ESHRE Endometriosis Guideline Development Group (2022). ESHRE guideline: endometriosis. Human Reproduction Open. https://doi.org/10.1093/hropen/hoac009
ESHRE Endometriosis Guideline Development Group. ESHRE guideline: endometriosis. Human Reproduction Open. 2022. doi:10.1093/hropen/hoac009
ESHRE Endometriosis Guideline Development Group. "ESHRE guideline: endometriosis." Human Reproduction Open, 2022.
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The 2022 ESHRE guideline backs diagnostic surgery only after negative scans, or when hormone treatment failed or was unsuitable. A panel of European experts read studies up to December 2020. The panel made 109 recommendations among women who have, or may have, the disease.
Key Findings
The group formulated 109 recommendations: 79 supported by research data and 30 good practice points based primarily on clinical expertise.
Laparoscopy (keyhole surgery) was once the diagnostic gold standard. The guideline now recommends it after negative imaging, or when empirical treatment failed or was inappropriate.
The group concluded that LUNA (laparoscopic uterosacral nerve ablation) adds no benefit to conventional surgery. It concluded presacral neurectomy helps midline pain as an add-on to conventional surgery, with more adverse effects.
The group found no evidence that keeping a symptom diary, or using a questionnaire or app, shortens the wait for an endometriosis diagnosis.
The group found no clear evidence that nutrition, Chinese medicine, electrotherapy, acupuncture, physiotherapy, exercise or psychological interventions increase the chance of pregnancy in women with endometriosis.
Interpretation
A consensus guideline works like this: experts grade published studies, then add their own judgment where data run thin. When evidence was too thin, the group wrote a conclusion and made no recommendation. Searches covered PubMed/MEDLINE and the Cochrane library, in English only. The paper says the new diagnostic process is based mostly on clinical practice, and published data played a smaller role. The group found no evidence that either diagnostic laparoscopy or empirical treatment is superior for symptom management in women suspected of endometriosis.
RRM Context
Empirical treatment here means hormonal contraceptives or progestogens. These suppress the cycle and hide symptoms without diagnosing the disease. Restorative reproductive medicine looks for the underlying cause first. RRM endorses excision as the surgical standard. For pain in deep endometriosis, the guideline group made no conclusions or recommendations on surgical technique.
Our editorial summary of this paper, not the article's abstract.
PMID 35350465 35350465 DOI 10.1093/hropen/hoac009 10.1093/hropen/hoac009 ESHRE Endometriosis Guideline Development Group et al. 2022, ESHRE Endometriosis Guideline Development Group 2022