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

Published:March 11, 2022DOI:https://doi.org/10.1016/j.jogc.2022.02.127
      Endometriosis is a common and often debilitating gynaecologic disease.
      • Wellbery C.
      Diagnosis and treatment of endometriosis.
      ,
      • Howard F.M.
      Endometriosis and mechanisms of pelvic pain.
      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).
      • Leyland N.
      • Casper R.
      • Laberge P.
      • Singh S.S.
      SOGC
      Endometriosis: diagnosis and management.
      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%
      P ≤ 0.05, denoting significant differences between groups 1 and 2.
      had tried at least 1 first-line agent
      61%
      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%
      P ≤ 0.05, denoting significant differences between groups 1 and 2.
      were on addback therapy with GnRH agonists
      54%
      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%
      P ≤ 0.05, denoting significant differences between groups 1 and 2.
      had incomplete surgery during their most recent excision/resection procedure
      20%
      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.
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      References

        • Wellbery C.
        Diagnosis and treatment of endometriosis.
        Am Fam Phys. 1999; 60: 1753
        • Howard F.M.
        Endometriosis and mechanisms of pelvic pain.
        J Min Invas Gynecol. 2009; 16: 540-550
        • Leyland N.
        • Casper R.
        • Laberge P.
        • Singh S.S.
        • SOGC
        Endometriosis: diagnosis and management.
        J Obstet Gynaecol Can. 2010 Jul; 32: S1-S32