14899 Conservative Treatment of Deep Endometriosis: Predicting Treatment Outcomes

Evidence-based conservative treatment strategies for deep endometriosis (DE) are lacking. We identify patient characteristics predicting treatment success. Retrospective cohort Tertiary referral center, 2015-2024 Patients aged 16-55 undergoing conservative management (expectant surveillance or hormonal therapy) of DE (>5mm lesion on imaging) of any location were included. Patients with lesions concerning for malignancy or isolated endometriomas were excluded. Failure of conservative DE management, defined by progression to surgery, was the primary outcome. Secondary outcomes included patient characteristics, symptoms (measured via Numerical Rating Scale), comorbidities, surgical history, and hormonal therapy associated with surgical progression. Chi-squared, ANOVA, Log-Rank testing evaluated variables. Seventy-four patients with DE underwent conservative management (57 hormonal, 17 expectant), 70.3% with rectosigmoid DE. Twelve patients (16.2%) failed (9.5 months) and 62 (83.8%) continued (3 years). No differences between failed and ongoing management groups were found for age (40,40,p=0.993), parity (1.7,1.4,p=0.697), DE lesion number (2.0,2.4,p=0.341), prior endometriosis surgeries (0.2,0.5,p=0.154), hormonal medication number (1.0,1.0,p=0.709) and hormone type (p>0.05). No differences were reported for overall pain (5.2,4.3,p=0.697), dysmenorrhea (3.3,6.1,p=0.129), and dyspareunia (3.0,2.3,p=0.732). Patients who failed had more ureteral DE (8.3%,1.6%,p=0.19), bladder DE (16.7%,4.8%,p=0.135), and fibromyalgia (25.0%,3.2%,p=0.006). Patients undergoing hormonal vs expectant conservative management had similar rates of progression to surgery (17.5%,11.8%,p=0.57). Conservative management of DE is successful in the majority of patients. Failure is difficult to predict, often occurring within 1 year. Further research on conservative management of DE is needed.