Objective: To assess the proportion of patients with symptomatic endometriosis satisfied with their medical treatment 12 months after enrollment in a stepped-care management protocol. Design: Prospective, single-arm, self-controlled study. Setting: Academic department. Patient(s): A cohort of 157 consecutive patients referred or self-referred to our center for symptomatic endometriosis. Interventions(s): 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. Main Outcome Measure(s): 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 0–10-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). Result(s): 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%–70%). 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. Conclusion(s): 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.

A stepped-care approach to symptomatic endometriosis management : A participatory research initiative / P. Vercellini, A. Donati, F. Ottolini, A. Frassineti, J. Fiorini, V. Nebuloni, M.P. Frattaruolo, A. Roberto, P. Mosconi, E. Somigliana. - In: FERTILITY AND STERILITY. - ISSN 0015-0282. - 109:6(2018 Jun), pp. 1086-1096. [10.1016/j.fertnstert.2018.01.037]

A stepped-care approach to symptomatic endometriosis management : A participatory research initiative

Vercellini, Paolo;Ottolini, Federica;Frattaruolo, Maria Pina;Somigliana, Edgardo
2018-06

Abstract

Objective: To assess the proportion of patients with symptomatic endometriosis satisfied with their medical treatment 12 months after enrollment in a stepped-care management protocol. Design: Prospective, single-arm, self-controlled study. Setting: Academic department. Patient(s): A cohort of 157 consecutive patients referred or self-referred to our center for symptomatic endometriosis. Interventions(s): 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. Main Outcome Measure(s): 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 0–10-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). Result(s): 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%–70%). 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. Conclusion(s): 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.
endometriosis; medical treatment; pelvic pain; surgery; reproductive medicine; obstetrics and gynecology
Settore MED/40 - Ginecologia e Ostetricia
FERTILITY AND STERILITY
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/579223
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