International consensus statement outlines endometriosis care

Nearly 70 issues associated with management of endometriosis are outlined in a first-of-its-kind worldwide consensus statement on the disease released by the World Endometriosis Society (WES) Montpellier Consortium, an international group.

Published in Human Reproduction, the document is the work of experts from 34 medical and non-medical organizations, including the National Institute of Child Health and Human Development and 56 people representing women with endometriosis. It incorporates viewpoints not only from clinicians, scientists, and surgeons, but also from patient organizations and pharmaceutical companies.

The statement is the outgrowth of a 2011 consensus meeting at the 11^th World Congress on Endometriosis at which the panel reviewed the medical literature. The WES Consensus covers all aspects of endometriosis management and treatment, including lifestyle and dietary interventions and complementary therapies. Among the panel’s findings, which represent the first time that endometriosis and pelvic pain have been treated as part of the same disease continuum, are the following:

• Early treatment is warranted for adolescents but there is no clear evidence on how best to manage the disease in this population.
• Laparoscopic surgery is effective for improving fertility in women with early-stage endometriosis and should be performed by physicians appropriately trained in the procedure. First-line treatments for management of pelvic pain include nonsteroidal anti-inflammatory drugs and other pain medications as well as progestins and oral contraceptives. Progestins, opioid analgesics, and GnRH analogs are appropriate for second-line therapy.
• Dietary intervention in the form of vitamins, minerals, salts, lactic ferments, and fish oil may have a role as an alternative to hormonal treatment in women who have undergone surgery for endometriosis. Acupuncture and high-frequency transcutaneous electrical nerve stimulation also may provide some pain relief.