The aim of this guideline is to provide clinicians
with up-to-date information about the diagnosis and treatment of endometriosis,
based upon the best available evidence. This guideline, which is reviewed
annually, was last updated on 30 June 2007.
Objective
The objective was to develop recommendations for the diagnosis and treatment
of endometriosis and its associated symptoms.
Design
A working group was convened comprised of practising gynaecologists
and experts in evidence-based medicine from Europe, as well as an endometriosis
self-help group representative.
After reviewing exisiting evidence-based guidelines
and systematic reviews, the expert panel met on three occasions for
a day during which the guideline was developed and refined. Recommendations
based soley on the clinical experience of the panel were avoided as
much as possible. The entire ESHRE Special Interest Group for endometriosis
and endometrium was given the opportunity to comment on the draft guideline,
after which it was available for comment on the ESHRE website for 3
months. The working group then ratified the guideline by unanimous or
near-unanimous voting; finally, it was approved by the ESHRE Executive
Committee.
Following this process, the guideline is now updated
annually, following a strict protocol, which includes an annual search
of new research followed by two months of peer review of the updated
guideline.
The guideline is available on this website with hyperlinks
to the supporting evidence, and the relevant references and abstracts.
Main conclusions
For women presenting with symptoms suggestive of endometriosis, a definitive
diagnosis of most forms of endometriosis requires visual inspection
of the pelvis at laparoscopy as the 'gold standard' investigation. However,
pain symptoms suggestive of the disease can be treated without a definitive
diagnosis using a therapeutic trial of a hormonal drug to reduce menstrual
flow.
In women with laparoscopically confirmed disease,
suppression of ovarian function for 6-months reduces endometriosis-associated
pain; all hormonal drugs studied are equally effective although their
side-effects and cost profiles differ. Ablation of endometriotic lesions
reduces endometriosis-associated pain and the smallest effect is seen
in patients with minimal disease; there is no evidence that also performing
laparoscopic uterine nerve ablation (LUNA) is necessary.
In minimal-mild endometriosis, suppression of ovarian
function to improve fertility is not effective, but ablation of endometriotic
lesions plus adhesiolysis is effective compared to diagnostic laparoscopy
alone. There is insufficient evidence available to determine whether
surgical excision of moderate-severe endometriosis enhances pregnancy
rates. IVF is appropriate treatment especially if there are coexisting
causes of infertility and/or other treatments have failed, but IVF pregnancy
rates are lower in women with endometriosis than in those with tubal
infertility.
The management of severe/deeply infiltrating endometriosis
is complex and referral to a centre with the necessary expertise is
strongly recommended. Patient
self-help groups can provide invaluable counselling, support
and advice.
The guideline has been produced by the ESHRE Special
Interest Group for Endometriosis and Endometriosis Guideline Development
Group, and the original, concise, version was published in Human
Reproduction 2005;20(10):2698-2704
This website provides access to the concise version
of this guideline and to further supporting documentation. To access
the concise version of this guideline please click on the 'Concise'
link under each chapter heading. To access the supporting documentation
for this guideline please click on the 'Supporting Documentation' link
under each chapter heading.