Medical and Surgical Management of Endometriosis: A Narrative Review of Clinical Outcomes

Endometriosis is a chronic, estrogen-dependent, and heterogeneous gynecologic disorder associated with persistent pain, infertility, and substantial impairment in quality of life (QoL), necessitating individualized and evidence-based management. This narrative review synthesizes contemporary evidence on the clinical outcomes of medical and surgical management of endometriosis, with particular emphasis on pain control, fertility outcomes, disease recurrence, QoL, and treatment safety. A structured literature search of PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library was conducted for studies published between 2015 and 2025, including randomized controlled trials, observational studies, and high-quality reviews reporting clinically relevant outcomes following medical and/or surgical interventions. Medical therapies, including hormonal suppression strategies, are consistently effective in reducing dysmenorrhea and chronic pelvic pain; however, they are limited by treatment-related adverse effects, symptom recurrence after discontinuation, and lack of sustained fertility benefit. Surgical management, particularly laparoscopic excision, demonstrates significant improvements in pain and spontaneous conception rates in selected patients; however, risks of recurrence, surgical complications, and reduction in ovarian reserve remain important considerations. Postoperative hormonal suppression is associated with prolonged recurrence-free intervals and improved long-term symptom control. Patient-reported outcome measures highlight meaningful improvements in QoL across treatment modalities but also underscore variability in long-term outcomes. Optimal management of endometriosis requires a multidisciplinary, patient-centered approach that integrates medical and surgical strategies, fertility preservation considerations, and long-term outcome monitoring to address the complex and recurrent nature of the disease.