The first line medical therapy that family physicians would start with would be something simple: oral contraceptive pills, even taken continuously, progestin-containing IUDs, which can help quite a bit with dysmenorrhea, or sometimes progestin-only therapies, which is the next level of therapy.
Gynecologists might entertain stronger medications like progestin therapies and then move on to some stronger therapies, which are quite fraught with side effects but may be quite effective in some patients. They put them in a semi-menopausal state, which sounds extreme, but in some patients, is life changing to really suppress the symptoms.
You mentioned surgery. Surgery becomes, certainly, a treatment option for patients. We don't use it for diagnosis only. We want to do an excellent surgery and plan to remove endometriosis and to excise the adhesions that we see. Secretions can be very simple and superficial perineal.
We have some pictures that we put in our slide deck that we sent. We can see very flesh-like lesions that, really, a community gynecologist would likely be comfortable treating.
When mention laser, that's just one of the tools we use. Not everybody uses a laser. We can use cautery, etc. It's just a tool. Treatment should usually involve removing the disease to confirm the pathology, but it can also be a more severe disease where we have involvement with bowel, bladder or ureter that requires a certain higher level of skill to be able to do safely and laparoscopically so that the patient doesn't have to have a big incision. It can be done with a minimally invasive approach and quicker recovery.