1. Endometriosis diagnosis and management should be incorporated into the primary health care of women worldwide (strong GPP).
2. In low-resource settings, diagnosis may commence with two simple questions about pelvic-abdominal pain and infertility (strong GPP).
3. Management, including prevention, should be integrated with other women's healthcare strategies in low-resource settings, and may include education, progestin-based contraceptives, family planning and lactation (strong GPP).

1. 4. Women with endometriosis require individualized care over a long-term period, where priorities may change owing to the type and severity of symptoms, impact of these symptoms, current or future fertility wish and lifestyle factors (strong GPP).
   5. Individualized care benefits from a multi-disciplinary network of experts sufficiently skilled in providing advice on and treatment of endometriosis and its associated symptoms, based on the best available knowledge, their extensive experience and their transparent record of success rates (strong GPP).

1. 6. Endometriosis support groups provide a valuable forum for women with endometriosis having the potential to assist women in improving their quality of life by teaching coping mechanisms and sharing experiences (strong GPP).
   7. Engagement of experienced and skilled medical practitioners, accredited educators and other stakeholders brings strength to an endometriosis organization (strong GPP).
   8. A philosophical shift to consideration of 'endometriosis and pelvic pain' as a spectrum or continuum of disease will avoid excluding women who lack laparoscopic confirmation of a diagnosis of endometriosis (weak GPP).

1. 9. Endometriosis should be considered as a possible diagnosis in adolescents with suggestive symptoms (strong).
   10. Currently, there is insufficient evidence to make strong recommendations for management amongst adolescents who may have endometriosis (weak).

1. 11. Endometriosis should be considered an obstetric risk factor and pregnancies managed accordingly (strong).

1. 12. Although endometriosis may occasionally recur, there is no strong evidence to deprive women of hormone replacement treatment (HRT) if they suffer severe menopausal symptoms but have a history of endometriosis, although combined estrogen-progestin hormone therapy is advisable (weak).

1. 13. The relative risk and absolute risk of ovarian cancer amongst women with endometriosis is so low as not to justify routine ovarian cancer screening (strong).

1. 14. Dietary intervention following endometriosis surgery in the form of vitamins, minerals, salts, lactic ferments and fish oil appears to be a suitable alternative to hormonal treatment, that is associated with similar pelvic pain reduction and quality of life improvement (weak).

1. 15. Well-tolerated, low-cost, easily accessible options such as non-steroidal anti-inflammatory drugs (NSAIDs), other analgesics, combined oral contraceptive pill (OCP) and progestins should be considered for use as first-line empirical medical treatment (strong).
   16. In some circumstances, second-line medical treatment with gonadotropin-releasing hormone agonists (GnRH-a) with add-back HRT, or the levonorgestrel-releasing intrauterine system (LNG-IUS) may be considered for use as empirical medical treatment for women who are not optimally treated with first-line empirical therapy prior to surgical diagnosis and treatment, whilst awaiting laparoscopic surgery (weak).

1. 17. Laparoscopic surgical removal of endometriosis is an effective first-line approach for treating pain related to endometriosis (strong).
   18. Although current randomized controlled trial (RCTs) have failed to demonstrate benefit of excision over ablation, it is recommended to excise lesions where possible, especially deep endometriotic lesions (weak).
   19. Laparoscopic surgery for endometriosis should always be undertaken in preference to laparotomy, where possible (strong GPP).
   20. The addition of laparoscopic uterine nerve ablation (LUNA) to laparoscopic removal of endometriosis does not improve pain relief (strong).
   21. Although presacral neurectomy (PSN) might benefit a small number of women, the benefits are likely to be outweighed by the potential for harmful effects (strong).
   22. Laparoscopic excision (cystectomy) for ovarian endometriomas is preferred where possible to minimize symptom recurrence and endometrioma recurrence (strong).
   23. The best surgical approach to deep endometriosis is unclear (weak).
   24. Highly specialized surgical expertise is required by surgeons, who undertake surgery for deep endometriosis, and it should be undertaken only within centres of expertise (strong GPP).

1. 25. Well-tolerated, low-cost, easily accessible options such as NSAIDs, other analgesics, combined OCP and progestins should be considered for first-line medical treatment of laparoscopically diagnosed endometriosis (strong).
   26. The combined OCP is an effective medical treatment to minimize the endometrioma recurrence rate after surgical removal of the cyst (strong).
   27. Second-line medical treatments could include GnRH-a, which should be used with add-back HRT, routinely), the LNG-IUS and depot progestins (weak).
   28. Danazol and gestrinone should not be used other than for women, established on these treatments in the absence of side effects, for whom other treatments have proven ineffective (strong).

1. 29. Aromatase inhibitors might be reasonable as a second-line medical treatment, but more research is required (weak).
   30. Selective progesterone receptor modulators (SPRMs) might be a reasonable second-line medical treatment, but more research is required (weak).
   31. GnRH antagonists might be reasonable as second-line medical treatment, but more research is required (weak).
   32. There is no evidence of a benefit of pentoxifylline on the reduction of pain (strong).
   33. There is no evidence of a benefit of anti tumour necrosis factor alpha (anti-TNF?) on the reduction of pain (weak).
   34. There is no benefit from raloxifene on prevention of recurrence of pain (strong).
   35. There is insufficient evidence of a benefit of rosiglitazone on the reduction of pain (weak).
   36. There is insufficient evidence of benefit of valproic acid on the reduction of pain (weak).
   37. Anti-angiogenesis agents are at research level only (strong).

1. 38. There is some evidence of effectiveness of acupuncture, but it requires repeated treatments and effects are unlikely to be long lasting (weak).
   39. There is evidence of effectiveness of transcutaneous electrical nerve stimulation (TENS) for short-term pain management for women with dysmenorrhoea (weak).
   40. There is insufficient evidence of effectiveness of traditional Chinese medicine (TCM) and applicability is uncertain outside of TCM settings (weak).
   41. Vitamin B1 and B6 can be used to relieve pain for women with dysmenorrhoea but there is limited evidence of effectiveness and there are safety concerns with vitamin B6 at higher doses (weak).
   42. There is some evidence of effectiveness of magnesium in reduction of pain for women with dysmenorrhoea (weak).
   43. There is no evidence of effectiveness for topical heat (weak).
   44. There is no evidence to support spinal manipulation (weak).
   45. There is insufficient evidence to support behavioural interventions (weak).

1. 46. Laparoscopic surgical removal of endometriosis improves fertility in stage I and II endometriosis (strong).
   47. Although RCTs have failed to demonstrate benefit of excision over ablation, it is recommended to excise lesions where possible, especially where pain is present (weak).
   48. Laparoscopic excision (cystectomy) where possible for endometriomas is preferred to laparoscopic ablation (drainage and coagulation) to enhance fertility (strong).
   49. The best surgical approach to deep endometriosis in women with infertility is unclear (weak).
   50. Medical adjunct therapy in conjunction with laparoscopic surgery has not been shown to have fertility benefit (strong).

1. 51. There is no evidence to support the use of controlled ovarian stimulation (COS) alone and insufficient evidence to recommend one agent over another (weak).
   52. Intrauterine insemination (IUI) with COS is effective in improving fertility in minimal and mild endometriosis, but the role of unstimulated IUI is uncertain (strong).
   53. Double insemination should be considered for IUI (weak).
   54. Although in vitro fertilization (IVF) may be less effective for endometriosis than for other causes of infertility, it should be considered for use to improve the success rate above expectant management (strong).

1. 55. There is insufficient evidence of benefit of GnRH-a treatment before IUI (weak).
   56. There is insufficient evidence of benefit of laparoscopic surgery prior to IUI/COS (weak).
   57. GnRH analogue administered for 3 - 6 months prior to IVF/ICSI (intracytoplasmic sperm injection) in women with endometriosis increases the clinical pregnancy rate (strong).
   58. There is insufficient evidence to support the use of the combined OCP prior to IVF/ICSI (weak).
   59. There are no data to compare the approach of pretreatment with the combined OCP versus GnRH-a (weak).
   60. There is no evidence that surgical removal of endometriosis or surgical treatment of endometriomas (by aspiration or cystectomy) improves success rates through IVF (weak).
   61. Ovarian response might be reduced in some women who have undergone surgery for endometriomas (weak).
   62. Since endometriomas may damage the ovary, and since complications can arise in women with endometriomas undergoing assisted reproductive technology (ART), laparoscopic ovarian cystectomy may sometimes be recommended for women with endometriomas larger than 3 cm diameter (weak).

1. 63. There is no evidence of fertility benefit from medical treatment - ovulation suppression may delay pregnancy and this is not recommended (strong).

1. 64. Lipiodol hysterosalpingogram improves live birth rates in women with endometriosis, but otherwise unexplained infertility, who are attempting natural conception (weak).
   65. There is no evidence of fertility benefit from pentoxifylline for women with mild-to-moderate endometriosis (strong).
   66. There is no evidence of fertility benefit of TCM over gestrinone or Danazol (weak).
   67. There is insufficient evidence of increased pregnancy rates from the use of vitamins (weak).
   68. There is insufficient reliable evidence of improved fertility with mifepristone (weak).
   69. There is no evidence of impact of rosiglitazone on fertility (weak).

Hum Reprod. 2013;28(6):1552-68