The management of stage III and IV endometriosis

The clinical manifestations of severe endome-triosis are variable and unpredictable in both presentation and course. There are also a proportion of women with severe endometriosis who remain asymptomatic. The treatment of severe endometriosis must be individualised, taking into account the impact of the disease and treatment on pain, fertility and quality of life. Surgery is usually required and multiple organs are sometimes involved. Therefore, if endometriosis is severe, referral to a center with the expertise to oVer all available treatments in a multidisciplinary team, including advanced laparoscopic surgery and laparot-omy, is strongly recommended. It is also important to involve the woman in all decisions, to be Xexible in diagnostic and therapeutic thinking, to maintain a good relationship with the woman and to seek advice where appropriate.