Objective: To analyze the influence of low-dose goserelin combined with dienogest on serum estrogen (E2), vascular endothelial growth factor (VEGF), membrane type 1 matrix metalloproteinase (MT1-MMP) and disease recurrence rate in patients with endometriosis (EMs) after hysteroscopy combined with laparoscopy, and to provide a basis for optimizing clinical postoperative treatment regimens. Methods: A total of 120 patients with EMs were prospectively enrolled. Following hysteroscopy combined with laparoscopy, they were divided into a combined group (n=60) and a single-drug group (n=60) according to different treatment protocols. The single-drug group received low-dose goserelin (1.8 mg per time, subcutaneous injection, once every 28 days); the combined group was additionally given dienogest (2 mg per time, oral administration, once daily) on the basis of the single-drug regimen, with both groups treated for 6 months. Serum hormone and cytokine levels, Endometriosis Health Profile-5 (EHP-5) scores, recurrence rate, ovarian reserve function and adverse reaction incidence were compared between the two groups. Results: After treatment, serum E2, progesterone (P), VEGF and MT1-MMP levels declined in both groups (P<0.05). The combined group had a higher E2 level (P<0.05) and lower VEGF and MT1-MMP levels (P<0.05). No significant intergroup difference was found in post-treatment P levels (P>0.05). Anti-Müllerian hormone levels and bilateral ovarian antral follicle counts decreased in both groups (P<0.05), yet the combined group maintained higher values than the single-drug group (P<0.05). EHP-5 scores dropped markedly in both groups (P<0.05), and the combined group achieved lower scores in pain and emotional domains relative to the single-drug group (P<0.05). The 12-month postoperative recurrence rate was significantly lower in the combined group (P<0.05). The total incidence of adverse reactions showed no statistical difference between the two groups (P>0.05). Conclusion: Low-dose goserelin combined with dienogest can downregulate serum E2, VEGF and MT1-MMP levels in post-surgical EMs patients and reduce recurrence risk, with acceptable safety.