STUDY QUESTION: How should endometriosis be diagnosed and managed based on the best
available evidence from published literature? SUMMARY ANSWER: The current guideline
provides 109 recommendations on diagnosis, treatments for pain and infertility, management
of disease recurrence, asymptomatic or extrapelvic disease, endometriosis in adolescents
and postmenopausal women, prevention and the association with cancer. WHAT IS KNOWN
ALREADY: Endometriosis is a chronic condition with a plethora of presentations in
terms of not only the occurrence of lesions, but also the presence of signs and symptoms.
The most important symptoms include pain and infertility. STUDY DESIGN, SIZE, DURATION:
The guideline was developed according to the structured methodology for development
of ESHRE guidelines. After formulation of key questions by a group of experts, literature
searches and assessments were performed. Papers published up to 1 December 2020 and
written in English were included in the literature review. PARTICIPANTS/MATERIALS,
SETTING, METHODS: Based on the collected evidence, recommendations were formulated
and discussed within specialist subgroups and then presented to the core guideline
development group (GDG) until consensus was reached. A stakeholder review was organized
after finalization of the draft. The final version was approved by the GDG and the
ESHRE Executive Committee. MAIN RESULTS AND THE ROLE OF CHANCE: This guideline aims
to help clinicians to apply best care for women with endometriosis. Although studies
mostly focus on women of reproductive age, the guideline also addresses endometriosis
in adolescents and postmenopausal women. The guideline outlines the diagnostic process
for endometriosis, which challenges laparoscopy and histology as gold standard diagnostic
tests. The options for treatment of endometriosis-associated pain symptoms include
analgesics, medical treatments and surgery. Non-pharmacological treatments are also
discussed. For management of endometriosis-associated infertility, surgical treatment
and/or medically assisted reproduction are feasible. While most of the more recent
studies confirm previous ESHRE recommendations, there are five topics in which significant
changes to recommendations were required and changes in clinical practice are to be
expected. LIMITATIONS, REASONS FOR CAUTION: The guideline describes different management
options but, based on existing evidence, no firm recommendations could be formulated
on the most appropriate treatments. Also, for specific clinical issues, such as asymptomatic
endometriosis or extrapelvic endometriosis, the evidence is too scarce to make evidence-based
recommendations. WIDER IMPLICATIONS OF THE FINDINGS: The guideline provides clinicians
with clear advice on best practice in endometriosis care, based on the best evidence
currently available. In addition, a list of research recommendations is provided to
stimulate further studies in endometriosis.
