In the 1970's, the mainstay of treatment for endometriosis was pelvic laparotomy. Today, endometriosis is for the most part concomitantly diagnosed and treated. Rapid advances in laparoscopic instrumentation have armed the gynecologic surgeon with multiple modalities that can be used to destroy endometriosis safely. These include improvements in laser and electrocoagulating technology as well as the introduction of adjuvants to prevent adhesions. Medical therapy is basically hormonal and has its origins in the observation that endometriosis is often found to regress during pregnancy and the menopause.
Ectopic endometrium responds to exogenous hormones in a manner similar to intrauterine endometrium.
Nevertheless, the response is variable. Estrogen and androgen are mentioned only historically since the side effects of endometrial hyperplasia and masculinization of female fetuses have decreased the use of these agents. Progestational agents have been shown to be an effective treatment for endometriosis. The agents that have been used include acetate, norethynodrel, megestrol acetate, dydrogesterone, norethisterone, and lynestrenol. Hormonally, danazol decreases estradiol concentration by decreasing the frequency and increments of estradiol pulses and prevents compensatory gonadotropin rises.