The management of stage III and IV endometriosis.

The clinical manifestations of severe endometriosis 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 offer all available treatments in a multidisciplinary team, including advanced laparoscopic surgery and laparotomy, is strongly recommended. It is also important to involve the woman in all decisions, to be flexible in diagnostic and therapeutic thinking, to maintain a good relationship with the woman and to seek advice where appropriate.