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Minsalud avanza en la regulación integral de la endometriosis: proyecto de resolución define atención, diagnóstico y seguimiento
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El Ministerio de Salud publicó recientemente un proyecto de resolución que busca establecer un marco técnico y normativo para la atención integral de la endometriosis en el país. La iniciativa propone lineamientos obligatorios para EPS, IPS y EOC, incorpora rutas de manejo, criterios clínicos estandarizados y crea el Registro Nacional de Pacientes con Endometriosis.
La endometriosis es una enfermedad inflamatoria crónica dependiente de estrógenos, caracterizada por la presencia de tejido endometrial fuera del útero. Además, se asocia a dolor pélvico, dismenorrea severa, infertilidad y deterioro de la calidad de vida. Aunque su prevalencia en mujeres en edad reproductiva puede superar el 10 %, sigue siendo subdiagnosticada, mal entendida y atendida de forma fragmentada.
El nuevo proyecto, actualmente en etapa de comentarios, responde a la necesidad de uniformar y garantizar una atención oportuna, integral y sin barreras, articulada con la Política de Salud Sexual y Reproductiva y el Plan Decenal de Salud Pública 2022-2031.
Diagnóstico clínico, imagenológico y quirúrgico: una guía nacional estandarizada
El proyecto define criterios diagnósticos claros, reconociendo tres pilares fundamentales:
- Clínico, basado en la sintomatología: dismenorrea incapacitante, dispareunia profunda, dolor pélvico crónico, dolor cíclico gastrointestinal o urinario, sangrados anormales y alteraciones reproductivas.
- Imagenológico, utilizando ecografía transvaginal como primera línea y resonancia magnética para lesiones profundas o sospecha de compromiso multiorgánico.
- Quirúrgico, mediante laparoscopia con biopsia dirigida, considerado el estándar para confirmación histológica en casos complejos.
Además, se establece la clasificación de la enfermedad utilizando los sistemas ASRM (American Society for Reproductive Medicine) y AAGL (American Association of Gynecologic Laparoscopists), esenciales para definir el plan terapéutico y seguimiento.
Tratamiento farmacológico y quirúrgico individualizado
El documento detalla un manejo clínico que debe ser personalizado según edad, severidad de los síntomas, deseo reproductivo, respuesta a tratamientos previos y presencia de comorbilidades.
- Opciones farmacológicas: anticonceptivos combinados, progestágenos, dispositivos intrauterinos con levonorgestrel, análogos de GnRH con o sin terapia de reemplazo, inhibidores de aromatasa (uso off-label en casos refractarios), entre otros.
- Tratamiento quirúrgico: resección laparoscópica o ablación de lesiones, liberación de adherencias, histerectomía en casos seleccionados, especialmente en enfermedad severa no responsiva a fármacos.
La resolución destaca que el tratamiento debe ser definido en escenarios multidisciplinarios, especialmente para endometriosis profunda, asociada a compromiso intestinal, vesical o de ligamentos uterosacros.
Enfoque interdisciplinario, seguimiento y rehabilitación
Uno de los puntos centrales es el abordaje desde equipos interdisciplinarios, integrando ginecología, urología, coloproctología, anestesia, psicología, psiquiatría, nutrición, rehabilitación, medicina reproductiva y trabajo social. El seguimiento debe incluir:
- Evaluación periódica de la respuesta clínica.
- Revisión de comorbilidades asociadas.
- Apoyo psicosocial para mejorar la adherencia terapéutica.
- Derivación a fertilidad asistida cuando aplique.
Asimismo, el proyecto recomienda educación continua para el talento humano y fortalecimiento de las capacidades en atención primaria para el reconocimiento temprano de los síntomas.
Garantías en el sistema de salud: roles de EPS, IPS y gestores
El proyecto de resolución delimita funciones claras:
- EPS y EOC: deben garantizar la conformación de redes integrales de atención, derivación sin barreras administrativas y provisión de tecnologías diagnósticas y terapéuticas necesarias.
- IPS: deben desarrollar rutas de atención documentadas, protocolos clínicos y garantizar acceso oportuno a ecografía transvaginal, laparoscopia diagnóstica y atención por especialistas.
- Gestores farmacéuticos: deben asegurar la disponibilidad de tratamientos autorizados, incluyendo los indicados en manejo prolongado.
Este marco está alineado con los principios de la Ley Estatutaria en Salud (Ley 1751 de 2015) y la Resolución 3280 de 2018, que definen la atención integral como un derecho fundamental.
Registro Nacional de Pacientes con Endometriosis: una herramienta para la gestión del riesgo
Un componente innovador es la creación del Registro Nacional de Pacientes con Endometriosis, administrado por el Ministerio de Salud, con participación activa de las EPS e IPS en el reporte de información que facilitará el monitoreo de la adherencia institucional al protocolo y la trazabilidad de los casos. Este registro permitirá:
- Consolidar estadísticas de prevalencia.
- Caracterizar perfiles clínicos y demográficos.
- Identificar barreras en diagnóstico y atención.
- Evaluar resultados clínicos y costo-efectividad.
Del mismo modo, el proyecto incluye un Anexo Técnico con la ruta integral de atención, detallando flujogramas desde la sospecha clínica en atención primaria, hasta la atención especializada e intervenciones quirúrgicas, con semaforización del riesgo y criterios de remisión. Este anexo, de obligatorio cumplimiento, será revisado y actualizado cada dos años, o cuando la evidencia científica lo amerite, mediante acto administrativo.
Descargue aquí el proyecto de resolución completo:
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