Endometriosis centers of expertise in the Netherlands: Development toward regional networks of multidisciplinary care

Abstract

Endometriosis is a common and complex disease that is difficult to diagnose and treat. 1,2 Centralization of care in expertise centers can contribute to a multidisciplinary approach to both diagnosing and treating endometriosis. However, until June 2020, no criteria for endometriosis expertise centers in the Netherlands were established. The aim of centralization of endometriosis care is to improve treatment for women with endometriosis by shortening the delay in diagnosis and reducing morbidity, leading to an improvement of their quality of life. This aim is in accordance with the advices of the European Society of Human Reproduction and Embryology (ESHRE), the World Endometriosis Society (WES), and the National Institute for Health and Care Excellence (NICE). Centralization of surgery has already proved to be successful in other disciplines in terms of improving clinical outcome. 3,4 A retrospective multicenter study in France shows a correlation between surgical experience and postoperative complications in the treatment of deep infiltrating endometriosis. 5 Already in 2006, D'Hooghe and Hummelshoj discussed in their opinion paper how the treatment of and research into endometriosis could be improved by the implementation of multidisciplinary centers and networks of excellence. 6 In 2011, the WES formulated two consensus statements clarifying the importance of endometriosis expertise centers. 7 WES initiated a consensus workshop regarding centralization of care in 2017, where the following advices were formulated: the centralization of endometriosis care is necessary, with a specific focus on surgery, fertility, pain, and psychosocial guidance, seeking adequate support and the proper mode in each local context (WES, personal communication).In a number of European countries such as Denmark (2001), Germany (2005, and France (2017), expertise centers to centralize endometriosis care have been implemented (Table 1). [8][9][10]

Pathophysiology, diagnosis, and management of endometriosis

“…Specialist centers were first formally proposed in 2006,183 and this model of care has been successfully implemented in the UK and several other European countries such as Denmark, Germany, and France 184185. The role of specialist endometriosis centers should be to offer a coordinated, holistic, multidisciplinary, multimodal approach to women with complex symptoms of endometriosis that are experienced and evolve across the life course (fig 5).…”