Management of endometriosis: CNGOF/HAS clinical practice guidelines - Short version

Endometriosis remains a complex gynecological condition with limited consensus on optimal diagnostic and therapeutic pathways. While pelvic ultrasound is widely adopted as a diagnostic tool, uncertainty persists regarding the role of advanced imaging and hormonal interventions. Prior research has shown that combined hormonal contraceptives are frequently used for symptom management, but evidence for their long-term efficacy is incomplete. No prior work had resolved whether preoperative hormonal therapy consistently improves surgical outcomes. This gap motivated the need for updated clinical guidelines that integrate recent evidence and expert consensus. That uncertainty drove the development of a structured diagnostic algorithm and treatment recommendations. The lack of clarity around multidisciplinary care for complex cases also remains a challenge. No prior work had resolved the best postoperative hormonal strategies for women with endometriosis. This gap motivated the current synthesis of clinical practice guidelines.

The aim of this clinical practice guideline is to clarify the diagnostic and therapeutic pathways for endometriosis based on current evidence and expert consensus. The specific problem addressed is the variability in diagnostic approaches and treatment recommendations across clinical settings. The motivation stems from the need to standardize care and improve patient outcomes. This paper focuses on defining first-line and second-line investigations for endometriosis. It also seeks to establish evidence-based recommendations for hormonal therapy and surgical approaches. The authors aim to provide guidance on multidisciplinary care for complex cases. They also address the role of hormonal therapy in postmenopausal women and those undergoing fertility preservation. The paper clarifies the limitations of certain hormonal therapies in improving spontaneous pregnancy rates.

The authors employed a systematic review of clinical evidence related to endometriosis management. They synthesized findings from peer-reviewed literature and expert consensus statements. The methodology included a structured diagnostic algorithm for endometriosis. They evaluated hormonal therapies for pain management and postoperative care. The authors also analyzed the role of imaging techniques such as transvaginal ultrasound and pelvic MRI. A multidisciplinary care model was proposed for complex cases. The study incorporated guidelines from the CNGOF and HAS organizations. The recommendations were developed through consensus among gynecologists, radiologists, and other specialists.

The strongest finding is that physical examination and pelvic ultrasound are recommended as first-line diagnostic tools. Transvaginal ultrasound and pelvic MRI are proposed as second-line investigations when initial findings are inconclusive. Combined hormonal contraceptives and the 52mg levonorgestrel-releasing intrauterine system are suggested as first-line therapies for pain management. No evidence supports preoperative hormonal therapy to prevent surgical complications. Laparoscopic surgery is recommended for definitive treatment of endometriosis. Postmenopausal women who have undergone surgery may benefit from hormone replacement therapy. Multidisciplinary care is proposed for cases with recurrence or multiorgan involvement. Fertility preservation discussions are emphasized for women undergoing surgery for ovarian endometriomas.

The authors propose that physical examination and pelvic ultrasound are sufficient for initial endometriosis diagnosis. Transvaginal ultrasound and pelvic MRI are suggested when further clarification is needed. Combined hormonal contraceptives and the 52mg levonorgestrel-releasing IUS are recommended as first-line therapies for pain management. The authors suggest that preoperative hormonal therapy lacks evidence for preventing surgical complications. Laparoscopic surgery is proposed as the preferred surgical approach for endometriosis. Hormone replacement therapy may be offered to postmenopausal women after surgery. Multidisciplinary care is recommended for complex cases involving recurrence or multiorgan involvement. Fertility preservation discussions are emphasized for women undergoing surgery for ovarian endometriomas.