Endometriosis: Diagnosis and Management
244 - Published July 2010
Objective: To improve the understanding of endometriosis and to
provide evidence-based guidelines for the diagnosis and
management of endometriosis.
Outcomes: Outcomes evaluated include the impact of the medical
and surgical management of endometriosis on women’s
experience of morbidity and infertility.
Methods: Members of the guideline committee were selected on the
basis of individual expertise to represent a range of practical and
academic experience in terms of both location in Canada and type
of practice, as well as subspecialty expertise along with general
gynaecology background. The committee reviewed all available
evidence in the English and French medical literature and
available data from a survey of Canadian women.
Recommendations were established as consensus statements.
The final document was reviewed and approved by the Executive
and Council of the SOGC.
Results: This document provides a summary of up-to-date evidence
regarding diagnosis, investigations, and medical and surgical
management of endometriosis. The resulting recommendations
may be adapted by individual health care workers when serving
women with this condition.
Conclusions: Endometriosis is a common and sometimes
debilitating condition for women of reproductive age. A
multidisciplinary approach involving a combination of lifestyle
modifications, medications, and allied health services should be
used to limit the impact of this condition on activities of daily living
and fertility. In some circumstances surgery is required to confirm
the diagnosis and provide therapy to achieve the desired goal of
pain relief or improved fecundity. Women who find an acceptable
management strategy for this condition may have an improved
quality of life or attain their goal of successful pregnancy.
Evidence: Medline and Cochrane databases were searched for
articles in English and French on subjects related to
endometriosis, pelvic pain, and infertility from January 1999 to
October 2009 in order to prepare a Canadian consensus guideline
on the management of endometriosis.
Values: The quality of evidence was rated with use of the criteria
described by the Canadian Task Force on Preventive Health Care.
Recommendations for practice were ranked according to the
method described by the Task Force. See Table 1.
Benefits, harms, and costs: Implementation of the guideline
recommendations will improve the care of women with pain and
infertility associated with endometriosis.