September 27th, 2020

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Current Management of Endometriosis-Associated Pain in the United States
Authors:  Jessica E. McLaughlin, M.D., Srinidhi Reddy, M.D., Nicholas Stansbury, B.S., Norma S. Ketchum, B.S., Jonathan A. Gelfond, M.D., Ph.D., Belinda J. Yauger, M.D., Randal D. Robinson, M.D., and Jennifer F. Knudtson, M.D.
  OBJECTIVE: To investigate practice patterns of using hormonal, surgical, and nonhormonal complementary treatment of endometriosis-associated pain among Obstetrics and Gynecology physicians in the United States.

STUDY DESIGN: Cross-sectional 21-question survey sent to members of the American College of Obstetricians and Gynecologists.

RESULTS: The adjusted response rate was 24.5%. The most common initial medical hormonal treatment for pelvic pain and suspected endometriosis in patients not desiring pregnancy was continuous combined oral contraceptives (58%). For surgical treatment, laparoscopy is most commonly performed, and most (90%) treat endometriosis at the same time as diagnosis. For nonhormonal complementary treatment of endometriosis-associated pain, the majority prescribe nonsteroidal anti-inflammatory drugs (NSAIDS), while a minority choose other approaches such as opioids, acupuncture, and psychological support. Eighty-two percent of physicians believe there is a need for women with endometriosis to have psychosocial care; however, only 15% reported routinely referring patients for psychological counseling, and 72% indicated they do not feel adequately trained to recognize the need for and recommend care for the psychosocial aspects of endometriosis.

CONCLUSION: The majority of providers are treating endometriosis-associated pain with hormonal and surgical treatments. Only a minority of providers utilize nonhormonal complementary approaches, which high lights an area where more provider education is needed.
Keywords:  anti-inflammatory agents, chronic pain, contraceptive agents, hormonal/therapeutic use, endometrioma, endometriosis, gynecology, laparoscopy, non-steroidal/therapeutic use, pelvic pain, psychosocial care, women’s health
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