Cutting Through the Controversy: A Practical Pathway for Suspected Endometriosis in Everyday GYN Practice

Updated: Sep 4

By AIMIS, referencing the AIMIS Consensus led by Steven D. McCarus, MD

Why the controversy endures

Endometriosis provokes outsized debate for a condition that is both common and chronically life-altering. Disagreement persists over diagnosis methods, treatment strategies, and how to reduce diagnostic delay.

The AIMIS Consensus: from debate to a clinic-ready algorithm

AIMIS convened experts and developed a practical algorithm focused on early-stage disease, symptom relief, and reducing time-to-diagnosis. Dr. McCarus presented this consensus at ACOG to underscore its relevance.

Key clinical pillars from the AIMIS algorithm

1. Start with structure: detailed history, focused exam, and pain diaries.2. Use imaging judiciously: TVUS and MRI where appropriate.3. Begin medical therapy if workup is negative, with timed follow-ups.4. Aim for the 'estrogen threshold' to balance efficacy and safety.5. Employ long-duration medical therapy.6. Escalate or pivot based on patient response.7. Use surgery strategically and pair it with suppression.8. Refer early when needed.9. Support the whole patient with adjunctive therapies.10. Make the plan visible with a clinic-ready algorithm.

How the AIMIS algorithm fits with broader guidance

The AIMIS pathway complements 2024 expert statements emphasizing enhanced non-invasive imaging and hybrid medical-surgical strategies.

What this means for your clinic—today

You don’t have to choose 'team medicine' or 'team surgery.' Start with time-boxed medical therapy, escalate deliberately, and pair surgery with suppression when appropriate. Patients value explicit expectations.

About the AIMIS Consensus Paper

(Dr. Steven D. McCarus, lead author)

AIMIS produced a clinical algorithm for day-to-day decision-making in suspected or early-stage endometriosis. It emphasizes medical therapy first, shared decision-making, strategic surgery, and suppression. A flowchart is included for everyday practice.

Download Consesus Paper: