&lt;p&gt;Rethinking endometriosis care: applying the chronic care model via a multidisciplinary program for the care of women with endometriosis&lt;/p&gt;

Agarwal, Sanjay; Foster, Lauren; Groessl, Erik J.

doi:10.2147/ijwh.s207373

Cited by 44 publications

(48 citation statements)

References 22 publications

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“…Diagnosis from onset of symptoms can take an average of 7-8 years. Generally, a diagnosis of endometriosis is achieved by laparoscopic evaluation of the pelvis, however imaging techniques such as transvaginal sonography and magnetic resonance imaging may be utilized to diagnose deep lesions and endometriomas (10)(11)(12).…”

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confidence: 99%

Endometriosis-Associated Macrophages: Origin, Phenotype, and Function

2020

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Endometriosis is a complex, heterogeneous, chronic inflammatory condition impacting ∼176 million women worldwide. It is associated with chronic pelvic pain, infertility, and fatigue, and has a substantial impact on health-related quality of life. Endometriosis is defined by the growth of endometrial-like tissue outside the uterus, typically on the lining of the pelvic cavity and ovaries (known as "lesions"). Macrophages are complex cells at the center of this enigmatic condition; they are critical for the growth, development, vascularization, and innervation of lesions as well as generation of pain symptoms. In health, tissue-resident macrophages are seeded during early embryonic life are vital for development and homeostasis of tissues. In the adult, under inflammatory challenge, monocytes are recruited from the blood and differentiate into macrophages in tissues where they fulfill functions, such as fighting infection and repairing wounds. The interplay between tissue-resident and recruited macrophages is now at the forefront of macrophage research due to their differential roles in inflammatory disorders. In some cancers, tumor-associated macrophages (TAMs) are comprised of tissue-resident macrophages and recruited inflammatory monocytes that differentiate into macrophages within the tumor. These macrophages of different origins play differential roles in disease progression. Herein, we review the complexities of macrophage dynamics in health and disease and explore the paradigm that under disease-modified conditions, macrophages that normally maintain homeostasis become modified such that they promote disease. We also interrogate the evidence to support the existence of multiple phenotypic populations and origins of macrophages in endometriosis and how this could be exploited for therapy.

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confidence: 99%

Endometriosis-Associated Macrophages: Origin, Phenotype, and Function

2020

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“…Teede et al [41] recommended pharmacological medication and surgical techniques to treat PCOS. Endometriosis is a chronic, estrogen-dependent, and inflammatory disease of unknown etiology and without a cure [18]. It is associated with endometrial tissue growing outside the uterus, severe pelvic pain, menstrual irregularities and infertility, leading to a significant reduction in the quality of life and sexual satisfaction [42].…”

Section: Discussionmentioning

confidence: 99%

“…Almost all doctors stated that in order to treat these categories of diseases it is important to have a multidisciplinary approach [58]. Agarwal [18] moved further and highlighted the need for establishing multidisciplinary centers that include mental health services with several specialties, namely gynecology, endocrinology, urology, surgery, psychology, and pain medicine. These centers allow patients to get a better treatment and can facilitate research and education.…”

Section: Discussionmentioning

confidence: 99%

“…However, among the variety of known infertility diseases it has not been clearly determined which ones cause more physical and psychological problems to women. This is particularly poignant among those that are most difficult to diagnose and treat, namely polycystic ovary syndrome [16], premenstrual dysphoric disorder [17], endometriosis [18], premature ovarian failure [19], vulvodynia [20], and chronic pelvic pain [21]. Our aim in this paper is to contribute to the literature on the physical and psychosocial consequences of infertility on women from the perspective of the clinicians who treat these women in a specific geographic context.…”

Section: Introductionmentioning

confidence: 99%

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Clinicians’ Perceptions of Norwegian Women’s Experiences of Infertility Diseases

Fernandes

Skotnes

Major

et al. 2020

IJERPH

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Background: Norway has one of the best health systems in the world. However, it has a low birth rate, which decreased by 21.2% between 2009 and 2018, and one of the highest rates of infertility prevalence. The aim of this study is to understand how Norwegian doctors perceive female infertility diseases, namely those that are more difficult to diagnose and to treat, and that are more common in their practice. Method: Descriptive qualitative study was conducted with gynecologists and general practitioners. The sample resulted from the establishment of five criteria and on the doctors’ acceptance to participate in this study. Our sample comprised thirteen highly qualified and experienced doctors. Qualitative content analysis was the method chosen to analyze the collected data. Results: Clinical diseases (polycystic ovary syndrome, endometriosis and vulvodynia) and consequences of these diseases were the pinpointed themes. These led to a set of sub-themes: the main symptoms and the treatment of the diseases, from the perspective of both women and doctors (stigmatization, disturbances in women’s daily life, diagnostic delay, and governmental support). Conclusions: The three most relevant disorders mentioned were polycystic ovary syndrome, endometriosis and vulvodynia. These diseases cause several impacts on the lives of women, because they feel stigmatized and limited in their daily life and sexuality, and the diagnosis of these diseases takes too much time. Governments should better redistribute the financing of women’s health and allocate resources to specialized centers.

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“…Another potential reason for the observed diagnostic delay may be that women with endometriosis conventionally seek and receive treatment from a single healthcare provider, often their usual gynecologist or primary care physician [ 10 , 11 ]. This single-provider model of care may pose challenges in diagnosis and treatment for both the patient and provider for many reasons including mischaracterization of “normal” menstrual pain and the presence of non-specific symptoms.…”

Section: Introductionmentioning

confidence: 99%

Real-world characteristics of women with endometriosis-related pain entering a multidisciplinary endometriosis program

et al. 2021

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Background Women with endometriosis are commonly treated by their sole provider. In this single-provider model of care, women frequently report long diagnostic delays, unresolved pelvic pain, multiple laparoscopic surgeries, sequential consultations with numerous providers, and an overall dissatisfaction with care. The emergence of multidisciplinary endometriosis centers aims to reduce diagnostic delays, improve pain management, and promote patient satisfaction; however, baseline data at the time of presentation to a multidisciplinary center are lacking. Methods A real-world, retrospective, single-site, cross-sectional study of women with surgically confirmed and/or clinically diagnosed endometriosis generated baseline data for a planned longitudinal assessment of multidisciplinary care of endometriosis. The primary objective was to determine the proportion of patients experiencing mild, moderate, or severe pain for dysmenorrhea, non-menstrual pelvic pain (NMPP), and dyspareunia at entry into a multidisciplinary endometriosis clinic. Also explored were relationships between pain scores and clinical endpoints obtained from electronic medical records. Results More than half (59%) of the study participants (n = 638) reported experiencing pelvic pain for ≥ 5 years. Pain intensity was highest for patients reporting dysmenorrhea, followed by NMPP, and dyspareunia. Significant correlations were observed between total pelvic pain and patient age (r = –0.22, p < 0.001, n = 506) and number of previous healthcare providers (r = 0.16, p = 0.006, n = 292); number of previous providers and duration of pain (r = 0.21, p = < 0.0001, n = 279); and duration of pain and years since diagnosis (r = 0.60, p < 0.001, n = 302). Mean pain scores differed significantly by age group for dysmenorrhea (p < 0.001), NMPP (p = 0.005), and total pelvic pain (p < 0.001), but not for dyspareunia (p = 0.06), with the highest mean pain scores reported among those < 30 years of age. Conclusion These real-world data indicate that in the single-provider model of care, unresolved pelvic pain is common among women with endometriosis. Alternative care models, including a multidisciplinary approach, need to be evaluated for improvements in clinical outcomes. These data also highlight the importance of addressing NMPP, which may be particularly troublesome for patients.

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<p>Rethinking endometriosis care: applying the chronic care model via a multidisciplinary program for the care of women with endometriosis</p>

Cited by 44 publications

References 22 publications

Endometriosis-Associated Macrophages: Origin, Phenotype, and Function

Endometriosis-Associated Macrophages: Origin, Phenotype, and Function

Clinicians’ Perceptions of Norwegian Women’s Experiences of Infertility Diseases

Real-world characteristics of women with endometriosis-related pain entering a multidisciplinary endometriosis program

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