Endometriosis care in Vienna - A Synopsis of International Guideline Recommendations and Assessment of Healthcare Reality in Vienna

Background: Endometriosis is a chronic condition characterised by the presence of endometrium-like tissue outside the uterus. It is estimated to affect 10–15% of persons of reproductive age. The condition can be associated with delays in diagnosis and a considerable health burden. The aim of this report was to assess endometriosis care in Vienna against current international evidence-based guidelines and to identify potential gaps in care and unmet needs.

Methods: A mixed-methods design was used. Five international guidelines (ESHRE, NICE, RANZCOG, AWMF and HSE) were systematically reviewed, and their methodological quality was assessed using the AGREE II instrument. In addition, international literature on models of care and the results of two anonymous online surveys involving 53 patients diagnosed with endometriosis and 49 practising gynaecologists in Vienna were analysed. Quantitative data were analysed descriptively, while qualitative free-text responses were analysed using content analysis. The empirical findings were subsequently compared with the guideline recommendations.

Results: None of the five guidelines achieved consistently high quality across all six AGREE II domains. There was broad agreement on key diagnostic and therapeutic aspects, particularly the use of transvaginal ultrasound as the first-line imaging modality, hormonal treatment as first-line therapy for pain, and the selective use of surgery. The surveyed patients reported an average interval of 9.7 years between symptom onset and diagnosis. Following diagnosis, 28% had been referred to a certified endometriosis centre. A total of 90.6% reported an impact on their mental health. Among the surveyed gynaecologists, 16.3% reported having a formally documented care pathway, while 30.6% reported structured interdisciplinary collaboration. The comparison indicated broad alignment between clinical practice in Vienna and guideline recommendations in key clinical areas. Differences and potential gaps primarily concerned the organisation of care.

Discussion: The findings indicate differences between clinical recommendations and the organisational delivery of care. While guidelines provide relatively specific recommendations for key diagnostic and therapeutic measures, guidance on referral pathways, interdisciplinary collaboration and quality assurance often remains general. Given the small sample sizes and exploratory study design, the survey findings should not be interpreted as representative of endometriosis care in Vienna.

Conclusion: Endometriosis care in Vienna broadly aligns with international guideline recommendations in key diagnostic and therapeutic areas. Areas for further development include structured care pathways, clearly defined referral routes, access to specialised centres and interdisciplinary collaboration. Patient information and involvement in decision-making, as well as psychosocial support, are also relevant areas for improvement. The development of local quality standards and systematic evaluation could support implementation.