A Systematic Review of Guidelines for Diagnosis and Management of Endometriosis

A Systematic Review of Guidelines for Diagnosis and Management of Endometriosis

Quality Control of Guidelines for Diagnosis and Management of Endometriosis

Key Points


  • This is a systematic review article which evaluated national and international clinical guidelines for diagnosis and management of endometriosis.


  • There exists substantial variation in guidelines recommendations and their methodological quality.

What's done here:

  • Evaluation of the methodological quality of endometriosis guidelines searched from [1] EMBASE; [2] Medline; and [3] Pubmed databases using the Appraisal of Guidelines for REsearch & Evaluation (AGREE-II).
  • Mapping of methodologies and recommendations performed.
  • The relationships between recommendations and research evidence assessed.


  • There were 152 different recommendations, ten of which were comparable across guidelines.
  • The European Society of Human Reproduction and Embryology was evaluated as the highest methodological quality score: 88/100.
  • 42 recommendations (28%) were not supported by research evidence.


  • Methodological scoring may not associate with applicability and clinical practice.
  • The authors did not systematically review the randomised controlled trials and systematic reviews when judging the appropriateness of guideline recommendations.

Lay Summary

Guidelines are systematically developed statements derived from best research evidence to improve patient care through informed clinical practice. Appropriate guidelines can reduce unwarranted variations health practice and the implementation of better interventions. Endometriosis commonly has three different manifestations, including peritoneal endometriosis, ovarian endometriosis, and deep infiltrating endometriosis. Treatment decision often varies significantly between severity and associated symptoms such as pain and infertility. Therefore, it can be difficult to produce accurate diagnostic tests and effective therapeutic interventions to inform unified patient care because of many naturally occurring disease variation and a variety of symptoms.

Hirsch et al. evaluated the methodological quality of endometriosis guidelines, their recommendations, and research evidence through study search on EMBASE, Medline, and Pubmed databases. The results identified 879 titles and abstracts, including two international and five national guidelines. The authors then assessed the methodological quality using the Appraisal of Guidelines for REsearch & Evaluation (AGREE-II) instrument, extracted the guideline recommendations and the supporting research evidence.

Their analyses showed that there is significant variation in endometriosis guideline quality and recommendations. In total, there were one hundred and fifty-two different recommendations, in which ten recommendations were comparable across guidelines, and research evidence did not support 42. The European Society of Human Reproduction and Embryology was the highest quality instruction, with a methodological quality score of 88/100.

Although this systemic review is limited by the methodological scoring which may not associate with applicability and clinical practice, nonetheless the results showed substantial variation in the recommendations and methodological quality of endometriosis guidelines. This data suggests that future guidelines development should take into account high-quality methods and consultation with the principal stakeholders (including women with endometriosis) to ensure well informed clinical practice.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/28755422

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