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This 2008 survey of 1,364 West German gynecologists outlines current diagnostic and therapeutic practices for endometriosis. Respondents identified dysmenorrhoea, infertility, and pelvic pain as the most common symptoms, with laparoscopy serving as the recognized diagnostic standard despite some clinicians relying on clinical or ultrasound findings. Hormonal treatments, particularly progestins and danazol, were the primary therapeutic approach, while surgical intervention was frequently combined with hormonal suppression, especially for infertile patients. The study highlights a significant need for improved patient information regarding the links between endometriosis and infertility, as well as the distinction from physiological menstrual pain. This paper is centrally about endometriosis — specifically detailing the prevalence, diagnosis, and treatment preferences reported by practicing gynecologists in West Germany.
Abstract
The aim of this study is to obtain an actual survey of diagnostic and therapeutic procedures of endometriosis (EMT) in gynaecological practice in West Germany. A questionnaire was sent to 6,700 gynaecologist; 1,364 responded. Approximately 5% of all the patients in daily practice have symptoms related to EMT. Most of the patients are in their twenties. The common clinical symptoms of EMT are dysmenorrhoea (91.8%), infertility (79.7%), pelvic pain (70.9%), menstrual irregularity (46.3%), dyspareunia (21.8%) and painful defaecation (12.8%). The diagnostic standard is laparoscopy, but there are many doctors diagnosing EMT also by means of gynaecological examination (23.8%) or ultrasound (21.3%) - especially in young patients. Hormones are the first choice of therapy. Progestins and danazol are preferred. GnRH-analogues are only used by a smaller proportion of gynaecologists - particularly in infertile patients. Surgical procedures with or without hormonal suppression are another line of therapy adapted by 70.9% of the gynaecologists, which are often preferred in infertile patients. Psychological problems in EMT are caused by the uncertainties between EMT and infertility and by the difficulties between physiological menstrual discomfort and pain caused by EMT. 68.5% of the gynaecologists suggest that more information beyond diagnosis and therapy should be given to the patients. Promotion of self-supporting groups should be encouraged by the doctors.
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DOI: 10.1055/s-2007-1022312
Endometriose - Diagnostik und Therapie
Ergebnisse einer aktuellen Umfrage unter 6700 westdeutschen GynäkologenEndometriosis - Diagnosis and TreatmentResults of a topical inquiry with 6700 West German GynaecologistsPublication History
Publication Date:
18 March 2008 (online)
Zusammenfassung
Ziel der vorliegenden Untersuchung ist es, einen aktuellen Überblick über Diagnostik und Therapie der Endometriose (EMT) in Westdeutschland zu gewinnen. An dieser Umfrage haben sich 1364 von 6700 befragten Gynäkologen beteiligt. EMT-Patientinnen machen durchschnittlich gut 5 % des Praxisklienteis aus. Meist handelt es sich um Patientinnen zwischen dem zwanzigsten und dreißigsten Lebensjahr. Als typische Beschwerden wurden Dysmenorrhoe (91,8%), Sterilitätsproblematiken (79,7%), unspezifische Unterbauchschmerzen (70,9%), Menstruationsstörungen (46,3%), Dyspareunie (21,8%) und Defäkationsstörungen (12,8 %) genannt. Der endoskopische Nachweis wird als diagnostischer Standard allgemein anerkannt. Allerdings ist ein erheblicher Teil der Kollegen bereit, eine EMT auch aufgrund klinischer (23,8%) bzw. sonographischer (21,3%) Untersuchungsbefunde zu diagnostizieren - typischerweise bei jugendlichen Patientinnen. Therapeutisch stehen hormonelle Maßnahmen im Vordergrund. Hierbei werden bevorzugt Gestagene und Danazol eingesetzt; GnRH-Analoga spielen eine untergeordnete Rolle und werden vor allem bei Sterilitätspatientinnen eingesetzt. Operative Behandlungsverfahren werden von 70,9 % der Kollegen neben oder in Kombination mit der hormonellen Suppressionstherapie durchgeführt, bevorzugt im Rahmen der Sterilitätsbehandlung. Besondere psychische Belastungen ergeben sich für EMT-Patientinnen aus den therapeutisch ungeklärten Zusammenhängen zwischen Sterilität und EMT sowie der schweren Abgrenzbarkeit physiologischer Menstruationsbeschwerden von behandlungsbedürftiger EMT. Nach Einschätzung von 68,5% aller Kollegen sind hier weiterführende, über Diagnose und Therapie hinausreichende Patientinnen-Informationen erforderlich. Auch die Einrichtung von Selbsthilfegruppen findet unter der Ärzteschaft breiten Rückhalt.
Abstract
The aim of this study is to obtain an actual survey of diagnostic and therapeutic procedures of endometriosis (EMT) in gynaecological practice in West Germany. A questionnaire was sent to 6,700 gynaecologists; 1,364 responded. Approximately 5% of all the patients in daily practice have symptoms related to EMT. Most of the patients are in their 'twenties. The common clinical Symptoms of EMT are dysmenorrhoea (91.8%), infertility (79.7%), pelvic pain (70.9%), menstrual irregularity (46.3 %), dyspareunia (21.8 %) and painful defaecation (12.8%). The diagnostic standard is laparoscopy, but there are many doctors diagnosing EMT also by means of a gynaecological examination (23.8%) or ultrasound (21.3%) - especially in young patients. Hormones are the first choice of therapy. Progestins and danazol are preferred. GnRH-analogues are only used by a smaller proportion of gynaecologists - particularly in infertile patients. Surgical procedures with or without hormonal suppression are another line of therapy adapted by 70.9% of the gynaecologists, which are often preferred in infertile patients. Psychological problems in EMT are caused by the uncertainties between EMT and infertility and by the difficulties between physiological menstrual discomfort and pain caused by EMT. 68.5% of the gynaecologists suggest that more information beyond diagnosis and therapy should be given to the patients. Promotion of self-supporting groups should be encouraged by the doctors.
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