Primary gonadotropin-releasing hormone agonist therapy for suspected endometriosis: a nonsurgical approach to the diagnosis and treatment of chronic pelvic pain.

R L Barbieri
The American journal of managed care · 1997 · vol. 3(2) , pp. 285–90 · PMID:10169263 · W56903312
article OA: closed CC0 ⤵ 10 in-corpus citations
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A 3-month empiric course of gonadotropin-releasing hormone agonist therapy can be used as a nonsurgical approach for diagnosing and treating chronic pelvic pain suspected to be endometriosis.

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Abstract

Chronic pelvic pain is a condition that affects one in seven women of reproductive age in the United States. Direct and indirect medical costs associated with this condition are estimated to be more than $3 billion annually before factoring in the costs of diagnostic testing. At many medical centers, endometriosis is the most common single cause of chronic pelvic pain; other causes include intra-abdominal adhesions, chronic pelvic inflammatory disease, ovarian cysts, and adenomyosis. The current approach to diagnosis and treatment of chronic pelvic pain is a two-step approach, with medical history, physical examination, laboratory testing, and empiric therapy (nonsteroidal anti-inflammatory drugs, oral contraceptives, and/or antibiotics) comprising Step 1 and surgical diagnosis with laparoscopy as Step 2. At many centers, the most common diagnosis at the time of laparoscopy for chronic pelvic pain is endometriosis, typically minimal to mild disease that can be effectively treated with hormonal therapy. Therefore, a rational alternative approach is a 3-month empiric course of therapy with a gonadotropin-releasing hormone agonist before laparoscopy. The advantages of this approach are the high rate of pain relief in women, the possibility of avoiding an invasive procedure (laparoscopy), the ability to extend therapy, if pain is relieved, to the full 6-month therapeutic course of endometriosis, and a potentially lower cost relative to laparoscopy.

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Condition tags

mesh:D004715mesh:D017699endometriosisadenomyosischronic_pelvic_pain

MeSH descriptors

Endometriosis Hormone Antagonists Laparoscopy Leuprolide Pelvic Pain Chronic Disease Chronic Disease Cost of Illness Endometriosis Endometriosis Endometriosis Female Hormone Antagonists Hormone Antagonists Humans Laparoscopy Leuprolide Leuprolide Managed Care Programs Pelvic Pain

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

Cited by (10)

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