Diagnosis and Treatment of Endometriosis. Guideline of the DGGG, SGGG and OEGGG (S2k Level, AWMF Registry Number 015/045, August 2020)

Abstract

Aims The aim of this official guideline published and coordinated by the German Society of Gynaecology and Obstetrics (DGGG) in cooperation with the Austrian Society for Gynaecology and Obstetrics (OEGGG) and the Swiss Society for Gynaecology and Obstetrics (SGGG) was to provide consensus-based recommendations for the diagnosis and treatment of endometriosis based on an evaluation of the relevant literature.

Methods This S2k guideline represents the structured consensus of a representative panel of experts with different professional backgrounds commissioned by the Guideline Committee of the DGGG, OEGGG and SGGG.

Recommendations Recommendations on the epidemiology, aetiology, classification, symptomatology, diagnosis and treatment of endometriosis are given and special situations are discussed.

Key words

endometriosis - diagnosis - treatment - pelvic pain - guideline

Publication History

Received: 26 January 2021
Received: 30 January 2021

Accepted: 01 February 2021

Article published online:
14 April 2021

• References/Literatur

• 1 Sampson JA. Metastatic or Embolic Endometriosis, due to the Menstrual Dissemination of Endometrial Tissue into the Venous Circulation. Am J Pathol 1927; 3: 93-110.43
• 2 Meyer R. Über den Stand der Frage der Adenomyositis, Adenomyome im allgemeinen und insbesondere über Adenomyositis seroepithelialis und Adenomyometritis sarcomatosa. Zentralbl Gynäkol 1919; 36: 745-750
• 3 Leyendecker G, Kunz G, Noe M. et al. Endometriosis: a dysfunction and disease of the archimetra. Hum Reprod Update 1998; 4: 752-762
• 4 Leyendecker G, Wildt L, Mall G. The pathophysiology of endometriosis and adenomyosis: tissue injury and repair. Arch Gynecol Obstet 2009; 280: 529-538
• 5 Gordts S, Koninckx P, Brosens I. Pathogenesis of deep endometriosis. Fertil Steril 2017; 108: 872-885.e1
• 6 Koninckx PR, Ussia A, Adamyan L. et al. Pathogenesis of endometriosis: the genetic/epigenetic theory. Fertil Steril 2019; 111: 327-340
• 7 Parazzini F, Esposito G, Tozzi L. et al. Epidemiology of endometriosis and its comorbidities. Eur J Obstet Gynecol Reprod Biol 2017; 209: 3-7
• 8 Hirsch M, Begum MR, Paniz E. et al. Diagnosis and management of endometriosis: a systematic review of international and national guidelines. BJOG 2018; 125: 556-564
• 9 Clement PB, Young RH. Atlas of Gynecologic Surgical Pathology. 4th ed. Edinburgh, London, New York, Oxford, Philadelphia, St. Louis, Sydney: Elsevier; 2020: 183-184
• 10 Cockerham AZ. Adenomyosis: a challenge in clinical gynecology. J Midwifery Womens Health 2012; 57: 212-220
• 11 McCluggage WG, Robboy SJ. Mesenchymal uterine tumors, other than pure smooth muscle neoplasms, and adenomyosis. In: Robboyʼs Pathology of the Female Reproductive Tract. 2nd ed.. Churchill Livingstone; 2008: 450-456
• 12 Burghaus S, Fehm T, Fasching PA. et al. The International Endometriosis Evaluation Program (IEEP Study) – A Systematic Study for Physicians, Researchers and Patients. Geburtshilfe Frauenheilkd 2016; 76: 875-881
• 13 Palla VV, Karaolanis G, Katafigiotis I. et al. Ureteral endometriosis: A systematic literature review. Indian J Urol 2017; 33: 276-282
• 14 Schliep KC, Chen Z, Stanford JB. et al. Endometriosis diagnosis and staging by operating surgeon and expert review using multiple diagnostic tools: an inter-rater agreement study. BJOG 2017; 124: 220-229
• 15 Wu D, Hu M, Hong L. et al. Clinical efficacy of add-back therapy in treatment of endometriosis: a meta-analysis. Arch Gynecol Obstet 2014; 290: 513-523
• 16 Tsai HW, Wang PH, Huang BS. et al. Low-dose add-back therapy during postoperative GnRH agonist treatment. Taiwan J Obstet Gynecol 2016; 55: 55-59
• 17 Chaichian S, Kabir A, Mehdizadehkashi A. et al. Comparing the Efficacy of Surgery and Medical Therapy for Pain Management in Endometriosis: A Systematic Review and Meta-analysis. Pain Physician 2017; 20: 185-195
• 18 Zorbas KA, Economopoulos KP, Vlahos NF. Continuous versus cyclic oral contraceptives for the treatment of endometriosis: a systematic review. Arch Gynecol Obstet 2015; 292: 37-43
• 19 Adachi K, Takahashi K, Nakamura K. et al. Postoperative administration of dienogest for suppressing recurrence of disease and relieving pain in subjects with ovarian endometriomas. Gynecol Endocrinol 2016; 32: 646-649
• 20 Zheng Q, Mao H, Xu Y. et al. Can postoperative GnRH agonist treatment prevent endometriosis recurrence? A meta-analysis. Arch Gynecol Obstet 2016; 294: 201-207
• 21 Marjoribanks J, Ayeleke RO, Farquhar C. et al. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev 2015; (07) CD001751
• 22 Keyhan S, Hughes C, Price T. et al. An Update on Surgical versus Expectant Management of Ovarian Endometriomas in Infertile Women. Biomed Res Int 2015; 2015: 204792
• 23 Tao X, Chen L, Ge S. et al. Weigh the pros and cons to ovarian reserve before stripping ovarian endometriomas prior to IVF/ICSI: A meta-analysis. PLoS One 2017; 12: e0177426
• 24 Riley KA, Benton AS, Deimling TA. et al. Surgical Excision Versus Ablation for Superficial Endometriosis-Associated Pain: A Randomized Controlled Trial. J Minim Invasive Gynecol 2019; 26: 71-77
• 25 Angioni S, Nappi L, Pontis A. et al. Dienogest. A possible conservative approach in bladder endometriosis. Results of a pilot study. Gynecol Endocrinol 2015; 31: 406-408
• 26 Ceccaroni M, Clarizia R, Ceccarello M. et al. Total laparoscopic bladder resection in the management of deep endometriosis: “take it or leave it.” Radicality versus persistence. Int Urogynecol J 2019;
• 27 Knabben L, Imboden S, Fellmann B. et al. Urinary tract endometriosis in patients with deep infiltrating endometriosis: prevalence, symptoms, management, and proposal for a new clinical classification. Fertil Steril 2015; 103: 147-152
• 28 Hjordt Hansen MV, Dalsgaard T, Hartwell D. et al. Reproductive prognosis in endometriosis. A national cohort study. Acta Obstet Gynecol Scand 2014; 93: 483-489
• 29 Kim SG, Seo HG, Kim YS. Primiparous singleton women with endometriosis have an increased risk of preterm birth: Meta-analyses. Obstet Gynecol Sci 2017; 60: 283-288
• 30 Conti N, Cevenini G, Vannuccini S. et al. Women with endometriosis at first pregnancy have an increased risk of adverse obstetric outcome. J Matern Fetal Neonatal Med 2015; 28: 1795-1798
• 31 Berlac JF, Hartwell D, Skovlund CW. et al. Endometriosis increases the risk of obstetrical and neonatal complications. Acta Obstet Gynecol Scand 2017; 96: 751-760
• 32 Zullo F, Spagnolo E, Saccone G. et al. Endometriosis and obstetrics complications: a systematic review and meta-analysis. Fertil Steril 2017; 108: 667-672.e5
• 33 Vigano P, Corti L, Berlanda N. Beyond infertility: obstetrical and postpartum complications associated with endometriosis and adenomyosis. Fertil Steril 2015; 104: 802-812
• 34 Lalani S, Choudhry AJ, Firth B. et al. Endometriosis and adverse maternal, fetal and neonatal outcomes, a systematic review and meta-analysis. Hum Reprod 2018; 33: 1854-1865
• 35 Weidner K, Neumann A, Siedentopf F. et al. Chronischer Unterbauchschmerz: Die Bedeutung der Schmerzanamnese. Frauenarzt 2015; 56: 982-987
• 36 Hauser W, Bock F, Engeser P. et al. [Recommendations of the updated LONTS guidelines. Long-term opioid therapy for chronic noncancer pain]. Schmerz 2015; 29: 109-130
• 37 Somigliana E, Vigano P, Parazzini F. et al. Association between endometriosis and cancer: a comprehensive review and a critical analysis of clinical and epidemiological evidence. Gynecol Oncol 2006; 101: 331-341
• 38 Kim HS, Kim TH, Chung HH. et al. Risk and prognosis of ovarian cancer in women with endometriosis: a meta-analysis. Br J Cancer 2014; 110: 1878-1890
• 39 Zafrakas M, Grimbizis G, Timologou A. et al. Endometriosis and ovarian cancer risk: a systematic review of epidemiological studies. Front Surg 2014; 1: 14
• 40 Thomsen LH, Schnack TH, Buchardi K. et al. Risk factors of epithelial ovarian carcinomas among women with endometriosis: a systematic review. Acta Obstet Gynecol Scand 2017; 96: 761-778
• 41 Chen LC, Hsu JW, Huang KL. et al. Risk of developing major depression and anxiety disorders among women with endometriosis: A longitudinal follow-up study. J Affect Disord 2016; 190: 282-285
• 42 Evans S, Fernandez S, Olive L. et al. Psychological and mind-body interventions for endometriosis: A systematic review. J Psychosom Res 2019; 124: 109756
• 43 Lagana AS, La Rosa VL, Rapisarda AMC. et al. Anxiety and depression in patients with endometriosis: impact and management challenges. Int J Womens Health 2017; 9: 323-330
• 44 Coloma JL, Martinez-Zamora MA, Collado A. et al. Prevalence of fibromyalgia among women with deep infiltrating endometriosis. Int J Gynaecol Obstet 2019; 146: 157-163
• 45 Veasley: Chronic overlapping Pain Conditions. In: Häuser W, Perrot S. eds. Fibromyalgia Syndrome and Widespread Pain: From Construction to Relevant Recognition. Alphen aan den Rijn: Wolters Kluwer; 2018: 87-111
• 46 Wu CC, Chung SD, Lin HC. Endometriosis increased the risk of bladder pain syndrome/interstitial cystitis: a population-based study. Neurourol Urodyn 2018; 37: 1413-1418
• 47 Schweppe KW, Ebert AD, Kiesel L. Endometriosezentren und Qualitätsmanagement. Gynäkologe 2010; 43: 233-240 doi:10.1007/s00129-009-2484-x
• 48 Rahmenkonzept zur Nachsorge für medizinische Rehabilitation nach § 15 SGB VI der Deutschen Rentenversicherung. Stand: Juni 2015 (in der Fassung vom 1. Juli 2019). Accessed October 31, 2019 at: https://www.deutsche-rentenversicherung.de/SharedDocs/Downloads/DE/Experten/infos_reha_einrichtungen/konzepte_systemfragen/konzepte/rahmenkonzept_reha_nachsorge.pdf?__blob=publicationFile&v=4
• 49 Kofahl C. [Collective patient centeredness and patient involvement through self-help groups]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62: 3-9
• 50 Hundertmark-Mayser J, Möller-Bock B. Selbsthilfe im Gesundheitsbereich. Gesundheitsberichterstattung des Bundes, Heft 23. Herausgegeben vom Robert-Koch-Institut am 1. August 2004. Accessed October 31, 2019 at: http://www.gbe-bund.de/pdf/Heft23.pdf