Resolution of the II Ukrainian Forum of Experts on Endometriosis
DOI:
https://doi.org/10.18370/2309-4117.2025.79.18-28Keywords:
endometriosis, resolution, Ukrainian Forum of Experts on EndometriosisAbstract
Endometriosis is a chronic, incurable disease that requires a long-term and individualized approach to the management of patients from menarche to menopause. This disease significantly reduces the quality of life of most patients, affects sexual and family life, is the cause of infertility and increases the risk of ovarian cancer in older age. In addition to physical discomfort, endometriosis has a significant negative impact on mental health, causing the development of depression and anxiety, which can aggravate chronic pelvic pain.
In Ukraine, work is underway to update the national clinical protocol for the management of endometriosis. The working group, approved by the order of the Ministry of Health of Ukraine, uses the updated NICE (2024) and ESHRE (2022) guidelines to prepare current regulatory documents. The goal is to standardize approaches, take into account the latest scientific data and comprehensive management, which includes, in addition to medical aspects, also reproductive and social rehabilitation.
The ESHRE (2022) and NICE (2024) guidelines move away from laparoscopy as the “gold standard” of diagnosis. Instead, they emphasize the importance of clinical examination, imaging (ultrasound, MRI) and empirical treatment.
Drug therapy should be aimed at controlling symptoms. It is important to take into account individual characteristics, patient wishes, side effect profile and cost. Dydrogesterone has been recognized as effective
and safe for the treatment of endometriosis-associated pain, especially in patients who wish to plan a pregnancy, since it does not suppress ovulation. Nonsteroidal anti-inflammatory drugs, including high doses of ibuprofen, may be used to relieve pain.
Surgery involves removing the endometriosis lesions and is an important tool in cases of ineffective pharmacotherapy. However, surgery does not guarantee complete pain relief and has a high risk of recurrence, especially in young women. Repeated operations can significantly reduce ovarian reserve.
For women with endometriosis-related infertility, assisted reproductive technologies, including in vitro fertilization, can be used. The endometriosis fertility index is a useful tool for deciding on the optimal method of achieving pregnancy.
For successful management of patients, it is critical to develop a long-term plan that includes medical and surgical interventions, lifestyle modification, and the integration of psychological support. Raising women’s awareness of their condition, along with cognitive-behavioral therapy, and relaxation techniques, has been proven effective in reducing pain and improving the quality of life of such patients.
References
- Rees M, Kiemle G, Slade P. Psychological variables and quality of life in women with endometriosis, J Psychosom Obstet Gynaecol; 2022;43(1):58–65. DOI: 10.1080/0167482X.2020.1784874.
- Lamvu G, Antunez-Flores O, Orady M, Schneider B. Path to diagnosis and women’s perspectives on the impact of endometriosis pain. J Endometr Pelvic Pain Disord; 2020; 12(1);16-25. DOI:10.1177/2284026520903214
- Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022(2): hoac009. DOI: 10.1093/hropen/hoac009.
- Endometriosis: diagnosis and management: NICE guideline (2024) [NG73][Internet]. NICE. September 2017. Available from: https://www.nice.org.uk/guidance/ng73/resources/endometriosis-diagnosis-and-management-pdf-1837632548293
- Endometriosis Pain Treatment using Progestogens, with a Focus on Dydrogesterone (EMPIRE). Meeting report. 2023.
- Vercellini P, Buggio L, Berlanda N, et al. Estrogen-progestins and progestins for the management of endometriosis. Fertil Steril 2016;106(7):1552–71. DOI: 10.1016/j.fertnstert.2016.10.022.
- Vercellini P, Buggio L, Frattaruolo MP, et al. Medical treatment of endometriosis-related pain. Best Pract Res Clin Obstet Gynaecol 2018;51:68–91. DOI: 10.1016/j.bpobgyn.2018.01.015
- Vercellini P, Bracco B, Mosconi P, et al. Norethindrone acetate or dienogest for the treatment of symptomatic endometriosis: a before and after study. Fertil Steril 2016;105(3):734–43. DOI: 10.1016/j.fertnstert.2015.11.016.
- Pizza F, Cavender D, Stockard A, et al. Anti-Inflammatory Doses of Ibuprofen: Effect on Neutrophils and Exercise-Induced Muscle Injury. International Journal of Sports Medicine, 1999. 20(2):98–102. DOI: 10.1055/s-2007-971100.
- Stilley JAW, Birt JA, Sharpe-Timms KL. Cellular and molecular basis for endometriosis-associated infertility. Cell Tissue Res 2012;349(3):849–62. DOI: 10.1007/s00441-011-1309-0.
- Hill CJ, Fakhreldin M, Maclean A, et al. Endometriosis and the Fallopian Tubes: Theories of Origin and Clinical Implications. J Clin Med. 2020 Jun 18;9(6):1905. DOI: 10.3390/jcm9061905
- Hodgson RM, Lee HL, Wang R, et al. Interventions for endometriosis-related infertility: a systematic review and network meta-analysis. Fertil Steril. 2020 Feb;113(2):374–82. DOI: 10.1016/j.fertnstert.2019.09.031
- Meuleman C, Vandenabeele B, Fieuws S, et al. High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners. Fertil Steril2009;92(1):68–74. DOI: 10.1016/j.fertnstert.2008.04.056
- Dunselman GAJ, Vermeulen N, Becker C, et al. ESHRE guideline: management of women with endometriosis. Hum Reprod 2014;29(3):400–12. DOI: 10.1093/humrep/det457
- Grigoriadis G, Roman H, Gkrozou F, Daniilidis A. The Impact of Laparoscopic Surgery on Fertility Outcomes in Patients with Minimal / Mild Endometriosis. J. Clin. Med. 2024. 13(16):4817. DOI: 10.3390/jcm13164817.
- Marcoux S, Maheux R, Bérubé S. Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. N Engl J Med 1997;337(4):217–222. DOI: 10.1056/NEJM199707243370401.
- Parazzini F. Ablation of lesions or no treatment in minimal-mild endometriosis in infertile women: a randomized trial. Gruppo Italiano per lo Studio dell’Endometriosi. Hum Reprod 1999;14(5):1332–4. DOI: 10.1093/humrep/14.5.1332.
- Beretta P, Franchi M, Ghezzi F, et al. Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation. Fertil Steril 1998;70(6):1176–80. DOI: 10.1016/s0015-0282(98)00385-9.
- Rizk B, Turki R, Lotfy H, et al. Surgery for endometriosis-associated infertility: do we exaggerate the magnitude of effect? Facts Views Vis Obgyn 2015;7(2):109–18.
- Unlü C, Yıldırım G. Ovarian cystectomy in endometriomas: Combined approach. J Turk Ger Gynecol Assoc. 2014;15(3):177–89. Published 2014 Aug 8. DOI: 10.5152/jtgga.2014.1111
- Coccia ME, Rizzello F, Capezzuoli T, et al. Bilateral Endometrioma Excision: Surgery-Related Damage to Ovarian Reserve. Reproductive Sciences, 2019 Apr;26(4):543–50. DOI: 10.1177/1933719118777640
- Busaca M, Coccia ME, Aletti G, Guerriero S. Guidelines for diagnosis and treatment of endometriosis. [Internet]. Italian Journal of Gynaecology and Obstetrics. 2018. 30(2):7–21. Available from: https://flore.unifi.it/retrieve/e398c37f-9d88-179a-e053-3705fe0a4cff/Busacca2018Guidelines.pdf
- Seo J-W, Lee D-Y, Yoon B-K, Choi D. Eur J Obstet Gynecol Reprod Biol. 2017 Jan;208:81–5
- Zakhari A, Delpero E, McKeown S, et al. Endometriosis recurrence following post-operative hormonal suppression: a systematic review and meta-analysis.Hum Reprod Update. 2021;27(1):96–107. DOI: 10.1093/humupd/dmaa033
- Adamson GD, Pasta DJ. Endometriosis fertility index: the new, validated endometriosis staging system. Fertil Steril 2010; 94(5):1609–15. DOI: 10.1016/j.fertnstert.2009.09.035.
- Johnson NP, Hummelshoj L, Adamson GD, et al. World Endometriosis Society consensus on the classification of endometriosis. Hum Reprod 2017;32(2):315–24. DOI: 10.1093/humrep/dew293.
- Benaglia L, Somigliana E, Vercellini P, et al. Endometriotic ovarian cysts negatively affect the rate of spontaneous ovulation. Hum Reprod. 2009 Sep;24(9):2183–6. DOI: 10.1093/humrep/dep202
- González-Foruria I, Soldevila PB, Rodríguez I. Do ovarian endometriomas affect ovarian response to ovarian stimulation for IVF/ICSI? Reprod Biomed Online. 2020 Jul; 41(1):37–43. DOI: 10.1016/j.rbmo.2020.03.013
- Instructions for medical use of the drug Duphaston®. [Internet]. Available from: https://mozdocs.kiev.ua/likiview.php?id=15524
- Kvaskoff M, Mahamat-Saleh Y, Farland LV, et al. Endometriosis and cancer: a systematic review and meta-analysis. Hum Reprod Update. 2021 Feb 19;27(2):393–20. DOI: 10.1093/humupd/dmaa045
- Steinbuch SC, Lüß AM, Eltrop S, et al. Endometriosis-Associated Ovarian Cancer: From Molecular Pathologies to Clinical Relevance. Int J Mol Sci. 2024 Apr 13;25(8):4306. DOI: 10.3390/ijms25084306
- Adilbayeva A, Kunz J. Pathogenesis of Endometriosis and Endometriosis-Associated Cancers. Int J Mol Sci. 2024 Jul 11. DOI: 10.3390/ijms25147624
- Körner M, Burckhardt E, Mazzucchelli L. Higher frequency of chromosomal aberrations in ovarian endometriosis compared to extragonadal endometriosis: A possible link to endometrioid adenocarcinoma. Mod. Pathol. 2006, 19, 1615–23. DOI: 10.1038/modpathol.3800699
- Vercellini P, Viganò P, Buggio L, еt al. Perimenopausal management of ovarian endometriosis and associated cancer risk: When is medical or surgical treatment indicated? Best Pract. Res. Clin. Obstet. Gynaecol. 2018, 51, 151–168. DOI: 10.1016/j.bpobgyn.2018.01.017
- Shinmura H, Yoneyama K, Harigane E, еt al. Use of tumor markers to distinguish endometriosis-related ovarian neoplasms from ovarian endometrioma. Int J Gynecol Cancer. 2020 Jun; 30(6):831-836. DOI: 10.1136/ijgc-2020-001210
- Results of the qualitative-quantitative study: Duphaston® – the role of the drug in MC disirders and Endometriosis, UMG, 2023.
- Dipankar SP, Kushram B, Unnikrishnan P, et al. Psychological Distress and Quality of Life in Women With Endometriosis: A Narrative Review of Therapeutic Approaches and Challenges. Cureus 2025 Mar 6;17(3):e80180. DOI 10.7759/cureus.80180
- Rossi V, Galizia R, Tripodi F, еt al. Endometriosis and Sexual Functioning: How Much Do Cognitive and Psycho-Emotional Factors Matter? Int J Environ Res Public Health. 2022 Apr 27;19(9):5319. DOI: 10.3390/ijerph19095319.
- Cuffaro F, Russo E, Amedei A. Endometriosis, Pain, and Related Psychological Disorders: Unveiling the Interplay among the Microbiome, Inflammation, and Oxidative Stress as a Common Thread. Int. J. Mol. Sci. 2024;25:6473. DOI: 10.3390/ijms25126473
- Spinoni M, Capano AU, Porpora MG, Grano C. Understanding the psychological factors linking pelvic pain and health-related quality of life in endometriosis: the influence of illness representations and coping strategies, American Journal of Obstetrics and Gynecology. Am J Obstet Gynecol. 2025 Jul;233(1):54.e1–54.e10. DOI: 10.1016/j.ajog.2024.12.027
- Mokhtari T, Irandoost E, Sheikhbahaei F, et al. Stress, pain, anxiety, and depression in endometriosis-Targeting glial activation and inflammation. Int Immunopharmacol. 2024 May 10:132:111942. DOI: 10.1016/j.intimp.2024.111942.
- del Pino-Sedeño T, Cabrera-Maroto M, Abrante-Luis A, et al. Effectiveness of psychological interventions in endometriosis: a systematic review with meta-analysis Front Psychol. 2024 Oct 28:15:1457842. DOI: 10.3389/fpsyg.2024.1457842.
- Hansen KE, Brandsborg B, Kesmodel US, et al. Psychological interventions improve quality of life despite persistent pain in endometriosis: results of a 3-armed randomized controlled trial. Qual Life Res. 2023. 32:1727–44. DOI: 10.1007/s11136-023-03346-9/
- Donatti L, Podgaec S, Baracat EC. Efficacy of Cognitive Behavioral Therapy in treating women with endometriosis and chronic pelvic pain: A randomized trial. J Health Psychol. 2025 Apr;30(5):1004–16. DOI: 10.1177/13591053241240198.
Downloads
Published
How to Cite
Issue
Section
License

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.