Management Challenges of Deep Infiltrating Endometriosis

Deep infiltrating endometriosis (DIE) is the most aggressive of the three phenotypes that constitute endometriosis.It can affect the whole pelvis, subverting the anatomy and functionality of vital organs, with an important negativeimpact on the patient’s quality of life. The diagnosis of DIE is based on clinical and physical examination, instrumentalexamination, and, if surgery is needed, the identification and biopsy of lesions. The choice of the best therapeuticapproach for women with DIE is often challenging. Therapeutic options include medical and surgical treatment, andthe decision should be dictated by the patient’s medical history, disease stage, symptom severity, and personal choice.Medical therapy can control the symptoms and stop the development of pathology, keeping in mind the side effectsderived from a long-term treatment and the risk of recurrence once suspended. Surgical treatment should be proposedonly when it is strictly necessary (failed hormone therapy, contraindications to hormone treatment, severity of symptoms,infertility), preferring, whenever possible, a conservative approach performed by a multidisciplinary team. Alltherapeutic possibilities have to be explained by the physicians in order to help the patients to make the right choiceand minimize the impact of the disease on their lives.