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Endometriosis – Clinical Evidence Summary

Endometriosis – Quick Evidence Summary

Educational Derived from national clinical practice guidelines (paraphrased)

This section is an educational interpretation and does not reproduce original guideline text. It does not replace clinical judgment or institutional protocols.

1) Definition & clinical context ▾
  • Chronic inflammatory condition that can significantly affect quality of life.
  • Commonly linked to pelvic pain symptoms and may be associated with infertility.
  • Management is individualised and often requires long-term follow-up.
2) When to suspect endometriosis ▾
  • Chronic pelvic pain, dysmenorrhoea, deep dyspareunia.
  • Cyclical bowel and/or urinary symptoms.
  • Infertility, especially when pain symptoms are present.
  • Normal imaging does not exclude the diagnosis.
3) Clinical assessment ▾
  • Offer abdominal and pelvic examination to look for tenderness, reduced mobility, nodularity, or masses.
  • Absence of signs does not exclude disease.
  • Early discussion of management options is important; avoid unnecessary delay in symptom control strategies.
4) Imaging & investigations ▾
  • Transvaginal ultrasound is first-line imaging in suspected endometriosis.
  • MRI is typically reserved for suspected deep infiltrating disease or complex anatomy.
  • CT/PET-CT and serum biomarkers (e.g., CA-125) are not recommended for diagnostic purposes.
  • Negative imaging does not rule out endometriosis.
5) Empirical treatment & laparoscopy ▾
  • Empirical medical management may be offered based on clinical suspicion to improve symptoms and quality of life.
  • Consider laparoscopy when symptoms persist despite appropriate treatment or when diagnostic uncertainty remains.
  • If lesions are seen, biopsy/histology can support diagnosis; negative histology does not fully exclude disease.
6) Medical management of pain ▾
  • Analgesics are used as part of symptom control strategies.
  • First-line hormonal options include combined hormonal contraception or progestogens.
  • Second-line options may include GnRH agonists/antagonists with add-back therapy where appropriate.
  • Shared decision-making is essential (effectiveness, side effects, cost, and patient preference).
  • Postoperative hormonal suppression may reduce recurrence when pregnancy is not immediately desired.
7) Surgical management (high-level) ▾
  • Surgery may be considered when medical management is ineffective, unsuitable, or not tolerated.
  • Excision is generally preferred over ablation when surgery is performed for pain.
  • Endometrioma management aims to reduce recurrence while minimising ovarian damage.
  • Deep infiltrating endometriosis surgery is ideally performed by experienced teams, often within an MDT setting.
8) Hysterectomy considerations ▾
  • May be considered for persistent symptoms in women who have completed fertility after failure of conservative options.
  • Counsel that symptoms may persist even after hysterectomy.
  • Discuss implications of oophorectomy, early menopause, and potential need for HRT.
9) Fertility considerations ▾
  • Avoid hormonal suppression when actively trying to conceive.
  • When planning surgery, consider age, ovarian reserve, duration of infertility, and previous treatments.
  • Operative laparoscopy may improve pregnancy rates in selected early-stage disease.
  • ART may be appropriate, particularly with tubal impairment or additional male-factor infertility.
10) Non-medical interventions (supportive) ▾
  • Discuss supportive strategies that may improve quality of life (e.g., physiotherapy, nutrition, psychological support).
  • These should complement—not replace—medical or surgical management.
Attribution: Evidence-based educational summary derived from national clinical practice guidelines (paraphrased).
Designed by Dr Ashraf Dwidar.

Quick clinical reference derived from Irish national clinical practice guidelines (paraphrased), for rapid review

Endometriosis – Assessment and Management Pathway

Endometriosis – Diagnostic & Management Pathway (Educational infographic)

Educational infographic derived from national clinical practice guidelines (paraphrased). This content is intended for educational purposes only and does not replace clinical judgment, institutional protocols, or specialist consultation.