Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/a-0813-4411
Standards Used by a Clinical and Scientific Endometriosis Center for the Diagnosis and Therapy of Patients with Endometriosis
Article in several languages: English | deutschPublication History
received 26 August 2018
revised 30 October 2018
accepted 04 December 2018
Publication Date:
28 February 2019 (online)
![](https://www.thieme-connect.de/media/gebfra/201905/lookinside/thumbnails/10-1055-a-0813-4411_gf_en-1.jpg)
Abstract
Endometriosis is one of the most common benign gynecological diseases. The extremely heterogeneous complex of symptoms complicates the diagnosis and treatment of this disease. In most patients, there is a latency period of several years between the first occurrence of symptoms and the definitive diagnosis. This paper aims (1) to evaluate standards for the diagnosis and treatment of patients with (symptoms suspicious for) endometriosis in terms of feasibility, and (2) to assess the potential use of data collected by a certified clinical and scientific endometriosis center to answer scientific questions. Standards for outpatient consultations were developed for a special endometriosis outpatient clinic. Between January 2014 and December 2017, a total of 1715 outpatients with a suspicion of endometriosis presented to this special endometriosis outpatient clinic; the diagnosis and treatment of patients was carried out in accordance with the developed standards. Data of this patient cohort obtained from patient records created during outpatient consultations and from a questionnaire recorded in an Oracle-based database was analyzed. The patient cohort was also compared with another patient cohort who had attended different outpatient clinics and had been diagnosed intraoperatively with endometriosis. 41.8% of patients examined during special outpatient consultations had surgery for suspicion or recurrence of endometriosis. Endometriosis was confirmed in 81.5% of cases. Pain symptoms were the main indication for surgery in 70.1% of cases compared to 45.1% of cases in the comparison group. The structured approach used in the special endometriosis outpatient clinic is a key aspect of the care provided by the certified clinical and scientific endometriosis center. It ensures that patients are diagnosed and treated in accordance with guideline recommendations, that diagnosis and treatment comply with certification requirements, and that the collected data can be used to answer scientific questions.
-
References/Literatur
- 1 Saha R, Kuja-Halkola R, Tornvall P. et al. Reproductive and Lifestyle Factors Associated with Endometriosis in a Large Cross-Sectional Population Sample. J Womens Health (Larchmt) 2017; 26: 152-158
- 2 Sarıdoğan E. Adolescent endometriosis. Eur J Obstet Gynecol Reprod Biol 2017; 209: 46-49
- 3 Mahmood TA, Templeton A. Prevalence and genesis of endometriosis. Hum Reprod 1991; 6: 544-549
- 4 Witz CA, Burns WN. Endometriosis and infertility: is there a cause and effect relationship?. Gynecol Obstet Invest 2002; 53 (Suppl. 01) 2-11
- 5 Viganò P, Parazzini F, Somigliana E. et al. Endometriosis: epidemiology and aetiological factors. Best Pract Res Clin Obstet Gynaecol 2004; 18: 177-200
- 6 Buck Louis GM, Hediger ML, Peterson CM. et al. ENDO Study Working Group. Incidence of endometriosis by study population and diagnostic method: the ENDO study. Fertil Steril 2011; 96: 360-365
- 7 Hudelist G, Fritzer N, Thomas A. et al. Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences. Hum Reprod 2012; 27: 3412-3416
- 8 Simoens S, Hummelshoj L, DʼHooghe T. Endometriosis: cost estimates and methodological perspective. Hum Reprod Update 2007; 13: 395-404
- 9 Nnoaham KE, Hummelshoj L, Webster P. et al. World Endometriosis Research Foundation Global Study of Womenʼs Health consortium. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril 2011; 96: 366-373.e8
- 10 Simoens S, Dunselman G, Dirksen C. et al. The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres. Hum Reprod 2012; 27: 1292-1299
- 11 Soliman AM, Surrey E, Bonafede M. et al. Real-World Evaluation of Direct and Indirect Economic Burden Among Endometriosis Patients in the United States. Adv Ther 2018; 35: 408-423
- 12 Ebert AD, Ulrich U, Keckstein J. et al. Endometriosis Research Foundation, and the European Endometriosis League. Implementation of certified endometriosis centers: 5-year experience in German-speaking Europe. Gynecol Obstet Invest 2013; 76: 4-9
- 13 Thiel FC, Scharl A, Hildebrandt T. et al. Financing of certified centers: a willingness-to-pay analysis. Arch Gynecol Obstet 2013; 287: 495-509
- 14 Hudelist G, Fritzer N, Staettner S. et al. Uterine sliding sign: a simple sonographic predictor for presence of deep infiltrating endometriosis of the rectum. Ultrasound Obstet Gynecol 2013; 41: 692-695
- 15 Exacoustos C, Manganaro L, Zupi E. Imaging for the evaluation of endometriosis and adenomyosis. Best Pract Res Clin Obstet Gynaecol 2014; 28: 655-681
- 16 Van den Bosch T, Dueholm M, Leone FP. et al. Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. Ultrasound Obstet Gynecol 2015; 46: 284-298
- 17 Bazot M, Lafont C, Rouzier R. et al. Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis. Fertil Steril 2009; 92: 1825-1833
- 18 Lermann J, Hackl J, Burghaus S. et al. Die medikamentöse Therapie der Patientin mit Endometriose. Frauenheilkunde up2date 2017; 11: 27-41
- 19 Renner SP, Lermann J, Burghaus S. et al. Die operative Therapie der Endometriose. Frauenheilkunde up2date 2016; 10: 311-330
- 20 Ulrich U, Buchweitz O, Greb R. et al. German and Austrian Societies for Obstetrics and Gynecology. National German Guideline (S2k): Guideline for the Diagnosis and Treatment of Endometriosis: Long Version – AWMF Registry No. 015-045. Geburtsh Frauenheilk 2014; 74: 1104-1118
- 21 Abbott J, Hawe J, Hunter D. et al. Laparoscopic excision of endometriosis: a randomized, placebo-controlled trial. Fertil Steril 2004; 82: 878-884
- 22 Deguara CS, Pepas L, Davis C. Does minimally invasive surgery for endometriosis improve pelvic symptoms and quality of life?. Curr Opin Obstet Gynecol 2012; 24: 241-244
- 23 Jacobson TZ, Duffy JM, Barlow D. et al. Laparoscopic surgery for subfertility associated with endometriosis. Cochrane Database Syst Rev 2010; (01) CD001398
- 24 Singh SS, Suen MW. Surgery for endometriosis: beyond medical therapies. Fertil Steril 2017; 107: 549-554
- 25 Barra F, Ferrero S. mTor Inhibitors for the Treatment of Endometriosis. Geburtsh Frauenheilk 2018; 78: 283-284
- 26 Kacan T, Yildiz C, Baloglu Kacan S. et al. Everolimus as an mTOR Inhibitor Suppresses Endometriotic Implants: an Experimental Rat Study. Geburtsh Frauenheilk 2017; 77: 66-72
- 27 Petraglia F, Hornung D, Seitz C. et al. Reduced pelvic pain in women with endometriosis: efficacy of long-term dienogest treatment. Arch Gynecol Obstet 2012; 285: 167-173
- 28 Oladosu FA, Tu FF, Hellman KM. Nonsteroidal antiinflammatory drug resistance in dysmenorrhea: epidemiology, causes, and treatment. Am J Obstet Gynecol 2018; 218: 390-400
- 29 Butrick CW. Chronic pelvic pain: how many surgeries are enough?. Clin Obstet Gynecol 2007; 50: 412-424
- 30 Lovrincevic M. Chronic pelvic pain in women of childbearing age. Curr Opin Anaesthesiol 2003; 16: 275-280
- 31 Siedentopf F, Tariverdian N, Rücke M. et al. Immune status, psychosocial distress and reduced quality of life in infertile patients with endometriosis. Am J Reprod Immunol 2008; 60: 449-461
- 32 Burghaus S, Fehm T, Fasching PA. et al. The International Endometriosis Evaluation Program (IEEP Study) – A Systematic Study for Physicians, Researchers and Patients. Geburtsh Frauenheilk 2016; 76: 875-881
- 33 Dunselman GA, Vermeulen N, Becker C. et al. European Society of Human Reproduction and Embryology. ESHRE guideline: management of women with endometriosis. Hum Reprod 2014; 29: 400-412
- 34 Johnson NP, Hummelshoj L. Consensus on current management of endometriosis. Hum Reprod 2013; 28: 1552-1568
- 35 Fauconnier A, Chapron C. Endometriosis and pelvic pain: epidemiological evidence of the relationship and implications. Hum Reprod Update 2005; 11: 595-606
- 36 Vercellini P, Giudice LC, Evers JL. et al. Reducing low-value care in endometriosis between limited evidence and unresolved issues: a proposal. Hum Reprod 2015; 30: 1996-2004
- 37 Nnoaham KE, Hummelshoj L, Kennedy SH. et al. World Endometriosis Research Foundation Womenʼs Health Symptom Survey Consortium. Developing symptom-based predictive models of endometriosis as a clinical screening tool: results from a multicenter study. Fertil Steril 2012; 98: 692-701.e5
- 38 Vercellini P, Trespidi L, De Giorgi O. et al. Endometriosis and pelvic pain: relation to disease stage and localization. Fertil Steril 1996; 65: 299-304
- 39 Renner SP, Boosz AS, Burghaus S. et al. Visual pain mapping in endometriosis. Arch Gynecol Obstet 2012; 286: 687-693
- 40 Practice Committee of the American Society for Reproductive Medicine. Treatment of pelvic pain associated with endometriosis: a committee opinion. Fertil Steril 2014; 101: 927-935
- 41 Nisenblat V, Bossuyt PM, Farquhar C. et al. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev 2016; (02) CD009591
- 42 Janssen EB, Rijkers AC, Hoppenbrouwers K. et al. Prevalence of endometriosis diagnosed by laparoscopy in adolescents with dysmenorrhea or chronic pelvic pain: a systematic review. Hum Reprod Update 2013; 19: 570-582
- 43 Shakiba K, Bena JF, McGill KM. et al. Surgical treatment of endometriosis: a 7-year follow-up on the requirement for further surgery. Obstet Gynecol 2008; 111: 1285-1292
- 44 Renner SP, Rix S, Boosz A. et al. Preoperative pain and recurrence risk in patients with peritoneal endometriosis. Gynecol Endocrinol 2010; 26: 230-235
- 45 Vercellini P, Somigliana E, Viganò P. et al. The effect of second-line surgery on reproductive performance of women with recurrent endometriosis: a systematic review. Acta Obstet Gynecol Scand 2009; 88: 1074-1082
- 46 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