Page 97 - Diagnostic delay of endometriosis

Surgically treat endometriosis when identified at laparoscopy, i.e. ‘see and treat’, as this is effective for reducing endometriosis-associated pain
Refer women with suspected or diagnosed deep endometriosis to a centre of expertise that offers all available treatments in a multidisciplinary context
Perform operative laparoscopy (excision or ablation of the endometriosis lesions) including adhesiolysis, rather than performing diagnostic laparoscopy only in infertile women with AFS/ ASRM stage I/II endometriosis, to increase ongoing pregnancy rates
Perform excision of the endometrioma capsule, instead of drainage and electro coagulation of the endometrioma wall in infertilewomen with ovarian endometrioma undergoing surgery, to increase spontaneous pregnancy rates
Counsel women with endometrioma regarding the risks of reduced ovarian function after surgery and the possible loss of the ovary.
The decision to proceed with surgery should be considered carefully if the woman has had previous ovarian surgery
Use assisted reproductive technologies for infertility associated with endometriosis, especially if tubal function is compromised or if there is male factor infertility, and/or other treatments have failed
Continue to treat women with a history of endometriosis after surgical menopause with combined estrogen/progestagen or tibolone, at least up to the age of natural menopause
Fully inform and counsel women about any incidental finding of endometriosis
60 56 50 (90%) (84%) (75%)
63 62 52 (94%) (93%) (78%)
65 60 58 (97%) (90%) (87%)
59 56 56 (88%) (84%) (84%)
63 64 62 (94%) (95%) (93%)
64 63 61 (96%) (94%) (91%)
61 60 55 (91%) (90%) (82%)
57 59 52 (85%) (88%) (78%)
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Gynaecologists’ view on diagnostic delay and care performance | 95