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diagnosis
no endometriosis
subfertility + diagnosis endometriosis
suspicion endometriosis:
history, (recto-) vaginal examination, vaginal ultrasound
diagnosis (suspicion) endometriosis
diagnosis ovarian endometriosis
diagnosis deep endometriosis
(empiric) analgesic OC/P/GnRH analogue
consider MRI to rule out deep endometriosis
MRI if indication for surgery
patient not satisfied: empiric medical treatment or diagnostic l’scopy before MUPC
patient satisfied: no laparoscopy
patient not satisfied: consider MRI, then consider diagnostic l’scopy
medical treatment OR therapeutic laparoscopy
medical treatment OR therapeutic laparoscopy
see & treat laparoscopy + tube testing
How to define proven endometriosis?
 To date in majority of articles:
‘women had laparoscopically confirmed
endometriosis...’  Should become:
‘women had confirmed endometriosis based on physical examination, ultrasound and/or MRI’
 (Need for RCT: management approach not including systematic laparoscopy for diagnosis)
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