Updated guideline for clinical evaluation and management of endometriosis

Jae Hoon Lee; Byung Seok Lee

doi:10.5124/jkma.2019.62.10.525

J Korean Med Assoc > Volume 62(10); 2019 > Article

Lee and Lee: Updated guideline for clinical evaluation and management of endometriosis

Focused Issue of This Month

Endometriosis

Journal of the Korean Medical Association 2019; 62(10): 525-532.

Published online: October 11, 2019

DOI: http://dx.doi.org/10.5124/jkma.2019.62.10.525

Updated guideline for clinical evaluation and management of endometriosis

Jae Hoon Lee, MD

, Byung Seok Lee, MD

Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Corresponding author: Byung Seok Lee. DR222@yuhs.ac

Received August 28, 2019 Accepted September 03, 2019

Korean Medical Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Endometriosis is a common disease in reproductive aged women, and it detrimentally affects patients' quality of life and fertility. Moreover, because of the complexity of the disease itself, proper effective management is difficult. Within this context, this review proposes the guidelines of the Korean Society of Endometriosis and other world leading societies for endometriosis with an emphasis on: diagnosis of endometriosis, treatment for endometriosis associated pain and infertility, management of asymptomatic women, endometriosis associated malignancy, and endometriosis in postmenopausal women. In recent years, the importance of medical treatment as opposed to surgical removal in the management of endometriosis is gaining popularity. Many guidelines recommend empirical treatment without diagnostic laparoscopy and long term use of medication. This is also closely connected to the social trend of late marriage age and childbirth age. Nevertheless, timely surgical interventions and assisted reproductive procedures are still crucial in the management of endometriosis. Because treatment goals differ in each patient's individual situation, possible treatment options may vary and individualized management is also important. Ultimately, a multimodal approach that is tailored to each individual's therapeutic purpose is of paramount importance in the treatment of endometriosis.

Endometriosis; Pain; Infertility; Reproductive techniques

Notes

No potential conflict of interest relevant to this article was reported.

References

1. Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D'Hooghe T, De Bie B, Heikinheimo O, Horne AW, Kiesel L, Nap A, Prentice A, Saridogan E, Soriano D, Nelen W. European Society of Human Reproduction and Embryology. ESHRE guideline: management of women with endometriosis. Hum Reprod 2014;29:400-412.

2. Ballard KD, Seaman HE, de Vries CS, Wright JT. Can symptomatology help in the diagnosis of endometriosis? Findings from a national case-control study: Part 1 BJOG 2008;115:1382-1391.

3. Fauconnier A, Chapron C. Endometriosis and pelvic pain: epidemiological evidence of the relationship and implications. Hum Reprod Update 2005;11:595-606.

4. Hwang H, Chung YJ, Lee SR, Park HT, Song JY, Kim H, Lee DY, Lee EJ, Kim MR, Oh ST. Clinical evaluation and management of endometriosis: guideline for Korean patients from Korean Society of Endometriosis. Obstet Gynecol Sci 2018;61:553-564.

5. Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. Fertil Steril 2012;98:591-598.

6. Practice Committee of the American Society for Reproductive Medicine. Treatment of pelvic pain associated with endometriosis: a committee opinion. Fertil Steril 2014;101:927-935.

7. Johnson NP, Hummelshoj L. World Endometriosis Society Montpellier Consortium. Consensus on current management of endometriosis. Hum Reprod 2013;28:1552-1568.

8. Lemaire GS. More than just menstrual cramps: symptoms and uncertainty among women with endometriosis. J Obstet Gynecol Neonatal Nurs 2004;33:71-79.

9. Hirsch M, Begum MR, Paniz E, Barker C, Davis CJ, Duffy J. Diagnosis and management of endometriosis: a systematic review of international and national guidelines. BJOG 2018;125:556-564.

10. Hudelist G, English J, Thomas AE, Tinelli A, Singer CF, Keckstein J. Diagnostic accuracy of transvaginal ultrasound for non-invasive diagnosis of bowel endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2011;37:257-263.

11. Soares SR, Martínez-Varea A, Hidalgo-Mora JJ, Pellicer A. Pharmacologic therapies in endometriosis: a systematic review. Fertil Steril 2012;98:529-555.

12. Falcone T, Lebovic DI. Clinical management of endometriosis. Obstet Gynecol 2011;118:691-705.

13. Moghissi KS, Schlaff WD, Olive DL, Skinner MA, Yin H. Goserelin acetate (Zoladex) with or without hormone replacement therapy for the treatment of endometriosis. Fertil Steril 1998;69:1056-1062.

14. Makarainen L, Rönnberg L, Kauppila A. Medroxyprogesterone acetate supplementation diminishes the hypoestrogenic side effects of gonadotropin-releasing hormone agonist without changing its efficacy in endometriosis. Fertil Steril 1996;65:29-34.

15. Hart RJ, Hickey M, Maouris P, Buckett W. Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev 2008;(2):CD004992.

16. Carmona F, Martinez-Zamora MA, Rabanal A, Martinez-Roman S, Balasch J. Ovarian cystectomy versus laser vaporization in the treatment of ovarian endometriomas: a randomized clinical trial with a five-year follow-up. Fertil Steril 2011;96:251-254.

17. Wright J, Lotfallah H, Jones K, Lovell D. A randomized trial of excision versus ablation for mild endometriosis. Fertil Steril 2005;83:1830-1836.

18. Proctor ML, Latthe PM, Farquhar CM, Khan KS, Johnson NP. Surgical interruption of pelvic nerve pathways for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev 2005;(4):CD001896.

19. Yap C, Furness S, Farquhar C. Pre and post operative medical therapy for endometriosis surgery. Cochrane Database Syst Rev 2004;(3):CD003678.

20. Missmer SA, Hankinson SE, Spiegelman D, Barbieri RL, Marshall LM, Hunter DJ. Incidence of laparoscopically confirmed endometriosis by demographic, anthropometric, and lifestyle factors. Am J Epidemiol 2004;160:784-796.

21. Hughes E, Brown J, Collins JJ, Farquhar C, Fedorkow DM, Vandekerckhove P. Ovulation suppression for endometriosis. Cochrane Database Syst Rev 2007;(3):CD000155.

22. Marcoux S, Maheux R, Bérubé S. Canadian Collaborative Group on Endometriosis. Laparoscopic surgery in infertile women with minimal or mild endometriosis. N Engl J Med 1997;337:217-222.

23. Schenken RS. Modern concepts of endometriosis. Classification and its consequences for therapy. J Reprod Med 1998;43:3 Suppl. 269-275.

24. Vercellini P, Fedele L, Aimi G, De Giorgi O, Consonni D, Crosignani PG. Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis: the predictive value of the current classification system. Hum Reprod 2006;21:2679-2685.

25. Tummon IS, Asher LJ, Martin JS, Tulandi T. Randomized controlled trial of superovulation and insemination for infertility associated with minimal or mild endometriosis. Fertil Steril 1997;68:8-12.

26. Werbrouck E, Spiessens C, Meuleman C, D'Hooghe T. No difference in cycle pregnancy rate and in cumulative live-birth rate between women with surgically treated minimal to mild endometriosis and women with unexplained infertility after controlled ovarian hyperstimulation and intrauterine insemination. Fertil Steril 2006;86:566-571.

27. Sallam HN, Garcia-Velasco JA, Dias S, Arici A. Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis. Cochrane Database Syst Rev 2006;(1):CD004635.

28. Opoien HK, Fedorcsak P, Byholm T, Tanbo T. Complete surgical removal of minimal and mild endometriosis improves outcome of subsequent IVF/ICSI treatment. Reprod Biomed Online 2011;23:389-395.

29. Gylfason JT, Kristjansson KA, Sverrisdottir G, Jonsdottir K, Rafnsson V, Geirsson RT. Pelvic endometriosis diagnosed in an entire nation over 20 years. Am J Epidemiol 2010;172:237-243.