Evidence-based guideline demonstrates optimal diagnostic and therapeutic strategies in women with endometriosis, highlighting balanced surgical and hormonal management.
Key Points
To establish evidence-based clinical recommendations for the diagnosis and management of endometriosis and its associated pain and infertility.
A multidisciplinary European panel of practicing gynecologists, evidence-based medicine methodologists, and patient representatives reviewed existing systematic reviews and guidelines.
The expert panel refined recommendations over three consensus meetings, followed by peer review from the ESHRE Special Interest Group, a three-month public consultation, and unanimous panel voting.
Laparoscopy provides definitive gold-standard diagnosis, but empirical hormonal therapy is effective for relieving suggestive pain symptoms prior to surgical confirmation.
Suppression of ovarian function for 6 months reduces pain across all evaluated hormonal agents, while surgical ablation combined with adhesiolysis reduces pain and improves fertility in minimal-to-mild disease.
Laparoscopic uterine nerve ablation offers no added pain relief, medical ovarian suppression does not improve fertility in mild disease, and in vitro fertilization yields lower pregnancy rates than in tubal factor infertility.