***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: The effect of treatment with danazol was evaluated with respect to expectant management after laparoscopic conservative surgery . All patients conservatively operated at laparoscopy for stage III-IV endometriosis from July 1994 to October 1996 were requested to enter the study . Patients who underwent surgery for recurrent endometriosis were excluded from the study , as well as patients who had taken hormonal therapies before laparoscopy . Informed consent was obtained from 77 women who were r and omized after surgery to treatment with danazol 600 mg daily for 3 months ( n = 36 ) or to expectant management ( n = 41 ) . All patients were regularly followed up every 6 months for evaluation of fertility , recurrence of pain symptoms and disease . During the follow-up , six ( 55 % ) of the 11 infertile women allocated to danazol and eight ( 50 % ) of the 16 given no treatment became pregnant ( not significant ) . Moderate/severe pelvic pain recurred during follow-up in seven ( 23 % ) of the 31 women with pelvic pain allocated to the danazol group and nine ( 31 % ) of the 29 allocated to no treatment ; the respective cumulative pain recurrence rates at 12 months were 26 and 34 % ( log rank test , not significant ) . Three women ( 8.3 % ) treated with danazol and six ( 15 % ) who received no treatment had disease recurrence as demonstrated by gynaecological examination and /or pelvic ultrasonography ( not significant ) . Our results do not demonstrate a significant advantage of 3 month danazol therapy after laparoscopic surgery for stage III-IV endometriosis with respect to postoperative expectant management OBJECTIVE We sought to evaluate the efficacy of postoperative administration of monophasic , combined , low-dose oral contraceptives on endometrioma recurrence and on persistence-recurrence of associated pain symptoms after laparoscopic treatment of moderate-to-severe endometriosis . STUDY DESIGN In a prospect i ve , r and omized trial 70 patients who were not attempting to conceive , aged 20 to 35 years , underwent laparoscopic excision of ovarian endometriomas , followed  by either postoperative administration of low-dose cyclic oral contraceptives for 6 months or no treatment on the basis of a computer-generated sequence . At 3 and 6 months after surgery and then at 6-month intervals , both groups underwent ultrasonographic examination for possible evidence of endometrioma recurrence and for evaluation of the absence , persistence , or recurrence of pain symptoms .  RESULTS Two patients in the oral contraceptive group did not complete the study . After a mean follow-up of 22 months ( range , 12 - 48 months ) , there were 2 ( 6.1 % ) endometrioma recurrences in the 33 patients who received postoperative oral contraceptives versus 1 ( 2.9 % ) recurrence in the 35 patients in the control group ( not significant ) . The moderate-to-severe pain recurrence rate was 9.1 % in the oral contraceptive group versus 17.1 % in the control group ( not significant ) . The mean time to recurrence of either symptoms or endometriomas was 18.2 months in the oral contraceptive group versus 12.7 months in the control group . The 12-month cumulative recurrence rate at life-table analysis was significantly lower for patients receiving oral contraceptives versus control subjects , whereas no significant difference was evident at 24 and 36 months . CONCLUSION Postoperative administration of low-dose cyclic oral contraceptives does not significantly affect the long-term recurrence rate of endometriosis after surgical treatment . A delay in recurrence is evident at life-table analysis BACKGROUND Little is known about the precise nature of the relationship between dysmenorrhoea ( DM ) and endometriosis . Our aim was to evaluate the relationship between the severity of DM in women with posterior deep infiltrating endometriosis ( DIE ) and indicators of the extent of their disease . METHODS Various indicators of the extent of DIE were recorded during surgery in 209 women . The severity of their DM was assessed with a  pain scale .  The scale was retrospective for 155 women and prospect i ve for 54 . Correlations were sought with an ordinal logistic regression model with cumulative odds . RESULTS On univariate analysis the following variables were related to the severity of DM : number of previous surgical procedures for endometriosis ; revised American Fertility society classification ; extensiveness of adnexal adhesion ; Douglas obliteration ; size of the posterior DIE implant ; extent of the sub-peritoneal infiltration by the posterior DIE ( rectal , vaginal or both versus sub-peritoneal only ) . Current infertility was associated with less severe DM . After multiple regression analysis , presence of a rectal or vaginal infiltration by the posterior DIE and extensiveness of adnexal adhesion were the only factors that remained related to DM severity . CONCLUSIONS The concept of ' very deep infiltrating endometriosis ' , defined as implants invading the wall of the pelvic organ , should be tested in future classification systems specifically addressed to the prediction of endometriosis-related pain Objective To ascertain whether the frequency of pelvic pain recurrence is reduced and time to symptoms recurrence is prolonged in women with symptomatic endometriosis undergoing conservative surgery and post‐operative hormonal therapy  compared with women treated with  surgery  only . Pregnancy rates and time to conception in women wanting children were also evaluated To evaluate the clinical value of postoperative hormone therapy in endometriosis , 60 patients with advanced disease were r and omized to receive in a double-blind study danazol ( 200 mg , 3 times daily ) , medroxyprogesterone acetate ( MPA ) ( 100 mg daily ) or placebo post-operatively for 6 months . Treatment efficacy was evaluated clinical ly and at laparoscopy 6 months after medication . In relation to placebo , danazol and high-dose MPA treatments , which did not differ from each other in efficacy , significantly alleviated pelvic pain . In addition , the peritoneal endometriosis lesions found at 6-months laparoscopy were significantly smaller in the MPA and danazol groups than in the placebo group . Breakthrough bleeding , weight gain and acne complicated  danazol treatment but only breakthrough bleeding complicated MPA treatment . These data suggest that postoperative treatment of advanced endometriosis with high-dose MPA or danazol is clinical ly beneficial OBJECTIVES To determine the relative risk of symptom recurrence and /or reoperation after hysterectomy with ovarian preservation for the treatment of endometriosis . DESIGN Historical prospect i ve study of patients with endometriosis who underwent hysterectomy with or without ovarian preservation .  PATIENTS One hundred thirty-eight women who underwent hysterectomy with the diagnosis of endometriosis . METHODS A computer search identified 138 women who underwent hysterectomy with the diagnosis of endometriosis at Johns Hopkins Hospital from 1979 to 1991 . Follow-up information was obtained from medical records , outpatient charts , and telephone surveys . RESULTS Twenty-nine women had hysterectomy  with some ovarian tissue preserved ; 109 had all ovarian tissue removed . Of those with ovarian preservation , 18 of 29 ( 62 % ) had recurrent pain and 9 of 29 ( 31 % ) required reoperation . Of those who had no ovarian preservation , 11 of 109 ( 10 % ) had recurrent symptoms and 4 of 109 ( 3.7 % ) required reoperation . Ovarian conservation was associated with a relative risk for pain recurrence of 6.1 ( 95 % confidence interval [ CI ] 2.5 to 14.6 ) compared with patients with oophorectomy in a Cox proportional hazards model . The relative risk for reoperation in patients with ovarian conservation was 8.1 ( 95 % CI 2.1 to 31.3 ) . CONCLUSION Compared with women who had oophorectomy for endometriosis , patients who underwent hysterectomy with ovarian conservation had 6.1 times greater risk of developing recurrent pain and 8.1 times greater risk of reoperation BACKGROUND This study investigates the outcomes for women up to 5 years after laparoscopic excision of endometriosis . METHODS In this prospect i ve observational cohort study , 254 women with chronic pelvic pain were referred to two units specializing in minimal access surgical management of endometriosis . Of these , 216 women underwent surgical assessment and 176 were confirmed to have endometriosis .  Question naires and visual analogue scale ( VAS ) scores for dysmenorrhoea , non-menstrual pelvic pain , dyspareunia and dyschesia as well as quality of life instruments ; the EQ-5Dindex and  EQ-5Dvas  ,  Short-Form 12 ( SF-12 ) and  sexual activity question naires were completed pre-operatively . Intra-operative details of revised American Fertility Society ( rAFS ) stage , site of disease , associated tests , duration of surgery and complications were noted . Follow-up was performed by postal question naire and chart review . For women who had further surgery , rAFS stage , site of disease , other procedures and histology were all recorded . RESULTS Pain scores were all significantly reduced at 2 - 5 years for dysmenorrhoea ( median VAS baseline versus follow-up 2 - 5 years ) ; 9 versus 3.3 ( P < 0.0001 ) , non-menstrual pelvic pain 8 versus 3 ( P < 0.0001 ) , dyspareunia 7 versus 0 ( P < 0.0001 ) and dyschesia 7 versus 2 ( P < 0.0001 ) . Quality of life was improved for the EQ-5Dindex ( P = 0.008 and the EQ-5Qvas ( P = 0.03 ) and for sexual function with pleasure ( P = 0.001 ) and habit ( P = 0.012 ) being improved and discomfort being decreased ( P = 0.001 ) . The chance of requiring further surgery as determined by the Kaplan-Meier survival curve was 36 % . A rAFS score of > 70 was predictive of requiring further surgery ( P = 0.03 ) . Of women who had further surgery , endometriosis was found histologically in 68 % . CONCLUSIONS Laparoscopic excision of endometriosis significantly reduces pain and improves quality of life for up to 5 years . The probability of requiring further surgery is 36 % . Return of pain following laparoscopic excision is not always associated with clinical evidence of recurrence In order to analyse the efficacy of resection/ablation of minimal/mild endometriotic lesions for improving fertility , we conducted a r and omized clinical trial . Eligible patients were women aged < /=36 years who were trying to conceive and had a laparoscopically confirmed diagnosis of minimal/mild endometriosis ( stage I or II of the revised American Fertility Society classification ) and otherwise unexplained infertility for > /=2 years . Eligible women were r and omly assigned to resection or ablation of visible endometriosis ( 54 patients ) or diagnostic laparoscopy only ( 47 patients ) . After laparoscopy women tried to conceive spontaneously for 1 year ( follow-up period ) . A total of five women withdrew from the study : three for personal reasons , and two were lost to follow-up . Considering 51 women in the resection/ablation and 45 in the no-treatment group who ended the follow-up period , 12 ( 24 % ) in the resection/ablation group and 13 ( 29 % ) in the no treatment group conceived ; the difference was not significant . Two spontaneous abortions were observed in the resection/ablation group and three in the no-treatment one . Thus the 1 year birth rate was 10 out of 51 women ( 19.6 % ) in the resection/ablation group and 10 out of 45 women ( 22.2 % ) in the no-treatment group . In conclusion , the results of this study do not support the hypothesis that ablation of endometriotic lesions markedly improves fertility rates OBJECTIVE To examine whether ultralong GnRH analog ( GnRH-a ) therapy after surgical treatment of endometriosis and before ART influences the pregnancy rate . DESIGN Prospect i ve , r and omized , controlled study . SETTING University clinic for reproductive medicine and gynecologic endocrinology . PATIENT(S ) One hundred ten patients with stage II to IV endometriosis according to ASRM criteria . INTERVENTION(S ) Fifty-five patients received GnRH-a for 6 months after surgery and subsequently underwent up to 3 cycles of ART , and 55 patients received 3 cycles of ART alone immediately after surgery . MAIN OUTCOME MEASURE(S ) Clinical pregnancy rates . RESULTS The pregnancy rate per patient was higher among patients who received follow-up treatment with GnRH-a . The same results were found in patients with stage III or IV endometriosis who were undergoing IUI or IVF/ICSI . CONCLUSION ( S ) Ultralong GnRH-a therapy increases the pregnancy rate of ART in patients with severe endometriosis OBJECTIVE To evaluate the efficacy and safety of an intrauterine system releasing 20 microg of levonorgestrel per 24 hours in the long-term treatment of recurrent dysmenorrhea in women already operated on conservatively for endometriosis . DESIGN A prospect i ve noncomparative 
    Output:
    
In women with laparoscopically confirmed disease , suppression of ovarian function for 6 months reduces endometriosis-associated pain ; all hormonal drugs studied are equally effective although their side-effects and cost profiles differ .
Ablation of endometriotic lesions reduces endometriosis-associated pain and the smallest effect is seen in patients with minimal disease ; there is no evidence that also performing laparoscopic uterine nerve ablation ( LUNA ) is necessary .
In minimal-mild endometriosis , suppression of ovarian function to improve fertility is not effective , but ablation of endometriotic lesions plus adhesiolysis is effective compared to diagnostic laparoscopy alone .
There is insufficient evidence available to determine whether surgical excision of moderate-severe endometriosis enhances pregnancy rates .
IVF is appropriate treatment especially if there are coexisting causes of infertility and /or other treatments have failed , but IVF pregnancy rates are lower in women with endometriosis than in those with tubal infertility .