Interventions and Practice Implications for the Management of Endometriosis

An Integrative Approach for Endometriosis-Related Pain

BACKGROUND

Pain is a common, severe symptom related to endometriosis. Despite this prominent feature, there is limited literature regarding its description and use of integrative treatment methods.

OBJECTIVE

We aimed to describe endometriosis-related pain characteristics, severity, and association with an integrative approach encompassing pharmacological and non-pharmacological methods.

METHODS

A cross-sectional descriptive correlational study was conducted using convenience sampling of adult women with endometriosis-related pain. Three questionnaires were utilized: a demographic and general health questionnaire, a visual analog pain scale (VAS), and the short-form McGill pain questionnaire (SF-MPQ).

RESULTS

Participants included 93 women with a mean general pain level of 6.2/10 (SD = 2.7) on the VAS. The total mean pain score on the SF-MPQ was 26.25/45 (SD = 10.1). Sixty-four women (68.8%) reported experiencing pain at the time of completion of the questionnaire (mean: 1.6/4, SD = 1.3). All participants utilized analgesia; those who used opioids reported a higher overall mean pain score of 2.3 (SD = 1.3) than patients who did not use opioids reported a mean of 1.4 (SD = 1.2; z = 9.59; P < .001). Present pain intensity was significantly higher for women using opioids than those not using opioids. In all, 77 women (82.8%) used integrative methods to alleviate the pain symptoms. Women who utilized nutritional therapy as part of the non-pharmacological method experienced lower mean (SD) overall pain (4.4 [2.5]) compared with patients who did not utilize nutritional therapy (6.75 [2.5]; P < .01).

CONCLUSIONS

More studies are needed to find evidence-based treatment options for women for integrative pain relief for endometriosis-related pain.

Endometriosis: a guide to investigations and treatment in the emergency department

Endometriosis is an oestrogen-dependent disorder where endometrial tissue forms lesions outside the uterus, causing chronic inflammation and scarring. Women who have endometriosis may experience a highly variable range of non-specific signs and symptoms, including pelvic pain. Endometriosis is often misdiagnosed, partly because its signs and symptoms can easily be attributed to more common conditions that cause pelvic pain in women, resulting in delayed diagnosis and treatment. This article describes the pathophysiology, aetiology, risk factors for, and signs and symptoms of endometriosis. It also outlines how endometriosis should be investigated and treated in the emergency department (ED). Its aim is to support nurses to deliver effective care to women of reproductive age presenting to the ED with severe pelvic pain.

Treatment use and satisfaction in Australian women with endometriosis: A mixed-methods study

AIMS

This study aimed to document the frequency of conventional and complementary treatments used by Australian women with endometriosis and the perceived efficacy of these treatments; and to qualitatively explore women's treatment satisfaction.

METHODS

Using a mixed-methods design, 532 women with self-reported endometriosis were recruited from the community.

METHOD

Participants were asked about their medication, complementary and self-care treatment use, as well as perceived efficacy on a 0 (not effective) - 10 (extremely effective) numeric rating scale (NRS), and open-ended qualitative survey items about treatment satisfaction.

RESULTS

97% of women used medication for pain relief (mean perceived efficacy = 5.05) and 89% used complementary/ self-care strategies (mean perceived efficacy = 3.70), with medication rated as significantly more effective (p <.001). Content analysis of the qualitative data identified that 36% of women were dissatisfied with treatment, 34% were somewhat satisfied, and 24% were satisfied. We identified qualitative themes relating to: 1) Barriers to treatment, which included lack of access, stigma, and disappointment with medical professionals who were perceived as uncaring, unhelpful and in some cases, psychologically damaging; 2) The need for holistic, interdisciplinary care; and 3) Patient knowledge, advocacy and resilience in endometriosis management.

CONCLUSIONS

Our findings reveal important limitations in the current Australian healthcare model, including the need for patient-centred interdisciplinary care that treats the biopsychosocial needs of people with endometriosis; and widespread pain education, spanning medical training to community awareness. This article is protected by copyright. All rights reserved.