Resolution of the II Ukrainian Forum of Experts on Endometriosis

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.