Clinical practice guidelines for endometriosis in Japan (The 3rd edition)

Abstract

with detailed flow charts. The clinical questions (CQs) in the latter half of this edition are intended as a useful guide for decision-making in clinical practice. The authors are all physicians working tirelessly at the frontiers of endometriosis research in Japan, and this edition has undergone multiple generous revisions amid their busy schedules. Integration of the overall structure, revision of inconsistencies and duplication among CQs, and other onerous editing tasks were undertaken with tremendous dedication by the secretaries on the Japan Society of Endometriosis, Drs.

Improving the diagnosis of endometriosis in Asia‐Pacific: Consensus from the Asia‐Pacific Endometriosis Expert Panel for Endometriosis

“…Thus, current expert opinion and international guidelines tend to assert a preference for non‐surgical diagnosis of endometriosis in the first instance, through history‐taking, pelvic examination with or without vaginal/rectal examination, and imaging (Table 1). 33,54,58–63 Rather than focusing on the presence of identifiable lesions as the central tenet of the disease, many physicians now prefer to shift the focus toward the patient and her symptoms, and approach endometriosis clinically as a menstrual cycle‐dependent, chronic, inflammatory condition causing pelvic pain 33,54 . This clinical approach is usually coupled with a low threshold for empirical treatment, because it avoids unnecessary surgery, reduces delays to medical intervention, and helps to mitigate the negative impact of untreated disease.…”

“…This clinical approach is usually coupled with a low threshold for empirical treatment, because it avoids unnecessary surgery, reduces delays to medical intervention, and helps to mitigate the negative impact of untreated disease. As the quality of diagnostic imaging has improved over time, laparoscopic diagnosis has somewhat diminished in relative value; 63 in addition, the poor correlation between pain severity and laparoscopically determined disease extent further supports a clinical rather than surgical focus 45 . Thus, in most countries, diagnostic laparoscopy is now generally reserved for cases where the non‐invasive approach proves unsuccessful or too inconclusive 54,58,64 .…”

“…Thus, current expert opinion and international guidelines tend to assert a preference for non-surgical diagnosis of endometriosis in the first instance, through history-taking, pelvic examination with or without vaginal/rectal examination, and imaging (Table 1). 33,54,[58][59][60][61][62][63] Rather than focusing on the presence of identifiable lesions as the central tenet of the disease, many physicians now prefer to shift the focus toward the patient and her symptoms, and approach F I G U R E 1 Life-long patient journey: juggling pain management and fertility desires. *intrauterine devices (IUDs), oral contraceptives (OCs), and other drugs mentioned may not be approved in all countries for the treatment of endometriosis.…”

Sulawesi propolis induces higher apoptotic activity and lower inflammatory activity in a rat endometriosis model

“…Dienogest was selected as progestins have become the first-line treatment in Indonesian guidelines for the treatment of endometriosis [9] . Of the progestins, only dienogest and dydrogesterone have been studied in randomized controlled trials with placebo controls, and only dienogest has been proven to be safe for long-term use [10] .…”