ESHRE guideline for the diagnosis and treatment of endometriosis

The aim of this guideline is to provide clinicians with up-to-date information about the diagnosis and treatment of endometriosis, based upon the best available evidence. This guideline, which is reviewed annually, was last updated on 17 June 2006.
ObjectiveThe objective was to develop recommendations for the diagnosis and treatment of endometriosis and its associated symptoms.
DesignA working group was convened comprised of practising gynaecologists and experts in evidence-based medicine from Europe, as well as an endometriosis self-help group representative.
After reviewing exisiting evidence-based guidelines and systematic reviews, the expert panel met on three occasions for a day during which the guideline was developed and refined. Recommendations based soley on the clinical experience of the panel were avoided as much as possible. The entire ESHRE Special Interest Group for endometriosis and endometrium was given the opportunity to comment on the draft guideline, after which it was available for comment on the ESHRE website for 3 months. The working group then ratified the guideline by unanimous or near-unanimous voting; finally, it was approved by the ESHRE Executive Committee.
The guideline will be updated annually, and has been made available on this website with hyperlinks to the supporting evidence, and the relevant references and abstracts.
Main conclusionsFor women presenting with symptoms suggestive of endometriosis, a definitive diagnosis of most forms of endometriosis requires visual inspection of the pelvis at laparoscopy as the 'gold standard' investigation. However, pain symptoms suggestive of the disease can be treated without a definitive diagnosis using a therapeutic trial of a hormonal drug to reduce menstrual flow.
In women with laparoscopically confirmed disease, suppression of ovarian function for 6-months reduces endometriosis-associated pain; all hormonal drugs studied are equally effective although their side-effects and cost profiles differ. Ablation of endometriotic lesions reduces endometriosis-associated pain and the smallest effect is seen in patients with minimal disease; there is no evidence that also performing laparoscopic uterine nerve ablation (LUNA) is necessary.
In minimal-mild endometriosis, suppression of ovarian function to improve fertility is not effective, but ablation of endometriotic lesions plus adhesiolysis is effective compared to diagnostic laparoscopy alone. There is insufficient evidence available to determine whether surgical excision of moderate-severe endometriosis enhances pregnancy rates. IVF is appropriate treatment especially if there are coexisting causes of infertility and/or other treatments have failed, but IVF pregnancy rates are lower in women with endometriosis than in those with tubal infertility.
The management of severe/deeply infiltrating endometriosis is complex and referral to a centre with the necessary expertise is strongly recommended. Patient self-help groups can provide invaluable counselling, support and advice.
The guideline has been produced by the ESHRE Special Interest Group for Endometriosis and Endometriosis Guideline Development Group, and the original, concise, version was published in Human Reproduction 2005;20(10):2698-2704
This website provides access to the concise version of this guideline and to further supporting documentation. To access the concise version of this guideline please click on the 'Concise' link under each chapter heading. To access the supporting documentation for this guideline please click on the 'Supporting Documentation' link under each chapter heading.