Endometriosis management in low-income and middle-income countries—A critical review

Endometriosis is a chronic and multifactorial disease full of dilemmas, controversies, and complexities. It is progressive, recurrent, and difficult to diagnose and treat. The prevalence rate in a review was found to be very variable, from 2 to 36%, with an overall average rate of 18%. There are many questions that need to be answered and critically reviewed. A web-based survey was conducted to find out the management trend in clinical setting Pan India and reviewing the practice with available literature. Out of a total of 530 responders, 70% were postgraduate gynecologists, 15% were diploma holders, and 10% were general surgeons. Seventy-eight percent of the responders were from urban areas, and only 3% were from rural regions. The present survey revealed that the most preferred modality is laparoscopic surgery, followed by IUI (44.4%). The present survey showed that in the current practice, surgery is always done in 42%, followed by surgery and IVF in 20%, and IVF in 27%. The rest of them were individualized in favor of IVF or surgery. 82% of the respondents prefer doing cystectomy along with anatomical restoration. GnRH antagonists (cetrorelix and ganirelix) help to avoid pituitary suppression. Most of the respondents (43%) preferred to use antagonists in the present survey. It can be concluded on the basis of the present survey and trend in clinical practice that an individualized and comprehensive approach is to be practiced keeping in mind the age, previous surgery, ovarian reserve, size, and bilaterality of endometriomas.