Management

To date, there is no cure for endometriosis

The aim of treatment is to manage symptoms, particularly pain, and, where possible, to preserve fertility and quality of life.

Drug treatments are mainly based on painkillers and hormonal therapies, which aim to reduce the activity of endometriotic lesions. The latter are not recommended for women wishing to become pregnant.

In cases of treatment failure or severe forms of the condition, surgical management may be offered, involving the removal of lesions. The indications must be discussed on a case-by-case basis, particularly taking into account age, symptoms and plans for pregnancy.

A multidisciplinary approach is often necessary, including management of chronic pain, psychological support and, where appropriate, specialist infertility care.

Endometriosis remains underdiagnosed, particularly due to the trivialisation of menstrual pain and the variability of symptoms. Delayed diagnosis can contribute to the chronicity of pain and a reduced quality of life.

Early management allows for better control of symptoms and the adaptation of treatment strategies to each individual situation.

 

Treatment of pain associated with endometriosis

Painkillers (non-steroidal anti-inflammatory drugs or others)

Hormonal treatments:

  • Combined hormonal contraceptives
  • Progestogens (including progestogen-only contraceptives)
  • GnRH agonists
  • GnRH antagonists
  • Aromatase inhibitors

Surgical treatment:

  • The choice between medical and surgical treatment must be made on an individual basis, taking into account preferences, side effects, etc.

Medical treatments to complement surgery:

  • Preoperative hormonal treatment is not recommended.
  • Postoperative hormonal treatment may be offered to improve outcomes, particularly if there is no immediate desire to become pregnant.

Recommendations of the European Society of Human Reproduction and Embryology (ESHRE) on endometriosis (2022)

Criteria for referral to a specialist endometriosis centre

Do not rule out endometriosis if the abdominal or pelvic examination and the ultrasound scan are normal, and recognise that a referral may still be necessary even if the tests are normal.

Refer for specialist care for further investigations if:

  • the initial treatment is ineffective, poorly tolerated or contraindicated, or
  • symptoms have a negative impact on activities of daily living, or
  • symptoms persist or recur, or
  • pelvic signs of endometriosis are present without suspicion of deep endometriosis.

Refer women or patients to specialist endometriosis care in cases of suspected or confirmed diagnosis of:

  • endometrioma ;
  • deep endometriosis, particularly involving the bowel, bladder or ureters;
  • endometriosis outside the pelvic cavity.

Refer adolescent and young patients (aged ≤ 17) with suspected or diagnosed endometriosis to a specialist paediatric gynaecology service or a centre specializing in endometriosis for assessment.

Guidelines from the National Institute for Health and Care Excellence (NICE)

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