Allaire, C., Bedaiwy, M. A., & Yong, P. J. (2023). Diagnosis and management of endometriosis. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. https://doi.org/10.1503/cmaj.220637
Allaire C, Bedaiwy MA, Yong PJ. Diagnosis and management of endometriosis. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2023. doi:10.1503/cmaj.220637
Allaire, Catherine, et al. "Diagnosis and management of endometriosis." CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2023.
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Guidelines advise diagnosing endometriosis without surgery, says CMAJ
Recent guidelines advise doctors to diagnose endometriosis without surgery, a 2023 CMAJ review says. The diagnosis uses symptoms, an exam and imaging, and no imaging reliably detects superficial disease. The review addresses care in Canada. Its authors call current treatments not curative.
Key Findings
Patients with minimal to moderate disease in the untreated arms of 2 randomized trials had repeat laparoscopy at 6–12 months: progression in 29%–45%, no change in 33%–42%, regression in 22%–29%.
A United Kingdom case–control study of over 5000 patients with endometriosis found higher odds than controls of a history of trouble getting pregnant (OR 8.2) and dysmenorrhea (OR 8.1).
The review gives hormonal options for endometriosis a comparable efficacy of 60%–80%. Their goal is to suppress the menstrual cycle, and they are contraceptive.
Two systematic reviews and a Cochrane review of 5 randomized controlled trials found combined hormonal contraceptives reduced pain versus placebo, with low-quality studies and follow-up of 3–11 months.
After surgery, systematic reviews report disease that persists or recurs at a rate of 22% at 2 years and 40%–50% at 5 years.
Interpretation
This review of endometriosis diagnosis and care includes studies from 1960 to January 2022. Symptom severity does not match how much disease a patient has. No imaging test reliably finds superficial disease. The authors call current hormone and surgery treatments not curative, since disease often comes back after either one. The authors say diet and lifestyle changes need more study. Larger studies of diet, lifestyle, and non-surgical diagnosis would help.
RRM Context
Restorative reproductive medicine looks for the cause of pelvic pain and infertility. The review says symptom severity does not track extent of disease. It describes hormonal therapy as suppressing the menstrual cycle and stopping ovulation when ovulation is painful. Restorative clinicians ask what drives the symptoms in each couple, and a suppressed cycle shows less about the cause.
Our editorial summary of this paper, not the article's abstract.
Endometriosis is a chronic inflammatory disease that drives pain, organ dysfunction, and infertility. How RRM-trained clinicians diagnose and treat it through excision surgery, cycle charting, and longitudinal care.
