Changing the paradigm of endometriosis – from diagnosis to integrated long-term management: a joint society opinion paper

Endometriosis is a chronic, systemic, oestrogen-dependent disease with major impacts on pain, fertility and quality of life. This Society of Endometriosis and Uterine Disorders and American Institute for Minimally Invasive Surgery opinion synthesizes current evidence to redefine diagnostic and therapeutic strategies across the continuum of care. Diagnostic laparoscopy is no longer indicated, as clinical assessment combined with expert transvaginal ultrasonography and magnetic resonance imaging reliably identifies disease phenotypes and guides management. Medical therapy, particularly progestins, remains the foundation of long-term care, with gonadotrophin-releasing hormone analogues and antagonists as second-line options. Surgery is reserved for clearly defined indications - including deep infiltrating disease, infertility with correctable anatomy and organ-threatening involvement - and must be preceded by comprehensive imaging and followed by prolonged hormonal suppression to reduce recurrence. Integrated, individualized care pathways are essential to improve outcomes and support fertility preservation. This framework represents a modern paradigm for comprehensive endometriosis management.