Updated clinical guidelines for both management and diagnosis of endometriosis have been released.
Surgery is no longer required to diagnose endometriosis, and physiotherapy and psychology should be considered alongside hormonal treatment, according to the updated clinical guideline.
The ‘Australian Living Evidence Guideline: Endometriosis’, was announced on 10 May by RANZCOG and replaces the current guidance. It also includes a quick reference guide and flowchart for primary care providers and new resources for patients.
Non-invasive diagnosis of symptomatic women using transvaginal pelvic ultrasound and pelvic MRI has been emphasised in the new guideline. Transabdominal ultrasound can be suggested for patients where pelvic MRI is unavailable and transvaginal ultrasound is not appropriate given factors such as age and sexual history.
The guideline lists the common symptoms of endometriosis as severe painful periods, pain with sex, infertility, pelvic pain and heavy menstrual bleeding. First-line treatment can be offered while awaiting diagnosis.
Hormonal treatment such as combined oral contraceptives and progestogens (oral, injection, implant or IUD) is the first-line therapy, but practitioners are encouraged to consider also offering analgesics, physiotherapy and psychological interventions.
If treatment shows no improvement after three months, alternative first-line treatments and second-line treatment such as GnRH agonists or GnRH antagonists should be discussed.
Offering hormonal treatment to people with endometriosis who are trying to conceive is not advised, as it does not improve unassisted pregnancy rates. Patients prioritising fertility should be referred for specialist management, the guideline says.
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Patients with concerns about cancer risk due to endometriosis should be informed that they may have a small increase in endometrial and ovarian cancer, but the increase in absolute risk compared to the general population is low. No accurate screening test for early detection of these cancers currently exists and the CDC does not recommend additional testing for people with endometriosis. They may also have a reduced risk of cervical cancer.
A free eLearning module for multidisciplinary care providers will be available at the end of May to support consistency in the national quality of care.
“Having clear, evidence-based tools like the quick reference guide and flowchart will be a game-changer for primary care,” said Professor Danielle Mazza AM, head of the Department of General Practice at Monash University and member of the guideline development group.
“It will help primary care practitioners feel more confident starting treatment early and ensure we’re on the same page with specialists when it comes to managing what is often a complex, variable and long-term condition.”
The RANZCOG press release included a call to the Albanese government to extend funding beyond 2025 so that the guideline can continue to be updated and maintain the most recent scientific evidence.
“The living-evidence guideline represents a major step forward in providing consistent, high-quality care for Australians living with confirmed and suspected endometriosis,” said Professor Cindy Farquhar, chair of the RANZCOG Endometriosis Guideline Development Group.
“Considering up-to-date scientific evidence, expanded diagnostic options beyond surgery, and a truly interdisciplinary approach, we’re better positioned to deliver more timely, personalised, and effective care.”
The management of endometriosis for post-menopausal and pregnant women are not included in the guideline. Also considered out of scope were pregnancy complications, fertility treatments, hormonal treatment related to hysterectomy plus oophorectomy, gynaecological cancers and other causes of pelvic pain.
The full guideline can be found here.
