%0 Journal Article
%T A stepped-care approach to symptomatic endometriosis management: a participatory research initiative - Fertility and Sterility
%A Agnese Donati
%A Anna Roberto
%A Annalisa Frassineti
%A Edgardo Somigliana
%A Federica Ottolini
%A Jessica Fiorini
%A Maria Pina Frattaruolo
%A Paola Mosconi
%A Paolo Vercellini
%A Vanessa Nebuloni
%J Fertility and Sterility
%D 2018
%R https://doi.org/10.1016/j.fertnstert.2018.01.037
%X To assess the proportion of patients with symptomatic endometriosis satisfied with their medical treatment 12 months after enrollment in a stepped-care management protocol. Prospective, single-arm, self-controlled study. Academic department. A cohort of 157 consecutive patients referred or self-referred to our center for symptomatic endometriosis. Systematic detailed information process on medical and surgical treatment followed by a shared decision to start a stepped-care protocol including three subsequent medical therapy steps (oral contraception [OC]; 2.5 mg/d norethindrone acetate [NETA]; 2 mg/d dienogest [DNG]) and a fourth surgical step. Stepping up was triggered by drug inefficacy/intolerance. Satisfaction with treatment was assessed according to a five-category scale (very satisfied, satisfied, neither satisfied nor dissatisfied, dissatisfied, very dissatisfied). Variations were measured in pain symptoms with the use of a 0¨C10-point numeric rating scale (NRS), in quality of life with the use of the Short Form 12 questionnaire (SF-12), and in sexual functioning with the use of the Female Sexual Function Index (FSFI). At the end of the 12-month study period, 106 women were still using OC, 23 were using NETA, three were using DNG, and four had undergone surgery. Twenty-one participants (13%) dropped out from the study. In intention-to-treat analysis, excluding five drop-outs for pregnancy desire, the overall satisfaction rate with the stepped-care protocol was 62% (95/152; 95% CI 55%¨C70%). By 12-month follow-up, significant improvements were observed in all pain symptom scores and in SF-12 physical and mental component summary scores, whereas FSFI scores did not vary substantially. Most women with endometriosis-associated pelvic pain who chose a stepped-care approach were satisfied with OC and a low-cost progestin for the treatment of their symptoms. The need to step up to an expensive progestin or surgery was marginal.
%U https://www.fertstert.org/article/S0015-0282(18)30063-3/fulltext