Endometriosis

Scope: The guideline is intended for all health care professionals who deal with adult women with endometriosis.

BACKGROUND

• It is important to note that establishing the diagnosis of endometriosis can be difficult because the presentation of this condition is so variable, and there is significant overlap with other conditions such as irritable bowel syndrome and pelvic inflammatory disease.
• The choice of treatment will often depend on a multitude of factors, such as the patient’s age, fertility plans, previous treatment, and the description, severity, and location of both symptoms and disease.

EXCELLENT/GOOD RECOMMENDATIONS

• The measurement of serum CA-125 has limited value as a screening and diagnostic test.
• NSAIDs reduce pain associated with endometriosis
• Oral contraceptives, progesterones, danazol, GnRH agonists (Gonadotropin-Releasing Hormone agonists) reduce pain. While they have equal pain control effects, the choice depends upon their side-effect profile
• Laparoscopic ablation of minimal-moderate endometriosis appears to relieve pain. For endometriomas, laparoscopic cystectomy has better results compared with drainage and coagulation
• After conservative surgery, treatment with GnRH agonists may increase significantly the pain-free time interval
• In endometriosis-associated infertility, hormonal drugs are of no benefit, while laparoscopic ablation of minimal-moderate infertility may improve fertility rates.

FAIR EVIDENCE

• Laparoscopy is the "gold standard" in diagnosing endometriosis. Non-invasive tests may also be useful, such as trans-vaginal ultrasound (particularly for ovarian endometriosis), and MRI for detecting deep endometriosis
• In women who are not trying to conceive, pain may be may be improved with a therapeutic trial of combined oral contraceptives or progesterone
• Side-effects profiles limit the duration of therapy for some drugs”
  • Combined Oral Contraceptives (COC) and Depo-Provera may be used long-term;
  • Danazol, gestagens and GnRH agonists are restricted to 6 months. Some evidence suggests 3 months of treatment is as effective as 6 months in the case of GnRH agonists;
  • Add-back therapy (progesterone) can be used to continue therapy beyond 6 months and prevent bone-loss and menopausal side-effects.

INSUFFICIENT EVIDENCE TO MAKE A RECOMMENDATION

• It is unclear if uterine nerve ablation is required during laparoscopic ablation of minimal to moderate endometriosis.

Kennedy, S.H., & Gazvani, M.R. (2000, July). The investigation and management of endometriosis. Royal College of Obstetricians and Gynaecologists. Retrieved October 18, 2007 from: http://www.rcog.org.uk/index.asp?PageID=517

Date Endorsed: May 2004
Stale Date: May 2007

Rating (out of 4):  

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This page was last modified on: June 6, 2006

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