Management of Women with Endometriosis in Pakistan: Good Clinical Practice Recommendations

Shams-un-Nisa Sadia; Tasneem Akhtar; Zartaj Hayat; Syeda Batool Mazhar; Nabia Tariq; Sadaqat Jabeen; Zahra Muslim; Nadeem Faiyaz Zuberi

doi:10.71104/jsogp.v16i1.1012

Shams-un-Nisa Sadia Professor of Obstetrics & Gynaecology Riphah International Hospital, Riphah International University, Islamabad
Tasneem Akhtar Associate Professor/ Consultant Obs & Gynae, Shifa International Hospital, Islamabad
Zartaj Hayat Professor; Head unit2 OBGYN Foundation University Islamabad
Syeda Batool Mazhar Ex Professor/HOD, Dept of Obs and Gynae, PIMS, Islamabad
Nabia Tariq Consultant Gynaecologist General Practice Hospital Islamabad
Sadaqat Jabeen Ex Professor of Obs & Gynae/HOD Lady Reading Hospital Peshawar
Zahra Muslim Obstetrician & Gyanecologist Trainee Specialist at Australian Concept Fertility Medical Center Islamabad
Nadeem Faiyaz Zuberi Vice-Chair & Associate Professor Department of Obstetrics & Gynecology Aga Khan Univetsity, Karachi

DOI: https://doi.org/10.71104/jsogp.v16i1.1012

Keywords: guidelines, Endometriosis

Abstract

Executive summary

Diagnosis: A careful history is the cornerstone. Imaging supports diagnosis. Laparoscopy is not mandatory for diagnosis; empirical medical treatment is a valid first step.

Medical Treatment: First-line: NSAIDs + Combined Oral Contraceptives or Progestogens. Second-line: GnRH agonists/antagonists with add-back therapy.

Third line: Aromatase inhibitors (used with caution).

Evaluate every 6–12 months for efficacy and side effects.

Lifestyle & Psychosocial: Mental Health: Integrate Cognitive Behavioural Therapy (CBT), mindfulness, and psychosocial support.

Surgery: Excision is preferred over ablation. Laparoscopic cystectomy is standard for endometriomas >3-4cm. Drainage with sclerotherapy is option in selected patients. Avoid repeated surgeries.

Fertility: Do not use hormonal suppression to improve fertility. Determination of ovarian reserve before treatment is prognostically important. Surgery may improve natural conception (ASRM I–II); IVF preferred for advanced disease (ASRM III–IV); pre-treatment with GnRH agonists for 3+ months is beneficial.

Special Populations: Adolescents: Have a high index of suspicion. Postmenopausal Women: Menopausal Hormone Therapy (MHT) can be used but requires careful counselling.

Author Biographies

Shams-un-Nisa Sadia, Professor of Obstetrics & Gynaecology Riphah International Hospital, Riphah International University, Islamabad