TOPLINE

In women with rectovaginal endometriosis, both surgery and hormonal treatment were associated with substantial reductions in pain-related symptoms and improvements in functional outcomes, quality of life, and treatment satisfaction, with no statistically significant differences detected between the two groups.

METHODOLOGY

• Researchers in Germany conducted a retrospective cohort study to compare changes in pain-related symptoms, functional outcomes, quality of life, and treatment satisfaction in women with rectovaginal endometriosis who received surgical vs hormonal treatment.
• They included 210 women aged 18-60 years with rectovaginal endometriosis from a certified tertiary endometriosis centre between 2009 and 2018, of whom 164 underwent surgical treatment and 46 received hormonal treatment.
• Participants in the hormonal treatment group received gestagens, combined oral contraceptives, gonadotropin-releasing hormone analogues/antagonists, and/or other medical therapies, alone or in combination, whereas those in the surgical group underwent laparoscopic or open surgical excision.
• All women completed a study-specific standardised questionnaire to assess changes in symptoms before and after the treatment.
• The primary outcome was the comparison of changes in pain-related symptoms — such as pelvic pain, dysmenorrhoea, dyspareunia, and dyschezia — between the two groups; secondary outcomes included changes in bowel and bladder function, rectal bleeding, quality of life, and treatment satisfaction.

TAKEAWAY

• Both hormonal treatment and surgery were associated with a substantial reduction in pain-related symptoms, with no significant differences observed between the treatment strategies in terms of pelvic pain, dysmenorrhoea, dyspareunia, and dyschezia.
• Similarly, both the treatment groups showed no significant differences in functional outcomes such as rectal bleeding, bowel dysfunction, or bladder dysfunction.
• Quality of life improved in most patients across both the groups, and overall treatment satisfaction was high, with no significant difference observed between the two approaches despite numerically higher rates after surgery.

IN PRACTICE

"From a clinical perspective, our findings support a more individualised treatment approach in RVE [rectovaginal endometriosis]," the authors wrote.

"These results may help facilitate shared decision-making by providing realistic expectations regarding symptom trajectories under both strategies," they added.

SOURCE

This study was led by Franziska Werner, Endometriosis Research Centre Charité, Campus Virchow-Klinikum, Berlin, Germany. It was published online on June 21, 2026, in Archives of Gynecology and Obstetrics.

LIMITATIONS

The retrospective design and the use of a postal questionnaire may have introduced recall bias. The study-specific questionnaire used in the study was not a validated tool for endometriosis. The hormonal treatment group was smaller in size than the surgical group, which limited statistical power.

DISCLOSURES

The study received support from the German Research Foundation and the Open Access Publication Fund of Charité-Universitätsmedizin Berlin. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.