Classification algorithm of patients with endometriosis: Proposal for tailored management

Endometriosis is a pseudoneoplastic disease that has a significant personal and social impact. Unlike other neoplastic diseases, its management is burdened by uncertainty and controversy. The aim of this article is to furnish clinicians with a simple, useful and updated tool to select an appropriate diagnostic-therapeutic care pathway for affected women. Guidelines and recommendations cite advances in diagnostics, novel medications and optimized assisted reproductive techniques; however, such advancements have not simplified the management of endometriosis, since they often lack an integrated, multidisciplinary view of diagnostic, therapeutic and reproductive scenarios that inevitably overlap in the management of the disease. We selected and compared major society guidelines on the diagnosis and treatment of endometriosis. Three international and 5 national guidelines were analyzed. The overlapping recommendations were extracted and mapped, developing a simplified diagnostic-therapeutic care pathway in the form of an algorithm. We subdivided the patient population attending our tertiary referral center according to 4 decision nodes: type (deep infiltrating endometriosis or isolated endometrioma); stage (I-IV according to the revised American Society for Reproductive Medicine classification); predominant health problem (pain or infertility); and fertility potential of the couple (normal/abnormal screening fertility). We identified 9 classes, each corresponding to a suggested mode of treatment (medical, surgical or assisted reproductive technique) according to the most recent evidence published. This simplified scheme is designed to standardize treatment and is intended for use as a tool in diagnostic and therapeutic planning with a view to reduce inappropriate treatment.