Endometriosis

NICE guideline [NG73]. Endometriosis: diagnosis and management. Last updated: Nov 2024. NICE CKS Endometriosis. Last revised: Nov 2024.

Guidelines

1st line: TVUSTransvaginal ultrasound 
  • Do not exclude endometriosis based on normal ultrasound
  • Aim is to screen for other pathologies, identify endometriomas, and deep endometriosis

Definitive test: laparoscopy (direct visualisation of the pelvis) + consider biopsy (to confirm diagnosis - but -ve histology does not exclude endometriosis)

Other tests:
  • MRI - consider to diagnose deep endometriosis and assess extent (only in secondary care)
  • CA125 - do not use to diagnose endometriosis
    • NB that endometriosis can increase CA125 level but has no diagnostic value

1st line: paracetamol and/or NSAID

If patient not planning to concieve: offer homronal treatment (COCP or progesterone)

1st line: laparosopic surgery (preferred over ablation for symptom relief, if fertility is not a main concern)
  • This can be preformed at diagnostic laparoscopy (consent patient)
  • Excision / ablation for endometritic lesions
  • Excision is preferred for endometriomas 

Last resort but most effective: laparoscopic hysterectomy (+/- oophorectomy) + excision of all endometriotic lesions

Consider pre-operative GnRH agonist for 3 months in deep endometriosis involving

Consider post-operative hormonal therapy (e.g. COCP, progesterone) to prolong benefits of surgery and manage symptoms.

Offer laparosopic interventions:

  • Excision or ablation of endometriosis (not involving the bowel / bladder / ureter)
  • Adhesiolysis​​​​​​
  • Ovarian cystectomy / laparoscopic drainage and ablation of endometriomas
Author: Adams Lau
Reviewer:
Last edited: 10/07/25