Today's treatments: how do you choose?

Objective: To provide a view on how the clinician can select appropriate treatment when managing individual patients with endometriosis. Methods: Review of randomized controlled trials and personal experience. Results: The main determinants of therapy choice are personal experience and patient acceptability. Placebo-controlled trial results support the use of naproxen, dydrogesterone, danazol and leuprolide for pain relief. Laser laparoscopy is more effective than expectant management for pain relief. In direct comparisons, oral contraceptives, Zoladex, danazol, gestrinone, nafarelin and leuprolide have similar efficacies in relieving pain, but have different side-effect profiles. In controlled trials, only laser laparoscopy was shown to improve fertility in minimal/mild disease. The physiological response of bone metabolism to GnRH agonist therapy should be seen in context and the place of add-back regimens understood. The general medical history of the patient must be considered when choosing therapy. Conclusions: The clinician must provide the patient with appropriate information on the treatment options to allow her to make an informed choice. (C) 1999 International Federation of Gynecology and Obstetrics.