Endometriosis secondary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Joseph Nasr, M.D.[2], Aravind Kuchkuntla, M.B.B.S[3]
Overview
There are no established strategies to prevent progression of endometriosis prior to diagnosis.
However, certain interventions may reduce recurrence, persistent pain, and long-term complications following diagnosis or surgical treatment.[1][2][3]
Secondary Prevention
Postoperative hormonal suppression is associated with reduced recurrence of endometriosis.
In a meta-analysis of 11 randomized trials and 3 prospective cohort studies (n = 1766), postoperative hormonal suppression reduced recurrence (10.7% vs 26.4%; RR 0.41, 95% CI 0.26–0.65).[3]
A separate meta-analysis demonstrated lower pain scores with postoperative suppression compared with no treatment (standard mean difference −0.49; 95% CI −0.91 to −0.07).[3]
Endometriosis is a chronic condition, and long-term suppressive hormonal therapy may be required to reduce symptom recurrence..[1][2]
Repeated surgical interventions should be avoided when possible due to limited high-quality evidence demonstrating long-term benefit.[4]
When hysterectomy is performed for endometriosis-associated pain, ovarian conservation is generally preferred in patients without genetic ovarian cancer risk to reduce long-term complications associated with surgical menopause.[5][6]
Guideline-supported presumed diagnosis based on symptoms and imaging may reduce unnecessary invasive diagnostic procedures.[7][8][9]
References
- ↑ 1.0 1.1 Coxon L, Demetriou L, Vincent K. Current developments in endometriosis-associated pain. Cell Rep Med. 2024;5(10):101769. doi:10.1016/j. xcrm.2024.101769
- ↑ 2.0 2.1 Kaplan CM, Kelleher E, Irani A, Schrepf A, Clauw DJ, Harte SE. Deciphering nociplastic pain: clinical features, risk factors and potential mechanisms. Nat Rev Neurol. 2024;20(6):347-363. doi:10.1038/s41582-024-00966-8
- ↑ 3.0 3.1 3.2 Zakhari A, Delpero E, McKeown S, Tomlinson G, Bougie O, Murji A. Endometriosis recurrence following post-operative hormonal suppression: a systematic review and meta-analysis. Hum Reprod Update. 2021;27(1):96-107. doi:10.1093/humupd/ dmaa033
- ↑ Fang QY, Campbell N, Mooney SS, Holdsworth-Carson SJ, Tyson K. Evidence for the role of multidisciplinary team care in people with pelvic pain and endometriosis: a systematic review. Aust N Z J Obstet Gynaecol. 2023;64(3):181-192. doi:10.1111/ajo.13755
- ↑ Kvaskoff M, Horne AW, Missmer SA. Informing women with endometriosis about ovarian cancer risk. Lancet. 2017;390(10111):2433-2434. doi:10.1016/S0140-6736(17)33049-0
- ↑ Stewart EA, Missmer SA, RoccaWA.Moving beyond reflexive and prophylactic gynecologic surgery. Mayo Clin Proc. 2021;96(2):291-294. doi: 10.1016/j.mayocp.2020.05.012
- ↑ Singh SS, Allaire C, Al-Nourhji O, et al. Guideline No. 449: diagnosis and impact of endometriosis—a canadian guideline. J Obstet Gynaecol Can. 2024; 46(5):102450. doi:10.1016/j.jogc.2024.102450
- ↑ Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Australian Clinical Practice Guideline for the Diagnosis and Management of Endometriosis. Royal Australian and New Zealand College of Obstetricians and Gynaecologists; 2021. Accessed February 10, 2025. https://ranzcog.edu.au/wp-content/uploads/+2022/02/Endometriosis-clinical-practice-guideline.+pdf
- ↑ National Institute for Health and Care Excellence. Endometriosis: Diagnosis and Management: NICE Guideline 37. Published September 6, 2017. Updated April 16, 2024. Accessed January 13, 2025. https://www.nice.org.+uk/guidance/ng73/evidence/full-guideline-pdf-+4550371315