Importance Score: 75 / 100 🔴
Updated Guidelines Advocate for Early Endometriosis Diagnosis and Treatment
Updated guidelines recommend that individuals exhibiting endometriosis symptoms should be offered diagnostic options like ultrasound to facilitate quicker treatment. These updated endometriosis guidelines aim to reduce the lengthy diagnostic process, which often involves waiting for surgical procedures.
The Need for Timely Diagnosis
- Endometriosis, a condition affecting individuals with a uterus (including some men), involves the growth of cells similar to the uterine lining in other parts of the body.
- It can lead to severe pain, infertility, and heavy menstrual cycles.
New Diagnostic Recommendations
The updated “living” evidence guideline for endometriosis, released by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), suggests:
- Transvaginal ultrasound as the primary diagnostic tool.
- Pelvic MRI as an alternative if ultrasound is not suitable.
These suggestions derive from growing evidence indicating enhanced diagnostic accuracy using these non-invasive techniques.
The new guideline supersedes RANZCOG’s initial clinical guidelines from 2021. As a “living” guideline, it will be updated based on cutting-edge research and emerging evidence.
Limitations of Traditional Methods
Dr. Marilla Druitt, a guideline developer, explained that while historically, tissue sampling during surgery was the standard for endometriosis diagnosis, recent research demonstrates that ultrasound can effectively detect deep infiltrating endometriosis with “excellent” sensitivity. However, she noted its limitations in detecting superficial cases.
Enhanced Ultrasound Techniques
- A new Medicare item number, becoming available in November, will support a more thorough ultrasound examination for endometriosis.
- This assessment will focus on identifying endometriosis tissue outside the uterus, including the ligaments connecting the uterus to the pelvis.
Increased Access and Training
Druitt emphasized that the Medicare item number should encourage more comprehensive assessments. To improve access, a greater number of sonographers will need to acquire accreditation.
Parallel Treatment and Diagnosis
Offering ultrasound as a first step in diagnosing endometriosis enables patients to begin treatment sooner, avoiding extensive surgical wait times, whether for addressing sub-fertility or persistent discomfort.
The guidelines advocate for initiating treatment and diagnosis simultaneously, eliminating treatment delays.
The guidelines will also assist general practitioners in starting first-line hormonal therapies while diagnostic investigations proceed. Specific primary care resources are also in place to enhance access to pivotal evidence-based recommendations.
Professor Danielle Mazza, the head of the department of general practice at Monash University and a member of the guideline development group, noted that clear, evidence-based resources like the quick reference guide and flowchart would revolutionize primary care.
Additional Recommendations
- The guidelines now suggest that physiotherapy and psychological care may be beneficial for individuals with pelvic pain and endometriosis.
- Patients seeking information regarding cancer risk in reproductive organs should be informed that while there might be a slight elevation in the risk of ovarian and endometrial cancer, the overall increase is minimal compared to the general population. They may also have a reduced risk of cervical cancer.
Druitt noted that numerous inflammatory conditions are linked to a slightly amplified cancer risk. In the context of endometriosis, the substantial data needed to demonstrate the correlation indicates that the absolute risk remains notably small.
New Patient Resources
There are also new resources developed for patients.
Alexis Wolfe, consumer liaison on the guideline development group, said the resources will give people information that would help them advocate for themselves and participate more confidently in decision-making with care providers.
Surgical Treatment Options
Regarding surgical treatments, the guidelines suggest that when dealing with the two different types of surgical treatments for endometriosis – ablation or excision – “existing evidence does not support one technique over the other, with the exception of endometrioma [cysts on the ovaries]” with the certainty of evidence being identified as “low”.
For endometriomas, excision is strongly recommended over ablation.
Response from Endometriosis Organizations
Jess Taylor, chair of the Australian Coalition for Endometriosis (ACE), highlighted the importance of a “living” guideline due to ongoing research in the field, as endometriosis has historically been under-researched. However, Taylor voiced disappointment that RANZCOG did not undertake formal public consultation.
The RANZCOG spokesperson stated that sector consultations occurred over three weeks, with extensions granted where feasible. While ACE requested a longer extension beyond the publication timelines dictated by the federal Department of Health, RANZCOG and the Department of Health are collaborating to include ACE’s feedback in future updates.
Syl and Lesley Freedman, co-founders of EndoActive, believe the guidelines reflect a shift toward patient-centered care.
The pair emphasized that while they appreciated the recognition that hysterectomies are not cures for endometriosis or adenomyosis, they remain concerned that the guidelines still do not clarify that pregnancy is not a cure or treatment for endo, calling it a harmful myth.