ESHRE guideline: management of women with endometriosis
TL;DR: This guideline was produced by a group of experts in the field using the structured methodology of the Manual for ESHRE Guideline Development, including a thorough systematic search of the literature, quality assessment of the included papers up to January 2012 and consensus within the guideline group on all recommendations.
Abstract: studydesign,size,duration: This guideline was produced by a group of experts in the field using the methodology of the Manual for ESHRE Guideline Development, including a thorough systematic search of the literature, quality assessment of the included papers up to January 2012 and consensus within the guideline group on all recommendations. To ensure input from women with endometriosis, a patient representative was part of the guideline development group. In addition, patient and additional clinical input was collected during the scoping and review phase of the guideline.
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TL;DR: This guideline was produced by a multidisciplinary group of experts in the field using the methodology of the Manual for ESHRE Guideline Development, including a thorough systematic search of the literature, quality assessment of the included papers up to September 2014 and consensus within the guideline group on all recommendations.
Abstract: study question: What is the optimal management of women with premature ovarian insufficiency (POI) based on the best available
evidence in the literature?
summary answer: The guideline development group (GDG) formulated 99 recommendations answering 31 key questions on the
diagnosis and treatment of women with POI.
what is known already: NA.
study design, size, duration: This guideline was produced by a multidisciplinary group of experts in the field using the methodology
of the Manual for ESHRE Guideline Development, including a thorough systematic search of the literature, quality assessment of the included
papers up to September 2014 and consensus within the guideline group on all recommendations. The GDG included a patient representative
to ensure input from women with POI. After finalization of the draft, the European Society for Human Reproduction and Embryology
(ESHRE) members and professional organizations were asked to review the guideline.
participants/materials, setting, methods: NA.
main results and the role of chance: The guideline provides 17 recommendations on diagnosis and assessment of POI and 46
recommendations on the different sequelae of POI and their consequences for monitoring and treatment. Furthermore, 24 recommendations
were formulated on hormone replacement therapy in women with POI, and two on alternative and complementary treatment. A chapter on
puberty induction resulted in five recommendations.
limitations, reasons for caution: The main limitation of the guideline is that, due to the lack of data, many of the recommendations
are based on expert opinion or indirect evidence from studies on post-menopausal women or women with Turner Syndrome.
wider implications of the findings: Despite the limitations, the guideline group is confident that this document will be able to
guide health care professionals in providing the best practice for managing women with POI given current evidence. Furthermore, the guideline
grouphas formulated research recommendations on the gaps in knowledge identified in the literature searches, in an attempt to stimulate research
on the key issues in POI.
801 citations
Cites background from "ESHRE guideline: management of wome..."
...For women with endometriosis who required oophorectomy, combined estrogen/progestogen therapy can be effective for the treatment of vasomotor symptoms and may reduce the risk of disease reactivation (Dunselman et al., 2014) C...
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TL;DR: A patient-centred, individualized, multi-modal and interdisciplinary integrated approach should be taken to maximize the quality of the patient’s ‘endometriosis life’ and how health-care professionals could rethink endometRIosis diagnosis and management is highlighted.
Abstract: Endometriosis is a chronic inflammatory disease defined as the presence of endometrial tissue outside the uterus, which causes pelvic pain and infertility. This disease should be viewed as a public health problem with a major effect on the quality of life of women as well as being a substantial economic burden. In light of the considerable progress with diagnostic imaging (for example, transvaginal ultrasound and MRI), exploratory laparoscopy should no longer be used to diagnose endometriotic lesions. Instead, diagnosis of endometriosis should be based on a structured process involving the combination of patient interviews, clinical examination and imaging. Notably, a diagnosis of endometriosis often leads to immediate surgery. Therefore, rethinking the diagnosis and management of endometriosis is warranted. Instead of assessing endometriosis on the day of the diagnosis, gynaecologists should consider the patient's 'endometriosis life'. Medical treatment is the first-line therapeutic option for patients with pelvic pain and no desire for immediate pregnancy. In women with infertility, careful consideration should be made regarding whether to provide assisted reproductive technologies prior to performing endometriosis surgery. Modern endometriosis management should be individualized with a patient-centred, multi-modal and interdisciplinary integrated approach.
391 citations
TL;DR: In this article, the authors reviewed the epidemiology of endometriosis as well as potential biomarkers for detection and with the goal of highlighting risk factors that could be used in combination with biomarkers to identify and treat women with endometrial cancer earlier.
Abstract: Endometriosis is a disease of adolescents and reproductive-aged women characterized by the presence of endometrial tissue outside the uterine cavity and commonly associated with chronic pelvic pain and infertility. Here we review the epidemiology of endometriosis as well as potential biomarkers for detection and with the goal of highlighting risk factors that could be used in combination with biomarkers to identify and treat women with endometriosis earlier. Early age at menarche, shorter menstrual length, and taller height are associated with a higher risk of endometriosis while parity, higher body mass index (BMI), and smoking are associated with decreased risk. Endometriosis often presents as infertility or continued pelvic pain despite treatment with analgesics and cyclic oral contraceptive pills. Despite a range of symptoms, diagnosis of endometriosis is often delayed due to lack of non-invasive, definitive, and consistent biomarkers for the diagnosis of endometriosis. Hormone therapy and analgesics are used for treatment of symptomatic endometriosis. However, the efficacy of these treatments is limited as endometriosis often recurs. In this review, we describe potential diagnostic biomarkers and risk factors that may be used as early non-invasive in vitro tools for identification of endometriosis to minimize diagnostic delay and improve reproductive health of patients.
329 citations
TL;DR: Remedying the diagnostic delay requires increased patient education and timely referral to a women's healthcare provider and a shift in physician approach to the disorder, which is expected to simplify endometriosis diagnosis and make the process accessible to more clinicians and patients, culminating in earlier effective management.
321 citations
References
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TL;DR: Alternative medicine use and expenditures increased substantially between 1990 and 1997, attributable primarily to an increase in the proportion of the population seeking alternative therapies, rather than increased visits per patient.
Abstract: Context.—A prior national survey documented the high prevalence and costs of
alternative medicine use in the United States in 1990.Objective.—To document trends in alternative medicine use in the United States
between 1990 and 1997.Design.—Nationally representative random household telephone surveys using comparable
key questions were conducted in 1991 and 1997 measuring utilization in 1990
and 1997, respectively.Participants.—A total of 1539 adults in 1991 and 2055 in 1997.Main Outcomes Measures.—Prevalence, estimated costs, and disclosure of alternative therapies
to physicians.Results.—Use of at least 1 of 16 alternative therapies during the previous year
increased from 33.8% in 1990 to 42.1% in 1997 (P≤.001).
The therapies increasing the most included herbal medicine, massage, megavitamins,
self-help groups, folk remedies, energy healing, and homeopathy. The probability
of users visiting an alternative medicine practitioner increased from 36.3%
to 46.3% (P=.002). In both surveys alternative therapies
were used most frequently for chronic conditions, including back problems,
anxiety, depression, and headaches. There was no significant change in disclosure
rates between the 2 survey years; 39.8% of alternative therapies were disclosed
to physicians in 1990 vs 38.5% in 1997. The percentage of users paying entirely
out-of-pocket for services provided by alternative medicine practitioners
did not change significantly between 1990 (64.0%) and 1997 (58.3%) (P=.36). Extrapolations to the US population suggest a 47.3%
increase in total visits to alternative medicine practitioners, from 427 million
in 1990 to 629 million in 1997, thereby exceeding total visits to all US primary
care physicians. An estimated 15 million adults in 1997 took prescription
medications concurrently with herbal remedies and/or high-dose vitamins (18.4%
of all prescription users). Estimated expenditures for alternative medicine
professional services increased 45.2% between 1990 and 1997 and were conservatively
estimated at $21.2 billion in 1997, with at least $12.2 billion paid out-of-pocket.
This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations.
Total 1997 out-of-pocket expenditures relating to alternative therapies were
conservatively estimated at $27.0 billion, which is comparable with the projected
1997 out-of-pocket expenditures for all US physician services.Conclusions.—Alternative medicine use and expenditures increased substantially between
1990 and 1997, attributable primarily to an increase in the proportion of
the population seeking alternative therapies, rather than increased visits
per patient.
6,814 citations
"ESHRE guideline: management of wome..." refers background in this paper
...…transcutaneous electrical nerve stimulation, dietary supplements, acupuncture and traditional Chinese medicine are not well established for pain management in endometriosis (Astin et al., 1998; Eisenberg et al., 1998; Proctor et al., 2002; Sesti et al., 2007; Flower et al., 2009; Zhu et al., 2011)....
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...The GDG has retrieved and evaluated existing evidence on complementary and alternative treatment options for pain in women with endometriosis, and concluded that the effectiveness of high-frequency transcutaneous electrical nerve stimulation, dietary supplements, acupuncture and traditional Chinese medicine are not well established for pain management in endometriosis (Astin et al., 1998; Eisenberg et al., 1998; Proctor et al., 2002; Sesti et al., 2007; Flower et al., 2009; Zhu et al., 2011)....
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TL;DR: This glossary will contribute to a more standardized communication among professionals responsible for ART practice, as well as those responsible for national, regional, and international registries.
1,442 citations
"ESHRE guideline: management of wome..." refers methods in this paper
...GPP MAR in women with endometriosis The World Health Organization ICMART (International Committee for Monitoring Assisted Reproductive Technology) definitions are used for the terms MAR and assisted reproduction technology (ART) (Zegers-Hochschild et al., 2009)....
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...Clinicians can prescribe GnRH agonists for a period of 3–6 months prior to treatment with ART to improve clinical pregnancy rates in infertile women with endometriosis (Sallam et al., 2006)....
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...The effectiveness of surgical excision of deep nodular lesions before treatment with ART in women with endometriosis-associated infertility is not well established with regard to reproductive outcome (Bianchi et al., 2009; Papaleo et al., 2011)....
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...GPP In infertile women with endometriosis, clinicians may offer treatment with ART after surgery, since cumulative endometriosis recurrence rates are not increased after controlled ovarian stimulation for IVF/ICSI (D’Hoogheet al., 2006; Benaglia et al., 2010; Coccia et al., 2010; Benaglia et al., 2011)....
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...One retrospective cohort study compared reproductive outcomes in a group of women with minimal to mild endometriosis in whom all visible endometriosis was completely removed using laparoscopy prior to ART to women undergoing diagnostic laparoscopy only and found a significantly higher implantation rate, pregnancy rate and live birth rate in the treated group (Opoien et al., 2011)....
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TL;DR: A 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, and the guideline was developed and refined.
Abstract: The objective was to develop recommendations for the diagnosis and treatment of endometriosis and its associated symptoms. A 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 existing 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 solely 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 regularly, and will be made available at http://www.endometriosis.org/guidelines.html with hyperlinks to the supporting evidence, and the relevant references and abstracts. For 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.
1,412 citations
"ESHRE guideline: management of wome..." refers background in this paper
...The ESHRE Guideline for the Diagnosis and Treatment of Endometriosis (2005) has been a reference point for best clinical care in endometriosis for years (Kennedy et al., 2005)....
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...Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, which induces a chronic, inflammatory reaction (Kennedy et al., 2005)....
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...Key words: endometriosis / European Society of Human Reproduction and Embryology / guideline / evidence based Introduction Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, which induces a chronic, inflammatory reaction (Kennedy et al., 2005)....
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TL;DR: Age is the only sociodemographic characteristic for which a consistent positive relationship has been observed and the risk of endometriosis appears to increase for reproductive health factors that may relate to increased exposure to menstruation and decrease for personal habits.
1,378 citations
TL;DR: The role OS plays in normal cycling ovaries, follicular development and cyclical endometrial changes is reviewed and female infertility and how it influences the outcomes of assisted reproductive techniques is discussed.
Abstract: In a healthy body, ROS (reactive oxygen species) and antioxidants remain in balance When the balance is disrupted towards an overabundance of ROS, oxidative stress (OS) occurs OS influences the entire reproductive lifespan of a woman and even thereafter (ie menopause) OS results from an imbalance between prooxidants (free radical species) and the body's scavenging ability (antioxidants) ROS are a double-edged sword – they serve as key signal molecules in physiological processes but also have a role in pathological processes involving the female reproductive tract ROS affect multiple physiological processes from oocyte maturation to fertilization, embryo development and pregnancy It has been suggested that OS modulates the age-related decline in fertility It plays a role during pregnancy and normal parturition and in initiation of preterm labor Most ovarian cancers appear in the surface epithelium, and repetitive ovulation has been thought to be a causative factor Ovulation-induced oxidative base damage and damage to DNA of the ovarian epithelium can be prevented by antioxidants There is growing literature on the effects of OS in female reproduction with involvement in the pathophsiology of preeclampsia, hydatidiform mole, free radical-induced birth defects and other situations such as abortions Numerous studies have shown that OS plays a role in the pathoysiology of infertility and assisted fertility There is some evidence of its role in endometriosis, tubal and peritoneal factor infertility and unexplained infertility This article reviews the role OS plays in normal cycling ovaries, follicular development and cyclical endometrial changes It also discusses OS-related female infertility and how it influences the outcomes of assisted reproductive techniques The review comprehensively explores the literature for evidence of the role of oxidative stress in conditions such as abortions, preeclampsia, hydatidiform mole, fetal embryopathies, preterm labour and preeclampsia and gestational diabetes The review also addresses the growing literature on the role of nitric oxide species in female reproduction The involvement of nitric oxide species in regulation of endometrial and ovarian function, etiopathogenesis of endometriosis, and maintenance of uterine quiescence, initiation of labour and ripening of cervix at parturition is discussed Complex interplay between cytokines and oxidative stress in the etiology of female reproductive disorders is discussed Oxidant status of the cell modulates angiogenesis, which is critical for follicular growth, corpus luteum formation endometrial differentiation and embryonic growth is also highlighted in the review Strategies to overcome oxidative stress and enhance fertility, both natural and assisted are delineated Early interventions being investigated for prevention of preeclampsia are enumerated Trials investigating combination intervention strategy of vitamin E and vitamin C supplementation in preventing preeclampsia are highlighted Antioxidants are powerful and there are few trials investigating antioxidant supplementation in female reproduction However, before clinicians recommend antioxidants, randomized controlled trials with sufficient power are necessary to prove the efficacy of antioxidant supplementation in disorders of female reproduction Serial measurement of oxidative stress biomarkers in longitudinal studies may help delineate the etiology of some of the diosorders in female reproduction such as preeclampsia
1,336 citations
"ESHRE guideline: management of wome..." refers background in this paper
...for improving infertility in women with endometriosis (Gerhard and Postneek, 1992; Harris and Rees, 2000; Xu et al., 2003; Agarwal et al., 2005; Burks-Wicks et al., 2005; Chan, 2008; Wurn et al., 2008; Zhou and Qu, 2009)....
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...…on O ctober 6, 2014 http://hum rep.oxfordjournals.org/ D ow nloaded from for improving infertility in women with endometriosis (Gerhard and Postneek, 1992; Harris and Rees, 2000; Xu et al., 2003; Agarwal et al., 2005; Burks-Wicks et al., 2005; Chan, 2008; Wurn et al., 2008; Zhou and Qu, 2009)....
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