ESHRE Logo ESHRE Guideline for the Diagnosis and Treatment of Endometriosis


For a definitive diagnosis of endometriosis visual inspection of the pelvis at laparoscopy is the gold standard investigation, unless disease is visable in the vagina or elsewhere.
Level 3

There is insufficient evidence to justify timing the laparoscopy at a specific time in the menstrual cycle, but it should not be performed during or within three months of hormonal treatment so as to avoid under-diagnosis (Evers, 1987).


Positive histology confirms the diagnosis of endometriosis; negative histology does not exclude it. Whether histology should be obtained if peritoneal disease alone is present is controversial: visual inspection is usually adequate but histological confirmation of at least one lesion is ideal. In cases of ovarian endometrioma (> 4 cms in diameter), and in deeply infiltrating disease, histology should be obtained to identify endometriosis and to exclude rare instances of malignancy.

If the patient wants pain symptoms suggestive of endometriosis to be treated without a definitive diagnosis, then a therapeutic trial of a hormonal drug to reduce menstrual flow is appropriate (see Empirical Treatment section).

The management of severe/deeply infiltrating endometriosis is complex. Therefore, if disease of such severity is suspected or diagnosed, referral to a centre with the necessary expertise to offer all available treatments in a multi-disciplinary context, including advanced laparoscopic surgery and laparotomy, is strongly recommended.


Supporting Documentation





This guideline, which is reviewed annually, was last updated on 30 June 2007

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