Current management of endometriosis-associated pain in the United States

OBJECTIVE: To investigate practice patterns of using hormonal, surgical, and nonhormonal complementary treatment of endometriosis-associated pain among Obstetrics and Gynecology phy-sicians 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 re-sponse rate was 24.5%. The most common initial medical hormonal treatment for pelvic pain and suspected endo-metriosis in patients not desiring pregnancy was con-tinuous 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, acu-puncture, and psychological support. Eighty-two percent of physicians believe there is a need for women with endo-metriosis to have psychosocial care; however, only 15% reported routinely referring patients for psychological counseling, and 72% indi-cated they do not feel ade-quately 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.