Minimal endometriosis: a therapeutic dilemma?

Accidental finding of minimal endometriosis during surgery for complaints unassociated with endometriosis presents a therapeutical dilemma. Because the clinical significance of minimal endometriosis is not thoroughly defined, it is uncertain by which means, if at all, such types of peritoneal or ovarian lesions should be treated. We, therefore, compiled our clinical observations and evaluated them in relation to the results reported in the recent literature. A search on the clinical importance and the need for any treatment of minimal and mild endometriosis was conducted. Based on the available evidence, we are tempted to conclude that minimal endometriosis should be treated surgically when accidentally discovered. This approach should be exerted even in the absence of clinical symptoms. However, postoperative medical treatment is not warranted in those patients who are without clinical complaints. Because the clinical course of minimal endometriosis is not predictable, any benefit from specific medications remains uncertain. When associated with infertility, minimal endometriosis should be surgically erased, thus to allow spontaneous conceptions to occur. As there is no evidence of medical treatment modalities altering the clinical course of minimal and mild endometriosis, any specific medical treatment (i.e. GnRH analogues, danazol) is not indicated in asymptomatic patients and those desiring pregnancy.