European Accreditation of Endometriosis Centers of Expertise

and Germany [5] , report on their country’s efforts to increase the quality of endometriosis care by programs of accreditation and centralization. In this editorial, we want to present the early work on centralization of endometriosis care in Denmark, in order to situate this process and the developments in Germany and the UK into a larger perspective. In Denmark, treatment of advanced endometriosis was centralized more than 10 years ago, initiated by close collaboration between the founder of the Danish Patient’s Endometriosis Society Lone Hummelshoj and the last author of this editorial. After development of surgical techniques through repeated visits to established European centers, the need for sub-specialization was evident, but this goal seemed far away, since many colleagues perceived endometriosis as a disseminated disease resistant to surgical treatment. The possibilities for dialogue between medical doctors and decision-makers in the political and administrative system were limited, but the patients’ representative, Lone Hummelshoj had the formal authority to motivate the Minister of Health to invite herself and A.F. to a meeting, where the idea of two national referral centers was put forward and acknowledged. Formal guidelines from the Danish Health and Medicines Authority on centralized treatment of advanced disease then followed in 2001. Implementation occurred over the Endometriosis is an estrogen-dependent gynecological disease, characterized by endometrium outside the uterus, affecting 10% of reproductive-aged women, associated with pelvic pain (dysmenorrhea, dyspareunia, nonmenstrual pelvic pain) and infertility, diagnosed by laparoscopy and classified into minimal, mild, moderate and severe stages by the American Society of Reproductive Medicine [1] . Due to a delay of 4–10 years between onset of symptoms and diagnosis, the origin of endometriosis is still not clear and treatment options have been almost the same for the last decades. Endometriosis can be treated by surgical excision or by hormonal treatment, combined with anti-inflammatory drugs. However, none of these therapeutic paradigms are curative, all have side effects, and recurrence has been reported frequently after surgery or cessation of hormonal treatment. Endometriosis impairs health-related quality of life and work productivity across countries and ethnicities, yet women continue to experience diagnostic delays in primary care [2] . The economic burden associated with endometriosis treated in referral centers is high and compares to other chronic diseases (diabetes, Crohn’s disease, rheumatoid arthritis). It arises predominantly from productivity loss and is predicted by decreased quality of life [3] . In this issue of Gynecologic and Obstetric Investigation , experts from two large European countries, the UK [4] Published online: August 7, 2013