Friday, January 24, 2014

So what's Europe doing?

Here's a link to the European Society of Human Reproduction and Embryology's guidelines for the management of women with endometriosis:

""Are hormonal therapies effective for painful symptoms associated with endometriosis? Currently, hormonal contraceptives, progestagens and anti-progestagens, GnRHagonists and antagonists and aromatase inhibitors are in clinical use. With no overwhelming evidence to support particular treatments over others, it is important that the decisions involved in any treatment plan
are individual, and that a woman is able to make these based on an informed choice and a good understanding of what is happening to her body. GnRHagonists, with and without add-back therapy, are effective in the relief of endometriosis-associated pain, but can be associated with severe side effects, which should be discussed with the woman when offering treatment. No evidence exists on the effectiveness of GnRH antagonists for endometriosis-associated pain (Brown et al., 2010). Due to the severe side effects, aromatase inhibitors should only be prescribed to women after all other options for medical or surgical treatment are exhausted."

"Excision of lesions could be preferential with regard to the possibility of retrieving samples for histology. Furthermore, ablative techniques are unlikely to be suitable for advanced forms of endometriosis....Based on the current evidence, the GDG concluded that there is no proven benefit of post-operative hormonal therapy (within 6 months after surgery), if this treatment is prescribed with the sole aim of improving the outcome of surgery (Furness et al., 2004). However, there is also no proven harm of prescribing hormonal therapy after surgery; hence some forms of post-operative hormonal therapy could be prescribed for other indications, as contraception or secondary prevention."

"As a consequence, the lack of clear-cut evidence leads to many research questions. We propose that future research on clinical aspects of endometriosis should include at least: (i) The effectiveness of surgical excision of AFS/ASRM Stage III–IV endometriosis in the treatment of infertility in comparison to direct referral toART, (ii) the diagnostic value of laparoscopy with or without histological verification, (iii) the best way of secondary prevention of endometriosis, (iv) the best management, with respect to both reproductive outcome and pain, of ovarian endometrioma
and of deep endometriosis in women with an active child wish, (v) the use of biomarkers for diagnosis and disease monitoring in endometriosis, (vi) the benefit of anti-adhesion agents in surgery for endometriosis-associated pain, (vii) the clinical management of endometriosis in adolescents, (viii) the psychosocial impact of endometriosis and how this should be addressed: patient-centred care, couple-centred interventions, interventions to improve quality of life, (ix) the definition of
the prerequisites of centres of expertise in the management of endometriosis, and finally, (x) the achievement of an earlier diagnosis of the disease, by raising the awareness amongst primary care specialists, gastroenterologists and internal medicine specialists."

"Several studies have reported a long delay in the diagnosis of endometriosis. Recent studies report, specifically for Europe, an overall diagnostic delay of 10 years in Germany and Austria, 8 years in the UK and Spain, 7 years in Norway, 7–10 years in Italy and 4–5 years in Ireland and Belgium (Ballard et al., 2006; Nnoaham et al., 2011; Hudelist et al., 2012)."