Diagnosis and Management of Endometriosis: Are We Following the Canadian Clinical Practice Guidelines?

Abstract

Endometriosis is a common and often debilitating gynaecologic disease. 1 Wellbery C. Diagnosis and treatment of endometriosis. Am Fam Phys. 1999; 60: 1753 PubMed Google Scholar ,2 Howard F.M. Endometriosis and mechanisms of pelvic pain. J Min Invas Gynecol. 2009; 16: 540-550 Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar In an effort to standardize treatment, the Society of Obstetricians and Gynaecologists of Canada (SOGC) published updated clinical practice guidelines on the diagnosis and management of endometriosis in 2010 (Table 1). 3 Leyland N. Casper R. Laberge P. Singh S.S. SOGCEndometriosis: diagnosis and management. J Obstet Gynaecol Can. 2010 Jul; 32: S1-S32 Abstract Full Text PDF PubMed Scopus (230) Google Scholar The objective of this study was to determine whether Canadian community physicians adhered to national recommendations. Table 1Summary of key findings compared with SOGC guidelines Management Key findings Group 1 (2011–2012) Group 2 (2015) Medical First-line therapies include CHCs or progestins 48% a P ≤ 0.05, denoting significant differences between groups 1 and 2. had tried at least 1 first-line agent 61% a P ≤ 0.05, denoting significant differences between groups 1 and 2. had tried at least 1 first-line agent Ideally, CHCs should be administered continuously 27% prescribed CHCs were on continuous therapy 32% prescribed CHCs were on continuous therapy Second-line therapies include GnRH agonists and the LNG-IUS 41% had tried second-line therapy 43% had tried second-line therapy Hormonal addback should be prescribed for patients on GnRH agonist therapy 36% a P ≤ 0.05, denoting significant differences between groups 1 and 2. were on addback therapy with GnRH agonists 54% a P ≤ 0.05, denoting significant differences between groups 1 and 2. were on addback therapy with GnRH agonists Surgical Surgery should be considered after failure of both first- and second-line medical therapy 48% had not tried second-line medical therapy before surgery 53% had not tried second-line medical therapy before surgery Only surgeons who are capable of full resection should operate on endometriosis 38% a P ≤ 0.05, denoting significant differences between groups 1 and 2. had incomplete surgery during their most recent excision/resection procedure 20% a P ≤ 0.05, denoting significant differences between groups 1 and 2. had incomplete surgery during their most recent excision/resection procedure CHC: combined hormonal contraceptives; GnRH: gonadotropin-releasing hormone; LNG-IUS: levonorgestrel intrauterine system; SOGC: Society of Obstetricians and Gynaecologists of Canada. a P ≤ 0.05, denoting significant differences between groups 1 and 2. Open table in a new tab CHC: combined hormonal contraceptives; GnRH: gonadotropin-releasing hormone; LNG-IUS: levonorgestrel intrauterine system; SOGC: Society of Obstetricians and Gynaecologists of Canada.