Treatment of moderate-severe pain associated with early stage endometriosis; a consensus panel summary : Endometriosis pain treatment (2024)

Table of Contents
Revision notes Abstract Content Author and article information References Comments Comment on this article References
  • Record: found
  • Abstract: found
  • Article: found

Is Open Access

Preprint

In review

research-article

Treatment of moderate-severe pain associated with early stage endometriosis; aconsensus panel summary : Endometriosis pain treatment (1)

Author(s):

Steven McCarus 1 ,

Randa Jalloul 2 ,

Erica Stockwell 3 ,

Joy Brotherton 4 ,

Angela Chaudhari 5 ,

Laura Parnell 6 ,

Publication date (Electronic preprint): 19 November 2024

Journal: ScienceOpen Preprints

Publisher: ScienceOpen

Keywords: endometriosis, pelvic pain, dyspareunia, dysmenorrhea, hormone therapy, surgery, pain, gynecology, diagnosis, treatment

  • Download PDF
  • Download revision notes PDF
  • XML
  • Review article
  • Invite someone to review

Bookmark

        Revision notes

        First sentence in the Disclosure section was modified to better clarify the funding source.

        See Also
        Cyclooxygenase-2 Inhibitors in Gynecologic PracticeCervicitis and Cervix Pain: Causes, Symptoms, & TreatmentEat Your Way to Better Gynecological HealthAdhesion Prevention: What are my Options in Gynecological Surgery?

        Abstract

        Few chronic diseases carry such a personal and societal burden as endometriosis. Amultitude of symptoms similar to other diseases and various contributors to the diseasecompounds its complexity and perpetuates the delay in diagnosis and treatment. Thisliterature review and consensus panel synthesized the current research and clinicalpractices to develop a clinical algorithm to reduce symptoms, minimize time to diagnosis,and improve patient quality of life outcomes. Evaluating patients at earlier stagedendometriosis using best clinical practice should speed diagnosis but also intervene inthe disease process to better manage the chronicity. Treatment of the disease andsymptoms by modulating estradiol levels through medical therapy provides noninvasivepain relief. Initial evaluation with detailed patient history, examination, and utilizing paindiaries determine the course of action. The use of intentional medical therapy andscheduled follow-up provides structure for future clinical decisions to be based on. Shareddecision making between clinician and patient is important to ensure patient goals andbest clinical options are utilized. Surgical intervention should be used strategically andcombined with medical therapy to provide morepredictable patient outcomes with longerlasting results than surgery alone.

        Content

        Author and article information

        Journal

        Title: ScienceOpen Preprints

        Publisher: ScienceOpen

        Publication date (Electronic preprint): 19 November 2024

        Affiliations

        [1 ] Advent Health Winter Park;

        [2 ] University of Texas Health Sciences System;

        [3 ] Advent Health Celebration ( https://ror.org/048vjc278)

        [4 ] Marin Fertility Center;

        [5 ] Northwestern Medicine ( https://ror.org/04fzwnh64)

        [6 ] Precision Consulting;

        Author notes
        Author information
        Article

        DOI: 10.14293/PR2199.000538.v2

        SO-VID: 8597e329-670b-42b3-82aa-73afc658b334

        License:

        This work has been published open access under Creative Commons Attribution License CC BY 4.0 , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Conditions, terms of use and publishing policy can be found at www.scienceopen.com .

        History

        Date received : 6 December 2023

        Funding

        Funded by: funder-id , Pfizer Inc. and Sumitomo Pharma, Switzerland, GmbH;

        See Also
        Functional Medicine Obstetrics and Gynecology: Essential Lab Tests for Women's Health
        Categories

        Data availability: All data generated or analysed during this study are included in this published article (and its supplementary information files).

        ScienceOpen disciplines: Medicine

        Keywords: endometriosis,pelvic pain,dyspareunia,dysmenorrhea,hormone therapy,surgery,pain,gynecology,diagnosis,treatment

        References

        1. Practice Bulletin No. 114: Management of Endometriosis. Obstetrics & Gynecology. Vol. 116(1):223–236. 2010. Ovid Technologies (Wolters Kluwer Health). [Cross Ref]

        2. Nnoaham Kelechi E., Hummelshoj Lone, Webster Premila, d’Hooghe Thomas, de Cicco Nardone Fiorenzo, de Cicco Nardone Carlo, Jenkinson Crispin, Kennedy Stephen H., Zondervan Krina T.. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertility and Sterility. Vol. 96(2)2011. Elsevier BV. [Cross Ref]

        3. Simoens S., Hummelshoj L., D'Hooghe T.. Endometriosis: cost estimates and methodological perspective. Human Reproduction Update. Vol. 13(4):395–404. 2007. Oxford University Press (OUP). [Cross Ref]

        4. Bernuit David, Ebert Andreas D., Halis Gülden, Strothmann Anja, Gerlinger Christoph, Geppert Katharina, Faustmann Thomas. Female Perspectives on Endometriosis: Findings from the Uterine Bleeding and Pain Women'S Research Study. Journal of Endometriosis. Vol. 3(2):73–85. 2011. SAGE Publications. [Cross Ref]

        5. Greene Rebecca, Stratton Pamela, Cleary Sean D., Ballweg Mary Lou, Sinaii Ninet. Diagnostic experience among 4,334 women reporting surgically diagnosed endometriosis. Fertility and Sterility. Vol. 91(1):32–39. 2009. Elsevier BV. [Cross Ref]

        6. Davenport Sophie, Smith Diane, Green Dan J.. Barriers to a Timely Diagnosis of Endometriosis. Obstetrics & Gynecology. 2023. Ovid Technologies (Wolters Kluwer Health). [Cross Ref]

        7. Bougie O, Yap Ma.I, Sikora L, Flaxman T, Singh S. Influence of race/ethnicity on prevalence and presentation of endometriosis: a systematic review and meta‐analysis. BJOG: An International Journal of Obstetrics & Gynaecology. Vol. 126(9):1104–1115. 2019. Wiley. [Cross Ref]

        8. Vilasagar Smitha, Bougie Olga, Singh Sukhbir Sony. A Practical Guide to the Clinical Evaluation of Endometriosis-Associated Pelvic Pain. Journal of Minimally Invasive Gynecology. Vol. 27(2):270–279. 2020. Elsevier BV. [Cross Ref]

        9. Fourquet Jessica, Gao Xin, Zavala Diego, Orengo Juan C., Abac Sonia, Ruiz Abigail, Laboy Joaquín, Flores Idhaliz. Patients' report on how endometriosis affects health, work, and daily life. Fertility and Sterility. Vol. 93(7):2424–2428. 2010. Elsevier BV. [Cross Ref]

        10. Fourquet Jessica, Báez Lorna, Figueroa Michelle, Iriarte R. Iván, Flores Idhaliz. Quantification of the impact of endometriosis symptoms on health-related quality of life and work productivity. Fertility and Sterility. Vol. 96(1):107–112. 2011. Elsevier BV. [Cross Ref]

        11. Agarwal Sanjay K., Chapron Charles, Giudice Linda C., Laufer Marc R., Leyland Nicholas, Missmer Stacey A., Singh Sukhbir S., Taylor Hugh S.. Clinical diagnosis of endometriosis: a call to action. American Journal of Obstetrics and Gynecology. Vol. 220(4)2019. Elsevier BV. [Cross Ref]

        12. Lemaire Gail Schoen. More Than Just Menstrual Cramps: Symptoms and Uncertainty Among Women With Endometriosis. Journal of Obstetric, Gynecologic & Neonatal Nursing. Vol. 33(1):71–79. 2004. Elsevier BV. [Cross Ref]

        13. Taylor Hugh S, Kotlyar Alexander M, Flores Valerie A. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. The Lancet. Vol. 397(10276):839–852. 2021. Elsevier BV. [Cross Ref]

        14. Halcomb Elizabeth, Davidson Patricia, Hardaker Laura. Using the consensus development conference method in healthcare research. Nurse Researcher. Vol. 16(1):56–71. 2008. RCN Publishing Ltd. [Cross Ref]

        15. Waggoner Jane, Carline Jan D., Durning Steven J.. Is There a Consensus on Consensus Methodology? Descriptions and Recommendations for Future Consensus Research. Academic Medicine. Vol. 91(5):663–668. 2016. Ovid Technologies (Wolters Kluwer Health). [Cross Ref]

        16. Nair Raj, Aggarwal Rohit, Khanna Dinesh. Methods of Formal Consensus in Classification/Diagnostic Criteria and Guideline Development. Seminars in Arthritis and Rheumatism. Vol. 41(2):95–105. 2011. Elsevier BV. [Cross Ref]

        17. HORTON J.N.. Nominal group technique. Anaesthesia. Vol. 35(8):811–814. 1980. Wiley. [Cross Ref]

        18. Fink A, Kosecoff J, Chassin M, Brook R H. Consensus methods: characteristics and guidelines for use. American Journal of Public Health. Vol. 74(9):979–983. 1984. American Public Health Association. [Cross Ref]

        19. Burney Richard O., Giudice Linda C.. Pathogenesis and pathophysiology of endometriosis. Fertility and Sterility. Vol. 98(3):511–519. 2012. Elsevier BV. [Cross Ref]

        20. Giudice Linda C.. Endometriosis. New England Journal of Medicine. Vol. 362(25):2389–2398. 2010. Massachusetts Medical Society. [Cross Ref]

        21. Garcia Lydia, Isaacson Keith. Adenomyosis: Review of the Literature. Journal of Minimally Invasive Gynecology. Vol. 18(4):428–437. 2011. Elsevier BV. [Cross Ref]

        22. Asante Albert, Taylor Robert N.. Endometriosis: The Role of Neuroangiogenesis. Annual Review of Physiology. Vol. 73(1):163–182. 2011. Annual Reviews. [Cross Ref]

        23. Donnez Jacques, Dolmans Marie-Madeleine. Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review. Journal of Clinical Medicine. Vol. 10(5)2021. MDPI AG. [Cross Ref]

        24. Shi Zhanquan, Arai Koji Y., Jin Wanzhu, Weng Qiang, Watanabe Gen, Suzuki Akira K., Taya Kazuyoshi. Expression of Nerve Growth Factor and Its Receptors NTRK1 and TNFRSF1B Is Regulated by Estrogen and Progesterone in the Uteri of Golden Hamsters1. Biology of Reproduction. Vol. 74(5):850–856. 2006. Oxford University Press (OUP). [Cross Ref]

        25. CUTOLO MAURIZIO, CAPELLINO SILVIA, SULLI ALBERTO, SERIOLI BRUNO, SECCHI MARIA ELENA, VILLAGGIO BARBARA, STRAUB RAINER H.. Estrogens and Autoimmune Diseases. Annals of the New York Academy of Sciences. Vol. 1089(1):538–547. 2006. Wiley. [Cross Ref]

        26. Bulun Serdar E., Yang Sijun, Fang Zongjuan, Gurates Bilgin, Tamura Mitsutoshi, Zhou Jianfeng, Sebastian Siby. Role of aromatase in endometrial disease. The Journal of Steroid Biochemistry and Molecular Biology. Vol. 79(1-5):19–25. 2001. Elsevier BV. [Cross Ref]

        27. Sinaii N.. High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis. Human Reproduction. Vol. 17(10):2715–2724. 2002. Oxford University Press (OUP). [Cross Ref]

        28. Saunders Philippa T.K., Horne Andrew W.. Endometriosis: Etiology, pathobiology, and therapeutic prospects. Cell. Vol. 184(11):2807–2824. 2021. Elsevier BV. [Cross Ref]

        29. Zong Chunxiao, Sun Lu, Xu Xin, Xue Xiaoou. Huayu Sanjie Enema Liquid Relieves Pain in Endometriosis Model Rats by Inhibiting Inflammation, Peripheral Sensitization, and Pelvic Adhesion. Evidence-Based Complementary and Alternative Medicine. Vol. 2022:1–10. 2022. Hindawi Limited. [Cross Ref]

        30. Mechsner Sylvia. Endometriosis, an Ongoing Pain—Step-by-Step Treatment. Journal of Clinical Medicine. Vol. 11(2)2022. MDPI AG. [Cross Ref]

        31. Barbieri Robert L.. Hormone treatment of endometriosis: The estrogenthreshold hypothesis. American Journal of Obstetrics and Gynecology. Vol. 166(2):740–745. 1992. Elsevier BV. [Cross Ref]

        32. Dunselman G. A. J., Vermeulen N., Becker C., Calhaz-Jorge C., D'Hooghe T., De Bie B., Heikinheimo O., Horne A. W., Kiesel L., Nap A., Prentice A., Saridogan E., Soriano D., Nelen W.. ESHRE guideline: management of women with endometriosis. Human Reproduction. Vol. 29(3):400–412. 2014. Oxford University Press (OUP). [Cross Ref]

        33. HSU ALBERT L., KHACHIKYAN IZABELLA, STRATTON PAMELA. Invasive and Noninvasive Methods for the Diagnosis of Endometriosis. Clinical Obstetrics & Gynecology. Vol. 53(2):413–419. 2010. Ovid Technologies (Wolters Kluwer Health). [Cross Ref]

        34. Eskenazi Brenda, Warner Marcella, Bonsignore Luigi, Olive David, Samuels Steven, Vercellini Paolo. Validation study of nonsurgical diagnosis of endometriosis. Fertility and Sterility. Vol. 76(5):929–935. 2001. Elsevier BV. [Cross Ref]

        35. Bazot Marc, Lafont Clarisse, Rouzier Roman, Roseau Gilles, Thomassin-Naggara Isabelle, Daraï Emile. Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis. Fertility and Sterility. Vol. 92(6):1825–1833. 2009. Elsevier BV. [Cross Ref]

        36. Falcone Tommaso, Mascha Edward. The elusive diagnostic test for endometriosis. Fertility and Sterility. Vol. 80(4):886–888. 2003. Elsevier BV. [Cross Ref]

        37. Santulli Pietro, Streuli Isabelle, Melonio Isabelle, Marcellin Louis, M'Baye Magate, Bititi Amine, Borghese Bruno, Lafay Pillet Marie-Christine, Chapron Charles. Increased Serum Cancer Antigen-125 Is a Marker for Severity of Deep Endometriosis. Journal of Minimally Invasive Gynecology. Vol. 22(2):275–284. 2015. Elsevier BV. [Cross Ref]

        38. Nezhat Camran, Agarwal Shruti, Lee Deborah Ann, Tavallaee Mahkam. Can we accurately diagnose endometriosis without a diagnostic laparoscopy? Journal of the Turkish-German Gynecological Association. Vol. 23(2):117–119. 2022. Galenos Yayinevi. [Cross Ref]

        39. Rauh-Hain J. Alejandro, Laufer Marc R.. Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine: a new technique. Fertility and Sterility. Vol. 95(3):1113–1114. 2011. Elsevier BV. [Cross Ref]

        40. Sansone Alison M., Hisrich Brooke V., Young R. Brandt, Abel William F., Bowens Zachary, Blair Bailey B., Funkhouser Avery T., Schammel David P., Green Lisa J., Lessey Bruce A., Blenda Anna V.. Evaluation of BCL6 and SIRT1 as Non-Invasive Diagnostic Markers of Endometriosis. Current Issues in Molecular Biology. Vol. 43(3):1350–1360. 2021. MDPI AG. [Cross Ref]

        41. Louwen Frank, Kreis Nina-Naomi, Ritter Andreas, Friemel Alexandra, Solbach Christine, Yuan Juping. <i>BCL6</i>, a key oncogene, in the placenta, pre-eclampsia and endometriosis. Human Reproduction Update. Vol. 28(6):890–909. 2022. Oxford University Press (OUP). [Cross Ref]

        42. Mathias John R, Franklin Robert, Quast Don C, Fraga Nelda, Loftin Camille A, Yates Lori, Harrison Victoria. Relation of endometriosis and neuromuscular disease of the gastrointestinal tract: new insights. Fertility and Sterility. Vol. 70(1):81–88. 1998. Elsevier BV. [Cross Ref]

        43. Noar M.. AI-Derived Threshold Score of Intraabdominal Myoelectrical Activity Predicts Presence and Stage of Endometriosis with 100% Accuracy. Journal of Minimally Invasive Gynecology. Vol. 29(11)2022. Elsevier BV. [Cross Ref]

        44. Treatment of pelvic pain associated with endometriosis: a committee opinion. Fertility and Sterility. Vol. 101(4):927–935. 2014. Elsevier BV. [Cross Ref]

        45. Crosignani PierGiorgio, Olive David, Bergqvist Agneta, Luciano Anthony. Advances in the management of endometriosis: an update for clinicians. Human Reproduction Update. Vol. 12(2):179–189. 2006. Oxford University Press (OUP). [Cross Ref]

        46. Donnez Jacques, Taylor Hugh S., Taylor Robert N., Akin Mark D., Tatarchuk Tatyana F., Wilk Krzysztof, Gotteland Jean-Pierre, Lecomte Veronique, Bestel Elke. Treatment of endometriosis-associated pain with linzagolix, an oral gonadotropin-releasing hormone–antagonist: a randomized clinical trial. Fertility and Sterility. Vol. 114(1):44–55. 2020. Elsevier BV. [Cross Ref]

        47. Sinaii Ninet, Cleary Sean D., Younes Naji, Ballweg Mary Lou, Stratton Pamela. Treatment utilization for endometriosis symptoms: a cross-sectional survey study of lifetime experience. Fertility and Sterility. Vol. 87(6):1277–1286. 2007. Elsevier BV. [Cross Ref]

        48. Kalaitzopoulos Dimitrios Rafail, Samartzis Nicolas, Kolovos Georgios N., Mareti Evangelia, Samartzis Eleftherios Pierre, Eberhard Markus, Dinas Kostantinos, Daniilidis Angelos. Treatment of endometriosis: a review with comparison of 8 guidelines. BMC Women's Health. Vol. 21(1)2021. Springer Science and Business Media LLC. [Cross Ref]

        49. Ng Shu-Wing, Norwitz Gabriella A., Pavlicev Mihaela, Tilburgs Tamara, Simón Carlos, Norwitz Errol R.. Endometrial Decidualization: The Primary Driver of Pregnancy Health. International Journal of Molecular Sciences. Vol. 21(11)2020. MDPI AG. [Cross Ref]

        50. Olive David L., Pritts Elizabeth A.. Treatment of Endometriosis. New England Journal of Medicine. Vol. 345(4):266–275. 2001. Massachusetts Medical Society. [Cross Ref]

        51. Olive David L.. Gonadotropin-Releasing Hormone Agonists for Endometriosis. New England Journal of Medicine. Vol. 359(11):1136–1142. 2008. Massachusetts Medical Society. [Cross Ref]

        52. Harada Tasuku, Osuga Yutaka, Suzuki Yusuke, Fujisawa Masaki, Fukui Motoko, Kitawaki Jo. Relugolix, an oral gonadotropin-releasing hormone receptor antagonist, reduces endometriosis-associated pain compared with leuprorelin in Japanese women: a phase 3, randomized, double-blind, noninferiority study. Fertility and Sterility. Vol. 117(3):583–592. 2022. Elsevier BV. [Cross Ref]

        53. DiVasta Amy D., Feldman Henry A., Sadler Gallagher Jenny, Stokes Natalie A., Laufer Marc R., Hornstein Mark D., Gordon Catherine M.. Hormonal Add-Back Therapy for Females Treated With Gonadotropin-Releasing Hormone Agonist for Endometriosis. Obstetrics &amp; Gynecology. Vol. 126(3):617–627. 2015. Ovid Technologies (Wolters Kluwer Health). [Cross Ref]

        54. Hornstein Mark D., Hemmings Robert, Yuzpe A.Albert, LeRoy Heinrichs W.. Use of nafarelin versus placebo after reductive laparoscopic surgery for endometriosis. Fertility and Sterility. Vol. 68(5):860–864. 1997. Elsevier BV. [Cross Ref]

        55. Koninckx Philippe R., Martin Dan C.. Deep endometriosis: a consequence of infiltration or retraction or possibly adenomyosis externa? Fertility and Sterility. Vol. 58(5):924–928. 1992. Elsevier BV. [Cross Ref]

        56. Chapron C., Bourret A., Chopin N., Dousset B., Leconte M., Amsellem-Ouazana D., de Ziegler D., Borghese B.. Surgery for bladder endometriosis: long-term results and concomitant management of associated posterior deep lesions. Human Reproduction. Vol. 25(4):884–889. 2010. Oxford University Press (OUP). [Cross Ref]

        57. Nirgianakis Konstantinos, Ma Lijuan, McKinnon Brett, Mueller Michael D.. Recurrence Patterns after Surgery in Patients with Different Endometriosis Subtypes: A Long-Term Hospital-Based Cohort Study. Journal of Clinical Medicine. Vol. 9(2)2020. MDPI AG. [Cross Ref]

        58. Surrey Eric S., Soliman Ahmed M., Yang Hongbo, Du Ella Xiaoyan, Su Bowdoin. Treatment Patterns, Complications, and Health Care Utilization Among Endometriosis Patients Undergoing a Laparoscopy or a Hysterectomy: A Retrospective Claims Analysis. Advances in Therapy. Vol. 34(11):2436–2451. 2017. Springer Science and Business Media LLC. [Cross Ref]

        59. Soliman Ahmed M., Bonafede Machaon, Farr Amanda M., Castelli-Haley Jane, Winkel Craig. Analysis of subsequent surgery rates among endometriosis patients who underwent surgery with and without concomitant leuprolide acetate therapy. Current Medical Research and Opinion. Vol. 32(6):1073–1082. 2016. Informa UK Limited. [Cross Ref]

        60. WINKEL CRAIG A.. Combined Medical and Surgical Treatment of Women with Endometriosis. Clinical Obstetrics and Gynecology. Vol. 42(3)1999. Ovid Technologies (Wolters Kluwer Health). [Cross Ref]

        Comments

        Comment on this article

        Sign in to comment

        Treatment of moderate-severe pain associated with early stage endometriosis; a consensus panel summary : Endometriosis pain treatment (2024)

        References

        Top Articles
        Cloudy® Calm Portable Aroma Diffuser
        Cloudy® Focus Portable Aroma Diffuser
        Deniseeeefloressss
        Latest Posts
        • Notes on British television 1956-1996 made at the time. By Rae West
        Cloudy® Starter Kit: All Diffusers (Melatonin, Caffeine, Calm, Focus Personal Aroma Diffusers)
        Recommended Articles
        Article information

        Author: Lidia Grady

        Last Updated:

        Views: 6169

        Rating: 4.4 / 5 (65 voted)

        Reviews: 88% of readers found this page helpful

        Author information

        Name: Lidia Grady

        Birthday: 1992-01-22

        Address: Suite 493 356 Dale Fall, New Wanda, RI 52485

        Phone: +29914464387516

        Job: Customer Engineer

        Hobby: Cryptography, Writing, Dowsing, Stand-up comedy, Calligraphy, Web surfing, Ghost hunting

        Introduction: My name is Lidia Grady, I am a thankful, fine, glamorous, lucky, lively, pleasant, shiny person who loves writing and wants to share my knowledge and understanding with you.