Management of endometriosis CNGOF/HAS clinical practice guidelines

Pierre Collinet 1, 2 Xavier Fritel 3, 4 Christine Revel-Delhom 5 Marcos Ballester 6 Pierre-Adrien Bolze 7, 8 Bruno Borghese 9, 10, 11 Nicole Bornsztein 12 Jérémy Boujenah 13, 14 Thierry Brillac 15 Nathalie Chabbert-Buffet 16, 6, 17 Candice Chauffour 18 Nathalie Clary 19 Jonathan Cohen 16 Christine Decanter 20, 21, 22 Amélie Denouël 23 Gil Dubernard 24 Arnaud Fauconnier 25, 26 Hervé Fernandez 27, 28 Tristan Gauthier 29, 30 Francois Golfier 31 Cyrille Huchon 25 Guillaume Legendre 32, 33 Jérôme Loriau 34 Emmanuelle Mathieu-D’argent 16, 6, 35 Benjamin Merlot 36 Julien Niro 37 Pierre Panel 37 Philippe Paparel 38 Charles-André Philip 24 Stéphane Ploteau 39 Christophe Poncelet 40, 41 Benoît Rabischong 18 Horace Roman 21, 42 Chrystèle Rubod 1 Piétro Santulli 9, 43 Marine Sauvan 27 Isabelle Thomassin-Naggara 44, 45, 46 Antoine Torre 47 Jean-Michel Wattier 48 Chadi Yazbeck 49, 50 N. Bourdel 18 Michel Canis 18
10 Génomique, Epigénétique et Physiopathologie de la Reproduction
DRC - [Institut Cochin] Département Développement, Reproduction et Cancer
33 Equipe 7 - CESP - INSERM U1018 - Sexualité et soins (Genre, Sexualité, Santé)
UVSQ - Université de Versailles Saint-Quentin-en-Yvelines, UP11 - Université Paris-Sud - Paris 11, CESP - Centre de recherche en épidémiologie et santé des populations
Abstract : First-line diagnostic investigations for endometriosis are physical examination and pelvic ultrasound. The second-line investigations are: targeted pelvic examination performed by an expert clinician, transvaginal ultrasound performed by an expert physician sonographer (radiologist or gynaecologist), and pelvic MRI. Management of endometriosis is recommended when the disease has a functional impact. Recommended first-line hormonal therapies for the management of endometriosisrelated pain are combined hormonal contraceptives (CHCs) or the 52mg levonorgestrel-releasing intrauterine system (IUS). There is no evidence base on which to recommend systematic preoperative hormonal therapy solely to prevent surgical complications or facilitate surgery. After surgery for endometriosis, a CHC or 52mg levonorgestrel-releasing IUS is recommended as first-line treatment when pregnancy is not desired. In the event of failure of the initial treatment, recurrence, or multiorgan involvement, a multidisciplinary team meeting is recommended, involving physicians, surgeons and other professionals. A laparoscopic approach is recommended for surgical treatment of endometriosis. HRT can be offered to postmenopausal women who have undergone surgical treatment for endometriosis. Antigonadotrophic hormonal therapy is not recommended for patients with endometriosis and infertility to increase the chances of spontaneous pregnancy, including postoperatively. Fertility preservation options must be discussed with patients undergoing surgery for ovarian endometriomas.
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Pierre Collinet, Xavier Fritel, Christine Revel-Delhom, Marcos Ballester, Pierre-Adrien Bolze, et al.. Management of endometriosis CNGOF/HAS clinical practice guidelines. Journal of Gynecology Obstetrics and Human Reproduction, Elsevier, 2018, Epub ahead of print. ⟨10.1016/j.jogoh.2018.06.003⟩. ⟨inserm-01823259⟩



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