Surgery to resect endometriosis and adhesions, followed by a progesterone IUD, is recommended for patients with pain, with GnRH antagonists potentially used post-surgery for up to two years in severe cases.

“Usually if I do a progesterone suppression and the patient has pain, I recommend surgery because during surgery, I resect the endometriosis, I cut all the adhesions if they have it, and then I put a progesterone IUD and I send them home. For patients during surgery who have severe disease, stage three or four, then I also add these G&RH antagonists after surgery depending on their stage or symptoms from 6 months up to two years”