{"paper_id":"ae64140f-1800-4356-8062-a371b494d46a","body_text":"Management of Women with Endometriosis in Pakistan: Good Clinical Practice Recommendations\nAbstract\nExecutive summary\nDiagnosis: A careful history is the cornerstone. Imaging supports diagnosis. Laparoscopy is not mandatory for diagnosis; empirical medical treatment is a valid first step.\nMedical Treatment: First-line: NSAIDs + Combined Oral Contraceptives or Progestogens.\nSecond-line: GnRH agonists/antagonists with add-back therapy.\nThird line: Aromatase inhibitors (used with caution). Evaluate every 6–12 months for efficacy and side effects. Lifestyle & Psychosocial\nLifestyle & Psychosocial: Mental Health: Integrate Cognitive Behavioral Therapy (CBT), mindfulness, and psychosocial support.\nSurgery: Excision is preferred over ablation. Laparoscopic cystectomy is standard for endometriomas >3-4cm. Drainage with sclerotherapy is option in selected patients. Avoid repeated surgeries.\nFertility: Do not use hormonal suppression to improve fertility. Determination of ovarian reserve before treatment is prognostically important. Surgery may improve natural conception (ASRM I–II); IVF preferred for advanced disease (ASRM III–IV); pre-treatment with GnRH agonists for 3+ months is beneficial.\nSpecial Populations: Adolescents: Have a high index of suspicion. Postmenopausal Women: Menopausal Hormone Therapy (MHT) can be used but requires careful counselling.\nCopyright (c) 2026 Journal of The Society of Obstetricians and Gynaecologists of Pakistan\nThis work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.","source_license":"CC0","license_restricted":false}