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Consensus On the Current Management of Endometriosis

was arrived at the

World Endometriosis Society Montpellier Consortium 2013

Some areas of consensus are as follows:

  • Diagnosis and management of endometriosis should be incorporated into the primary health care of women worldwide

  • In low resource settings, diagnosis may commence with two simple questions about pelvic-abdominal pain and infertility accepting that a negative response does not exclude endometriosis

  • Laparoscopy (key hole surgery) should be preferred to  laparotomy (open surgery)

  • In case of more severe endometriosis surgeons should limit surgical excision and refer the case to a surgeon better equipped to deal with endometriosis

  • The first surgerical intervention has shown to deliver the greatest benefit

  • Laparoscopic surgical removal of endometriosis through either excision or ablation is an effective first line approach for treating pain related to endometriosis

  • Excision is unanimously recommended over ablation, where possible

  • There is a recurrence rate of 10% - 55% within 12 months after the expert removal of endometriosis

  • Excessive numbers of repeated laparoscopic procedures should be avoided

  • There is an ongoing debate over the role of hysterectomy (removal of part or all of the uterus) and of concurrent oophorectomy (removal of one or both ovaries)

  • First line medical treatment of endometriosis could include NSAIDS, other analgesic drugs and oral contraceptive pills [OCPs]

  • Second line medical treatment could include GnRH-a and should be used with add-back hormone replacement therapy [HRT]

  • Danazol and gestrinone should not be used because of significant side effects

  • Acupuncture seems to be moderately effective and safe for endometriosis but requires repeated treatments

  • There is an association between endometriosis and ovarian cancer but the overall risk of ovarian cancer among women with endometriosis remain low

  • Endometriosis support groups provide a valuable  forum for women with endometriosis

  • Endometriosis should be considered as a possible diagnosis in adolescents with suggestive symptoms

  • Most adolescents have stage I or II of the disease, although endometriosis of any stage may be present

  • There is insufficient evidence to make strong recommendations for management among adolescents who may have endometriosis

  • Early diagnosis and management of the disease is critical for at least a better quality of life later on

  • There is a pressing need for research into and guidelines for the management of symptomatic endometriosis and possible endometriosis among adolescents

  • Reseach continues in this area

(The information was taken from Human Reproduction, Vol.28, No.6 pp. 1552–1568, 2013)

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