and experience will help you gain control of this chronic debilitating condition. He tries to avoid surgery in the management of pelvic pain, but ultimate definitive treatment is only accomplished with the reduction of estrogen. Menopause can be natural at 47-52 years old, or it can be surgical with complete hysterectomy. Prior to definitive treatment, medications can lower estrogen and manage the disease, buying time in preventing major surgery. With the right treatment, fertility can be achieved in most patients diagnosed with endometriosis and pelvic pain relief can be significant with the right combination of surgery and medical treatment.