Allied Health and Complementary Therapy Usage in Australian Women With Chronic Pelvic Pain: a Cross-Sectional Study

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Current medical and surgical management strategies are often not sufficient to manage these symptoms and may lead to uptake of other therapies. Aims To determine the prevalence of allied health (AH) and complementary therapy (CM) use, the cost burden of these therapies and explore predictive factors for using allied health or complementary medicines. Materials and Methods An online cross-sectional questionnaire using the WERF EndoCost tool was undertaken between February to April 2017. People were eligible to participate in the survey if they were aged 18-45, living in Australia and had chronic pelvic pain. Results From 409 responses, 340/409 (83%) of respondents reported a diagnosis of endometriosis. One hundred and five (30%) women with self-reported endometriosis, and thirteen (18%) women with other forms of CPP saw at least one AH or CM practitioner in the previous two months, with physiotherapists and acupuncturists the most common. Women who accessed CM or AH services spent an average of $480.32 AUD in the previous two months. A positive correlation was found between education and number of AH or CM therapies accessed in the past two months (p<0.001) and between income level and number of therapists (p=0.028). Conclusions Women with CPP commonly access AH and CM therapies, with a high out of pocket cost. The high cost and associations with income and education levels may warrant a change to policy to improve equitable access to these services. Obstetrics & Gynecology Sexual & Reproductive Medicine complementary medicine allied health endometriosis pelvic pain cost of illness Figures Figure 1 Figure 2 Introduction Chronic pelvic pain (CPP) can be broadly categorised as pain in the pelvic region that lasts longer than six months and requires medical attention [ 1 ]. Causes of CPP include endometriosis, adenomyosis, irritable bowel syndrome, adhesions and interstitial cystitis, amongst others [ 1 ]. Estimates for CPP prevalence varies across countries, with prevalence estimates ranging from 5.7–26.6% in women of reproductive age [ 2 ]. Management of CPP depends on the specific cause but broadly incorporates pain education, physical therapy, psychological therapy and various pharmacological and surgical interventions [ 3 ]. Endometriosis is a leading cause of CPP, commonly managed by analgesia and hormonal treatments or surgery [ 4 ]. Despite established management protocols, women with endometriosis often express frustration with medical treatment due to its inability to cure the disease, bothersome medication side effect profiles [ 5 ] and poor symptom management [ 6 ]. These may be contributing factors to why only half (54.6%) of women with endometriosis are satisfied with their medical care [ 7 ]. Given the dissatisfaction with current medical management strategies, many women with CPP are using complementary medicine (CM) [ 8 ] and women with endometriosis are known to use both CM and allied health (AH) services (including physiotherapy and psychology) to help manage their symptoms [ 6 ]. Under the Australian public healthcare system, people with chronic illness are entitled to subsidised AH treatment if they have a chronic disease management plan [ 9 ]. Although access to subsidised treatment may alleviate the burden of healthcare costs, a recent Australian study found only 15.4% of respondents had such a plan, despite eligibility due to endometriosis [ 6 ]. Therefore, there is likely to be substantial out of pocket costs for these CM and AH treatments. Given the already significant costs for women in Australia with CPP [ 10 ] and the strong relationship between greater pain levels and negative impact on work [ 10 ] and education, [ 11 ] ensuring that cost-effective treatment is both accessible and affordable is a priority. Our study sought to determine which CM and AH modalities women with CPP were accessing, explore the cost burden of these, and determine any predictive factors for usage. Materials And Methods This survey was approved by the Western Sydney University Human Research Ethics Committee, approval number H12019 (approved 21st January 2017). All research complied with the relevant guidelines and regulations outlined in the National Statement on Ethical Conduct in Human Research (2018)[ 12 ]. Questionnaire The World Endometriosis Research Foundation (WERF) EndoCost tool consists of validated prospective hospital questionnaires and both retrospective and prospective patient questionnaires [ 13 ]. Our study used the 99 item retrospective patient questionnaire, modified to Australian income and ethnicity parameters as per the Australian Bureau of Statistics [ 14 ]. The survey was hosted on SurveyMonkey ( www.surveymonkey.com ), with an estimated 30–45-minute completion time. This paper reports on data related to the use of CM and therapies (such as acupuncture and herbal medicine) and AH usage. Two sections of the questionnaire covered CM and AH usage. All respondents were given the option to nominate up to five non-medical treatments used in the past two months. Respondents were advised that these treatments were not medical, surgical or related to monitoring but otherwise given a free text box to describe the category in their own words without restrictions. Recruitment Following ethics approval, the survey link was distributed via the social media platforms (Facebook, Twitter and Instagram) of Endometriosis Australia, EndoActive and the Pelvic Pain Foundation of Australia from February 2017 to April 2017, for a total of eight weeks. The total combined reach of these organizations on social media was just over 35,000 followers at the time of survey distribution. Each organization made two social media posts regarding the survey three to five weeks apart. Data collection was closed once there had been no new responses for five days. Informed consent was obtained from all respondents. Study population Women were eligible to participate in the survey if they were aged 18-45, currently living in Australia and had CPP. CPP was defined as pain in the pelvis for at least six months that caused the person to seek medical attention, regardless of the diagnosis, or lack thereof. This study was designed to measure prevalence and assess cost rather than test a hypothesis, therefore no sample size calculation was performed. Analyses Data were analysed using SPSS v26 (IBM Corporation, Chicago Ill.) and Excel v16 (Microsoft). Descriptive statistics were presented as means, weighted means and standard deviations (for normally distributed data), medians and interquartile ranges (for non-normally distributed data), or number and percentages (for categorical data). Inferential statistics for between-group comparisons were performed using a one-way ANOVA, chi-square test or Fishers Exact as appropriate. Correlations between categorical and continuous variables were analyzed using Spearman’s rank order correlation. Statistical significance was set at p<0.05. Missing data were reported and not replaced. Only numerical responses, or responses from which a number could be determined (e.g. listing therapies) were included. Respondents who could not recall a specific number were not counted as a response and a conservative approach was taken where respondents who listed “n+”, where n was a number, n was recorded as the number of therapists seen. CM and AH therapies were manually categorized and standardized by one author (removed for anonymous peer review) (e.g., physiotherapy and physiotherapist were included in the same category) with guidance from the senior author (removed for anonymous peer review), who has expertise in CM and AH. Responses which were clearly medical in nature, such as ultrasound, were not counted. Cumulative costs were determined for each therapy, by summing the costs each respondent had recorded for the particular therapy. The cost per session was also determined by dividing the total cost by the number of sessions for each respondent. The mean and weighted mean cost per session was then calculated. Costs were only calculated for respondents with a valid total cost and number of sessions. Results Four hundred and nine valid responses were received. Three hundred and forty (83.1%) respondents reported they had laparoscopically confirmed endometriosis (endometriosis cohort). Sixty-nine (16.9%) respondents experienced CPP without a laparoscopically confirmed diagnosis of endometriosis (other CPP cohort). The mean age of respondents in the endometriosis cohort was 30.6 (± 7) years and was 33.7 (± 16.3) years in the other CPP cohort. Those in the other CPP cohort reported diagnoses that included no known cause/diagnosis for CPP (40.6%), been told by their doctor they had endometriosis but no visual confirmation (43.5%), adenomyosis (10.1%) and ovarian cysts (5.8%). Table 1 outlines the demographics of the respondents. Table 1 Demographic characteristics of respondents Self-reported Endometriosis (n = 340) Other CPP (n = 69) Mean (SD) Mean (SD) Age (years) 30.6 (7.0) 33.7 (16.3) Ethnicity, n (%) Caucasian 312 (91.8%) 64 (92.8%) Asian 5 (1.5%) 2 (2.9%) Aboriginal and/or Torres Strait Islander 5 (1.5%) 1 (1.4%) Other 17 (5%) 2 (2.8%) Relationship status, n (%) Single 69 (20.3%) 14 (20.3%) Married/Defacto 211 (62.1%) 50 (72.5%) In a relationship but not living with partner 49 (14.4%) 4 (5.8) Divorced/Separated 9 (2.6%) 0 (0%) Widowed 0 (0%) 1 (1.4%) Blank 2 (0.6%) 0 (0%) Occupation, n (%) Self-employed 23 (6.8%) 4 (5.8%) Employed 236 (69.4%) 47 (68.1%) Attending school or University 70 (20.6%) 15 (21.7%) Home duties/ caring for children and family 43 (12.6%) 10 (14.5%) Doing voluntary work 18 (5.3%) 2 (2.9%) Unable to work due to pelvic pain symptoms 23 (6.8%) 7 (10.1%) Unable to work for other reasons 5 (1.5%) 2 (2.9%) Level of education, n (%) Primary School 0 (0%) 0 (0%) Lower secondary 24 (7%) 2 (2.9%) Upper secondary 47 (13.8%) 6 (8.7%) Post-secondary (TAFE) a 91 (26.8%) 22 (31.9%) University 123 (36.2%) 25 (36.2%) Post graduate 55 (16.2%) 14 (20.3%) Currently have children, n (%) Yes 97 (28.5%) 23 (33.3%) No 242 (71.2%) 46 (66.7%) Blank 1 (<1%) 0 (0%) rAFS/ASRM stage at most recent laparoscopy, n (%) Stage 1 14 (4.1%) Stage 2 51 (15%) Stage 3 75 (22.1%) Stage 4 115 (33.7%) Can’t remember 57 (16.8%) Blank 28 (8.3%) Overall AH and complementary therapy usage One hundred and forty-three (42.1%) women with endometriosis reported seeing at least one AH or complementary therapist prior to their diagnosis. Thirty-five (24.5%) women reported seeing one therapist, 50 (35.0%) reported seeing two, 21 (14.7%) reported seeing three, 12 (8.4%) reported seeing four and 25 (17.5%) reported seeing five or more therapists. One hundred and five (30.9%) women in the endometriosis cohort and 13 women in the other CPP cohort (18.8%) saw at least one AH or complementary therapist in the two months preceding the survey. Of the 105 women in the endometriosis cohort who had seen a therapist in the previous two months, the majority (60.0%), reported seeing one therapist and one-third (31.4%) reported two therapists. Of the 13 women in the other CPP cohort who had seen a therapist in the previous two months, almost half (46.2%) had seen one therapist and one-third (30.8%) reported seeing two therapists. Access to AH and CM health care providers The most commonly accessed AH and complementary therapists by those in the endometriosis cohort were physiotherapists (11.5%), mental health workers (e.g., psychologists, psychotherapist, counsellor) (6.5%), massage therapists (5.6%) and acupuncturists (5.6%). The other CPP cohort reported physiotherapists (7.3%), naturopaths (5.8%), acupuncturists (4.4%) and nutritionist/dietitians (4.4%) as the most common therapists consulted. Table 2 outlines the types of AH and complementary therapists consulted by respondents. Table 2 CM and AH health care providers seen by women with endometriosis and CPP Therapist/Health care provider Self-reported Endometriosis n (%) Other CPP n (%) Both cohorts ‡ n (% of total respondents) % of therapy users † Physiotherapist 39 (37.1%) 5 (38.5%) 44 (10.8%) 37.3% Mental Health Worker 22 (21.0%) 2 (15.4%) 24 (5.9%) 20.3% Acupuncturist 19 (18.1%) 3 (23.1%) 22 (5.4%) 18.6% Massage Therapist 19 (18.1%) 2 (15.4%) 21 (5.1%) 17.8% Naturopath 17 (16.2%) 4 (30.8%) 21 (5.1%) 17.8% Nutritionist/Dietitian 11 (10.5%) 3 (23.1%) 14 (3.4%) 11.9% Chiropractor 11 (10.5%) 1 (7.7%) 12 (2.9%) 10.2% Osteopath 8 (7.6%) 1 (7.7%) 9 (2.2%) 7.6% Supplements (unknown provider) 5 (4.8%) 0 (0.0%) 5 (1.2%) 4.2% Reflexologist 2 (1.9%) 0 (0.0%) 2 (0.5%) 1.7% Clinical Pilates Therapist 0 (0.0%) 1 (7.7%) 1 (0.2%) 0.8% Emmett Treatment 1 (0.9%) 0 (0.0%) 1 (0.2%) 0.8% Endo Diet 1 (0.9%) 0 (0.0%) 1 (0.2%) 0.8% Herbalist § 1 (0.9%) 0 (0.0%) 1 (0.2%) 0.8% Homeopath 1 (0.9%) 0 (0.0%) 1 (0.2%) 0.8% Integrated Medicine Doctor § 1 (0.9%) 0 (0.0%) 1 (0.2%) 0.8% Meditation 1 (0.9%) 0 (0.0%) 1 (0.2%) 0.8% Pelvic Floor Specialist § 1 (0.9%) 0 (0.0%) 1 (0.2%) 0.8% Sexologist 0 (0.0%) 1 (7.7%) 1 (0.2%) 0.8%) 160 23 183 Cost to women from consulting the health care provider Across the two cohorts, women had cumulatively spent a total of $ 53,315 on AH and complementary therapists in the two months preceding the survey, across 530 sessions, and 111 respondents with at least one valid response regarding costs and sessions; endometriosis (n=99), other CPP (n=12). Women who accessed CM or AH services spent an average of $ 480.32. Women in the endometriosis cohort, on average spent a total of $ 460.04, compared to women in the other CPP cohort who spent $ 647.58. Figure 1 outlines the cumulative cost per therapy in each cohort. Women in the endometriosis cohort spent the most money on physiotherapists ( $ 10,525), followed by mental health workers ( $ 7,555), naturopaths ( $ 7,320) and acupuncturists ( $ 6,587). Women in the other CPP cohort spent the most money on mental health workers ( $ 1,950), followed by physiotherapists ( $ 1,215), Clinical Pilates therapists ( $ 1,000) and acupuncturists ( $ 900). Total expenditure across the two cohorts was highest for physiotherapists ( $ 11,740), followed by mental health workers ( $ 9,505), naturopaths ( $ 7,936) and acupuncturists ( $ 7,487). The lowest expenditure was on reflexologists with a total of $ 80 across the two cohorts. Excluding therapists with only one respondent, naturopaths had the highest cost per session ( $ 187.65), followed by nutritionist/dietitians ( $ 131.07), mental health workers ( $ 127.27) and acupuncturists ( $ 87.83). Figure 2 outlines the weighted mean cost per session per therapist with data from both cohorts. Predictive Factors for AH/CM usage: A statistically significant positive correlation was found between education levels and number of AH or complementary therapists accessed in the past two months when looking at combined data for both cohorts, r s = 0.204 (p <0.001). A statistically significant positive correlation was found between income levels and number of therapists accessed when looking at combined data for both cohorts, r s = 0.108 (p = 0.028). Discussion Our study found that usage of CM or AH therapists was common amongst all those with CPP, irrespective of diagnosis. The use of complementary therapies is similar to other usage estimates found in Australian women with endometriosis (42.9%) [ 6 ] and higher than prevalence estimates of the general Australian population (36.0%) [ 15 ]. These high rates of usage are not unexpected given that predictive factors for CM usage are being female, <65 years old, well-educated and with chronic, unresolved health problems[ 16 ]. Women with endometriosis are often dissatisfied with medical treatments due to side effect profiles and unsatisfying interactions with medical staff [ 17 ]. These factors may lead to women with endometriosis feeling disempowered in the medical system. As such, patients may choose to see CM or AH practitioners, to increase feelings of empowerment [ 18 ]. Many doctors have expressed frustration with a lack of treatment options to offer women with endometriosis [ 19 ] and for not receiving adequate training in dealing with the complex psychosocial issues involved in CPP [ 20 ]. These factors may contribute to why women often report feeling dismissed or their pain experience minimised when visiting their doctor [ 21 ], and why they may choose to seek out CM or AH care despite the additional cost. Differences in the prevalence of use of various CM and AH modalities in our respondents may have a number of contributing factors. Allied health practitioners such as physiotherapists may have higher usage due to the Chronic Disease Management program in Australia which grants patients access to five subsidised AH sessions per year [ 22 ] but does not provide this for CM services. Previous studies have shown that less than one in five women with endometriosis in Australia actually have a chronic disease management plan [ 6 ] and therefore it’s unclear how much of a contributor this would be to differences in AH vs CM usage. Despite their popularity, there is limited high-quality evidence for each therapy accessed, including physiotherapy/physical therapy techniques such as pelvic floor muscle down-training[ 23 ], acupuncture [ 24 ] and psychological therapies [ 25 ]. There is no current research on naturopathy as a whole systems therapy but some evidence to suggest that supplements such as palmitoylethanolamide (PEA) that may be prescribed by a naturopath could be useful in managing pain [ 26 ]. Considering the popularity of these therapies within our cohort, as well as the significant cost burden associated, resources should be allocated into exploring the effectiveness of these therapies. In Australia, the National Action Plan for Endometriosis[ 27 ] acknowledges that endometriosis research into AH and complementary therapies should be prioritised. Our research suggests five key areas could be prioritised based on current usage: physiotherapy, psychology, acupuncture, massage and naturopathy. Our study found an association between increasing income and education levels and greater AH/CM therapy usage, consistent with other studies which found that education levels are positively correlated with complementary therapy usage [ 28 ]. There is conflicting evidence about whether income is associated with CM usage, however most studies report there is either a positive relationship or no relationship [ 29 ]. This suggests there may be equity and accessibility issues for patients with lower levels of education and/or income. In Australia, the Australian government acknowledges increasing accessibility to CM therapies as a priority in the National Action Plan for Endometriosis, but no such guidance exists for those with CPP from other causes. These significant rates of CM therapy usage in managing chronic pelvic pain are not specific to Australia [ 30 , 31 ] and therefore given the significant out of pocket costs associated with endometriosis in other countries [ 32 ], it is likely that issues of cost and accessibility are present across a wide variety of geographical locations. Strengths and limitations The main strengths of our study are that the results are consistent with the literature, there is a diverse range of respondents, and it uses the EndoCost tool which provides a large amount of comparable data. However, there are some important limitations that need to be outlined. Firstly, responses were self-reported and due to the anonymous nature of the survey no confirmation of diagnosis could be sought. However, a self-reported diagnosis of endometriosis is accurate in most cases[ 33 ]. Secondly, information about private health insurance was not collected. This may confound results as having private health insurance with extra cover has been shown to be associated with CM usage in Australian women with endometriosis [ 6 ] and therefore it is unclear if the costs found reflect a full fee or out-of-pocket cost. Finally, our sample had a high proportion of Caucasian respondents, which may have influenced the prevalence as there is some evidence to suggest CM usage is higher in Caucasian populations [ 29 ]. Conclusion Our study found that women with CPP, regardless of cause, have high rates of CM and AH usage, associated with a high cost to patients. Common therapies accessed within this population include physiotherapy, mental health care, acupuncture, massage therapy and naturopathy. Key drivers for seeking out CM or AH may be lack of effective medical treatment options or side effects. There was a positive association between usage of CM and/or AH and education and income levels. Given the high rate of usage, further research into the efficacy of specific treatments may be warranted. Moreover, the high cost and associations with income and education levels may warrant a change to policy to improve equitable access to these services. Declarations Ethics approval: Ethical approval was obtained from Western Sydney University Human Ethics Committee H12019 (approved 21 st January 2017). All research complied with the relevant guidelines and regulations outlined in the National Statement on Ethical Conduct in Human Research (2018). Informed consent was gained prior to participants completing the survey. Consent for publication: Not applicable Conflict of interest: AM, JS, CS, MA are part of NICM Health Research Institute. As a medical research institute, NICM receives research grants and donations from foundations, universities, government agencies, individuals and industry. Sponsors and donors provide untied funding for work to advance the vision and mission of the Institute. The project that is the subject of this article was not undertaken as part of a contractual relationship with any organisation other than the funding declared in the Acknowledgements. It should also be noted that NICM Health Research Institute conducts clinical trials relevant to this topic area, for which further details can be provided on request. MA is a clinical advisory board member for Endometriosis Australia. JA is the medical director for Endometriosis Australia. CN reports nothing to declare. Acknowledgments: Thank you to all the endometriosis organisations who distributed this survey including Endometriosis Australia, EndoActive and the Pelvic Pain Foundation of Australia. Thank you to the World Endometriosis Research Federation (WERF) for providing the EndoCost tool. Author contributions: Conceived and designed the study MA, CS, JA Data collection MA. Data analysis AM, MA. Project supervision MA. Contributed to writing the manuscript; Original draft AM, MA, JS. Review and editing MA, AM, JS, CN, JA, CS. All authors approved the final manuscript. Availability of data and material: The datasets used and/or analysed during the current study are not publicly available due to ethical restrictions available from the corresponding author on reasonable request. Disclaimers: The views, opinions, findings, and conclusions or recommendations expressed in this paper are strictly those of the author (s). Funding: No external funding was provided. AM was funded by an internal Western Sydney University Summer Scholarship. References Daniels JP, Khan KS: Chronic pelvic pain in women . BMJ 2010, 341 :c4834. Ahangari A: Prevalence of chronic pelvic pain among women: an updated review . Pain Physician 2014, 17 (2):E141-147. 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National Action Plan for Endometriosis [ http://www.health.gov.au/internet/main/publishing.nsf/Content/endometriosis ] Spinks J, Hollingsworth B: Policy Implications of Complementary and Alternative Medicine Use in Australia: Data from the National Health Survey . The Journal of Alternative and Complementary Medicine 2012, 18 (4):371–378. Reid R, Steel A, Wardle J, Trubody A, Adams J: Complementary medicine use by the Australian population: a critical mixed studies systematic review of utilisation, perceptions and factors associated with use . BMC Complementary and Alternative Medicine 2016, 16 (1):176. Schwartz ASK, Gross E, Geraedts K, Rauchfuss M, Wölfler MM, Häberlin F, von Orelli S, Eberhard M, Imesch P, Imthurn B et al : The use of home remedies and complementary health approaches in endometriosis . Reproductive BioMedicine Online 2019, 38 (2):260–271. Chen L, Michalsen A: Management of chronic pain using complementary and integrative medicine . Bmj 2017, 357 . Simoens S, Dunselman G, Dirksen C, Hummelshoj L, Bokor A, Brandes I, Brodszky V, Canis M, Colombo GL, DeLeire T et al : The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres . Hum Reprod 2012, 27 (5):1292–1299. Shafrir AL, Wise LA, Palmer JR, Shuaib ZO, Katuska LM, Vinayak P, Kvaskoff M, Terry KL, Missmer SA: Validity of self-reported endometriosis: a comparison across four cohorts . Hum Reprod 2021, 36 (5):1268–1278. Additional Declarations Competing interest reported. Conflict of interest: AM, JS, CS, MA are part of NICM Health Research Institute. As a medical research institute, NICM receives research grants and donations from foundations, universities, government agencies, individuals and industry. Sponsors and donors provide untied funding for work to advance the vision and mission of the Institute. The project that is the subject of this article was not undertaken as part of a contractual relationship with any organisation other than the funding declared in the Acknowledgements. It should also be noted that NICM Health Research Institute conducts clinical trials relevant to this topic area, for which further details can be provided on request. MA is a clinical advisory board member for Endometriosis Australia. JA is the medical director for Endometriosis Australia. CN reports nothing to declare. Cite Share Download PDF Status: Published Journal Publication published 11 Feb, 2022 Read the published version in BMC Women's Health → Version 1 posted Editorial decision: Major revision 07 Jan, 2022 Reviews received at journal 28 Dec, 2021 Reviewers agreed at journal 28 Dec, 2021 Reviewers agreed at journal 28 Dec, 2021 Reviewers invited by journal 28 Dec, 2021 Editor assigned by journal 23 Dec, 2021 Editor invited by journal 23 Dec, 2021 Submission checks completed at journal 23 Dec, 2021 First submitted to journal 12 Dec, 2021 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1164738","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":72168933,"identity":"ade9d593-d8f5-4692-888f-4d600fe6cf95","order_by":0,"name":"Astha Malik","email":"","orcid":"","institution":"Western Sydney University","correspondingAuthor":false,"prefix":"","firstName":"Astha","middleName":"","lastName":"Malik","suffix":""},{"id":72168930,"identity":"08803340-7b68-4af6-b8cb-f7c87bc2a772","order_by":1,"name":"Justin SINCLAIR","email":"","orcid":"","institution":"NICM Health Research Institute, Western Sydney University","correspondingAuthor":false,"prefix":"","firstName":"Justin","middleName":"","lastName":"SINCLAIR","suffix":""},{"id":72168935,"identity":"300e0b93-e206-4303-957f-8d28788f0207","order_by":2,"name":"Cecilia Ng","email":"","orcid":"","institution":"University of New South Wales","correspondingAuthor":false,"prefix":"","firstName":"Cecilia","middleName":"","lastName":"Ng","suffix":""},{"id":72168934,"identity":"942e3dc8-a077-42fc-a5ba-fa2f72d1ba81","order_by":3,"name":"Caroline Smith","email":"","orcid":"","institution":"NICM Health Research Institute, Western Sydney University","correspondingAuthor":false,"prefix":"","firstName":"Caroline","middleName":"","lastName":"Smith","suffix":""},{"id":72168931,"identity":"fef94458-5301-4c74-a827-b6fbf1271f44","order_by":4,"name":"Jason ABBOTT","email":"","orcid":"","institution":"University of New South Wales","correspondingAuthor":false,"prefix":"","firstName":"Jason","middleName":"","lastName":"ABBOTT","suffix":""},{"id":72168932,"identity":"917faa29-af8c-4fdc-b791-ac399699a62b","order_by":5,"name":"Mike ARMOUR","email":"data:image/png;base64,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","orcid":"","institution":"NICM Health Research Institute, Western Sydney University","correspondingAuthor":true,"prefix":"","firstName":"Mike","middleName":"","lastName":"ARMOUR","suffix":""}],"badges":[],"createdAt":"2021-12-13 01:29:02","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1164738/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1164738/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12905-022-01618-z","type":"published","date":"2022-02-11T07:49:18+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":16849253,"identity":"52e41498-cbf4-4720-9365-189a32b14545","added_by":"auto","created_at":"2021-12-29 22:18:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":48388,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCumulative cost per therapy, in $AUD in the previous two months\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-1164738/v1/6aa826743ddfc760fed3fb0b.png"},{"id":16849393,"identity":"a8709777-2b5e-4574-87a8-cbc48ffa0659","added_by":"auto","created_at":"2021-12-29 22:21:43","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":61290,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMean self-reported cost per session, in $AUD \u003c/strong\u003e\u003c/p\u003e\u003cp\u003e*Note: Only therapies with more than one respondent were used in this calculation.\u003c/p\u003e","description":"","filename":"fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-1164738/v1/735e3511364bca2ae1fad2b0.png"},{"id":18122057,"identity":"f89b884a-8f39-412f-8069-e1f19497281a","added_by":"auto","created_at":"2022-02-11 07:49:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1222185,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1164738/v1/2ae22406-aeb8-4dc0-a661-1b6e13fe05ce.pdf"}],"financialInterests":"Competing interest reported. Conflict of interest: AM, JS, CS, MA are part of NICM Health Research Institute. As a medical research institute, NICM receives research grants and donations from foundations, universities, government agencies, individuals and industry. Sponsors and donors provide untied funding for work to advance the vision and mission of the Institute. The project that is the subject of this article was not undertaken as part of a contractual relationship with any organisation other than the funding declared in the Acknowledgements. It should also be noted that NICM Health Research Institute conducts clinical trials relevant to this topic area, for which further details can be provided on request. MA is a clinical advisory board member for Endometriosis Australia. JA is the medical director for Endometriosis Australia. CN reports nothing to declare.","formattedTitle":"\u003cp\u003eAllied Health and Complementary Therapy Usage in Australian Women With Chronic Pelvic Pain: a Cross-Sectional Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eChronic pelvic pain (CPP) can be broadly categorised as pain in the pelvic region that lasts longer than six months and requires medical attention [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Causes of CPP include endometriosis, adenomyosis, irritable bowel syndrome, adhesions and interstitial cystitis, amongst others [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Estimates for CPP prevalence varies across countries, with prevalence estimates ranging from 5.7\u0026ndash;26.6% in women of reproductive age [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eManagement of CPP depends on the specific cause but broadly incorporates pain education, physical therapy, psychological therapy and various pharmacological and surgical interventions [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Endometriosis is a leading cause of CPP, commonly managed by analgesia and hormonal treatments or surgery [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite established management protocols, women with endometriosis often express frustration with medical treatment due to its inability to cure the disease, bothersome medication side effect profiles [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and poor symptom management [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. These may be contributing factors to why only half (54.6%) of women with endometriosis are satisfied with their medical care [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGiven the dissatisfaction with current medical management strategies, many women with CPP are using complementary medicine (CM) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] and women with endometriosis are known to use both CM and allied health (AH) services (including physiotherapy and psychology) to help manage their symptoms [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Under the Australian public healthcare system, people with chronic illness are entitled to subsidised AH treatment if they have a chronic disease management plan [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Although access to subsidised treatment may alleviate the burden of healthcare costs, a recent Australian study found only 15.4% of respondents had such a plan, despite eligibility due to endometriosis [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Therefore, there is likely to be substantial out of pocket costs for these CM and AH treatments. Given the already significant costs for women in Australia with CPP [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and the strong relationship between greater pain levels and negative impact on work [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and education, [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] ensuring that cost-effective treatment is both accessible and affordable is a priority.\u003c/p\u003e \u003cp\u003eOur study sought to determine which CM and AH modalities women with CPP were accessing, explore the cost burden of these, and determine any predictive factors for usage.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cp\u003e This survey was approved by the Western Sydney University Human Research Ethics Committee, approval number H12019 (approved 21st January 2017). All research complied with the relevant guidelines and regulations outlined in the National Statement on Ethical Conduct in Human Research (2018)[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eQuestionnaire\u003c/h2\u003e \u003cp\u003eThe World Endometriosis Research Foundation (WERF) EndoCost tool consists of validated prospective hospital questionnaires and both retrospective and prospective patient questionnaires [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Our study used the 99 item retrospective patient questionnaire, modified to Australian income and ethnicity parameters as per the Australian Bureau of Statistics [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The survey was hosted on SurveyMonkey (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003ca href=\"http://www.surveymonkey.com\" target=\"_blank\"\u003ewww.surveymonkey.com\u003c/a\u003e\u003c/span\u003e\u003c/span\u003e), with an estimated 30\u0026ndash;45-minute completion time. This paper reports on data related to the use of CM and therapies (such as acupuncture and herbal medicine) and AH usage.\u003c/p\u003e \u003cp\u003eTwo sections of the questionnaire covered CM and AH usage. All respondents were given the option to nominate up to five non-medical treatments used in the past two months. Respondents were advised that these treatments were not medical, surgical or related to monitoring but otherwise given a free text box to describe the category in their own words without restrictions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eRecruitment\u003c/h2\u003e \u003cp\u003e Following ethics approval, the survey link was distributed via the social media platforms (Facebook, Twitter and Instagram) of Endometriosis Australia, EndoActive and the Pelvic Pain Foundation of Australia from February 2017 to April 2017, for a total of eight weeks. The total combined reach of these organizations on social media was just over 35,000 followers at the time of survey distribution. Each organization made two social media posts regarding the survey three to five weeks apart. Data collection was closed once there had been no new responses for five days. Informed consent was obtained from all respondents.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eWomen were eligible to participate in the survey if they were aged 18-45, currently living in Australia and had CPP. CPP was defined as pain in the pelvis for at least six months that caused the person to seek medical attention, regardless of the diagnosis, or lack thereof. This study was designed to measure prevalence and assess cost rather than test a hypothesis, therefore no sample size calculation was performed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eAnalyses\u003c/h2\u003e \u003cp\u003eData were analysed using SPSS v26 (IBM Corporation, Chicago Ill.) and Excel v16 (Microsoft). Descriptive statistics were presented as means, weighted means and standard deviations (for normally distributed data), medians and interquartile ranges (for non-normally distributed data), or number and percentages (for categorical data). Inferential statistics for between-group comparisons were performed using a one-way ANOVA, chi-square test or Fishers Exact as appropriate. Correlations between categorical and continuous variables were analyzed using Spearman\u0026rsquo;s rank order correlation. Statistical significance was set at p\u0026lt;0.05. Missing data were reported and not replaced.\u003c/p\u003e \u003cp\u003eOnly numerical responses, or responses from which a number could be determined (e.g. listing therapies) were included. Respondents who could not recall a specific number were not counted as a response and a conservative approach was taken where respondents who listed \u0026ldquo;n+\u0026rdquo;, where n was a number, n was recorded as the number of therapists seen. CM and AH therapies were manually categorized and standardized by one author (removed for anonymous peer review) (e.g., physiotherapy and physiotherapist were included in the same category) with guidance from the senior author (removed for anonymous peer review), who has expertise in CM and AH. Responses which were clearly medical in nature, such as ultrasound, were not counted.\u003c/p\u003e \u003cp\u003eCumulative costs were determined for each therapy, by summing the costs each respondent had recorded for the particular therapy. The cost per session was also determined by dividing the total cost by the number of sessions for each respondent. The mean and weighted mean cost per session was then calculated. Costs were only calculated for respondents with a valid total cost and number of sessions.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eFour hundred and nine valid responses were received. Three hundred and forty (83.1%) respondents reported they had laparoscopically confirmed endometriosis (endometriosis cohort). Sixty-nine (16.9%) respondents experienced CPP without a laparoscopically confirmed diagnosis of endometriosis (other CPP cohort). The mean age of respondents in the endometriosis cohort was 30.6 (\u0026plusmn; 7) years and was 33.7 (\u0026plusmn; 16.3) years in the other CPP cohort. Those in the other CPP cohort reported diagnoses that included no known cause/diagnosis for CPP (40.6%), been told by their doctor they had endometriosis but no visual confirmation (43.5%), adenomyosis (10.1%) and ovarian cysts (5.8%). Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e outlines the demographics of the respondents.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographic characteristics of respondents\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSelf-reported Endometriosis (n\u0026thinsp;=\u0026thinsp;340)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOther CPP (n\u0026thinsp;=\u0026thinsp;69)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.6 (7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.7 (16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnicity, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCaucasian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e312 (91.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64 (92.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAsian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAboriginal and/or Torres Strait Islander\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRelationship status, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69 (20.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (20.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried/Defacto\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e211 (62.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50 (72.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIn a relationship but not living with partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49 (14.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDivorced/Separated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlank\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e236 (69.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47 (68.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAttending school or University\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70 (20.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (21.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHome duties/ caring for children and family\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43 (12.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (14.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDoing voluntary work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnable to work due to pelvic pain symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (10.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnable to work for other reasons\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of education, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLower secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUpper secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47 (13.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (8.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost-secondary (TAFE)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91 (26.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (31.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUniversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e123 (36.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (36.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost graduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55 (16.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (20.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrently have children, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97 (28.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e242 (71.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlank\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (\u0026lt;1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003erAFS/ASRM stage at most recent laparoscopy, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStage 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (4.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStage 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStage 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75 (22.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStage 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e115 (33.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCan\u0026rsquo;t remember\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57 (16.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlank\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec8\"\u003e\n \u003ch2\u003eOverall AH and complementary therapy usage\u003c/h2\u003e\n \u003cp\u003eOne hundred and forty-three (42.1%) women with endometriosis reported seeing at least one AH or complementary therapist prior to their diagnosis. Thirty-five (24.5%) women reported seeing one therapist, 50 (35.0%) reported seeing two, 21 (14.7%) reported seeing three, 12 (8.4%) reported seeing four and 25 (17.5%) reported seeing five or more therapists.\u003c/p\u003e\n \u003cp\u003eOne hundred and five (30.9%) women in the endometriosis cohort and 13 women in the other CPP cohort (18.8%) saw at least one AH or complementary therapist in the two months preceding the survey. Of the 105 women in the endometriosis cohort who had seen a therapist in the previous two months, the majority (60.0%), reported seeing one therapist and one-third (31.4%) reported two therapists. Of the 13 women in the other CPP cohort who had seen a therapist in the previous two months, almost half (46.2%) had seen one therapist and one-third (30.8%) reported seeing two therapists.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec9\"\u003e\n \u003ch2\u003eAccess to AH and CM health care providers\u003c/h2\u003e\n \u003cp\u003eThe most commonly accessed AH and complementary therapists by those in the endometriosis cohort were physiotherapists (11.5%), mental health workers (e.g., psychologists, psychotherapist, counsellor) (6.5%), massage therapists (5.6%) and acupuncturists (5.6%). The other CPP cohort reported physiotherapists (7.3%), naturopaths (5.8%), acupuncturists (4.4%) and nutritionist/dietitians (4.4%) as the most common therapists consulted.\u003c/p\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e outlines the types of AH and complementary therapists consulted by respondents. \u0026nbsp;\u003c/p\u003e\n \u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCM and AH health care providers seen by women with endometriosis and CPP\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eTherapist/Health care provider\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSelf-reported Endometriosis\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eOther CPP\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eBoth cohorts \u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003en (% of total respondents)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e% of therapy users\u003c/strong\u003e \u003csup\u003e\u003cstrong\u003e\u0026dagger;\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhysiotherapist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39 (37.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (38.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44 (10.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMental Health Worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (21.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (15.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcupuncturist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (18.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (23.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMassage Therapist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (18.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (15.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (5.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNaturopath\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (16.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (30.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (5.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNutritionist/Dietitian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (10.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (23.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChiropractor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (10.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (7.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOsteopath\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (7.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (7.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSupplements (unknown provider)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReflexologist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClinical Pilates Therapist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (7.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmmett Treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndo Diet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHerbalist \u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHomeopath\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIntegrated Medicine Doctor \u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMeditation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePelvic Floor Specialist \u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSexologist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (7.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e160\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e23\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e183\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec10\"\u003e\n \u003ch2\u003eCost to women from consulting the health care provider\u003c/h2\u003e\n \u003cp\u003eAcross the two cohorts, women had cumulatively spent a total of \u003cspan\u003e$\u003c/span\u003e53,315 on AH and complementary therapists in the two months preceding the survey, across 530 sessions, and 111 respondents with at least one valid response regarding costs and sessions; endometriosis (n=99), other CPP (n=12). Women who accessed CM or AH services spent an average of \u003cspan\u003e$\u003c/span\u003e480.32. Women in the endometriosis cohort, on average spent a total of \u003cspan\u003e$\u003c/span\u003e460.04, compared to women in the other CPP cohort who spent \u003cspan\u003e$\u003c/span\u003e647.58. Figure \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e outlines the cumulative cost per therapy in each cohort.\u003c/p\u003e\n \u003cp\u003eWomen in the endometriosis cohort spent the most money on physiotherapists (\u003cspan\u003e$\u003c/span\u003e10,525), followed by mental health workers (\u003cspan\u003e$\u003c/span\u003e7,555), naturopaths (\u003cspan\u003e$\u003c/span\u003e7,320) and acupuncturists (\u003cspan\u003e$\u003c/span\u003e6,587). Women in the other CPP cohort spent the most money on mental health workers (\u003cspan\u003e$\u003c/span\u003e1,950), followed by physiotherapists (\u003cspan\u003e$\u003c/span\u003e1,215), Clinical Pilates therapists (\u003cspan\u003e$\u003c/span\u003e1,000) and acupuncturists (\u003cspan\u003e$\u003c/span\u003e900).\u003c/p\u003e\n \u003cp\u003eTotal expenditure across the two cohorts was highest for physiotherapists (\u003cspan\u003e$\u003c/span\u003e11,740), followed by mental health workers (\u003cspan\u003e$\u003c/span\u003e9,505), naturopaths (\u003cspan\u003e$\u003c/span\u003e7,936) and acupuncturists (\u003cspan\u003e$\u003c/span\u003e7,487). The lowest expenditure was on reflexologists with a total of \u003cspan\u003e$\u003c/span\u003e80 across the two cohorts.\u003c/p\u003e\n \u003cp\u003eExcluding therapists with only one respondent, naturopaths had the highest cost per session (\u003cspan\u003e$\u003c/span\u003e187.65), followed by nutritionist/dietitians (\u003cspan\u003e$\u003c/span\u003e131.07), mental health workers (\u003cspan\u003e$\u003c/span\u003e127.27) and acupuncturists (\u003cspan\u003e$\u003c/span\u003e87.83). Figure 2 outlines the weighted mean cost per session per therapist with data from both cohorts.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec11\"\u003e\n \u003ch2\u003ePredictive Factors for AH/CM usage:\u003c/h2\u003e\n \u003cp\u003eA statistically significant positive correlation was found between education levels and number of AH or complementary therapists accessed in the past two months when looking at combined data for both cohorts, r\u003csub\u003es\u003c/sub\u003e = 0.204 (p \u0026lt;0.001). A statistically significant positive correlation was found between income levels and number of therapists accessed when looking at combined data for both cohorts, r\u003csub\u003es\u003c/sub\u003e = 0.108 (p = 0.028).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study found that usage of CM or AH therapists was common amongst all those with CPP, irrespective of diagnosis. The use of complementary therapies is similar to other usage estimates found in Australian women with endometriosis (42.9%) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and higher than prevalence estimates of the general Australian population (36.0%) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. These high rates of usage are not unexpected given that predictive factors for CM usage are being female, \u0026lt;65 years old, well-educated and with chronic, unresolved health problems[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWomen with endometriosis are often dissatisfied with medical treatments due to side effect profiles and unsatisfying interactions with medical staff [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. These factors may lead to women with endometriosis feeling disempowered in the medical system. As such, patients may choose to see CM or AH practitioners, to increase feelings of empowerment [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Many doctors have expressed frustration with a lack of treatment options to offer women with endometriosis [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] and for not receiving adequate training in dealing with the complex psychosocial issues involved in CPP [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. These factors may contribute to why women often report feeling dismissed or their pain experience minimised when visiting their doctor [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], and why they may choose to seek out CM or AH care despite the additional cost.\u003c/p\u003e \u003cp\u003eDifferences in the prevalence of use of various CM and AH modalities in our respondents may have a number of contributing factors. Allied health practitioners such as physiotherapists may have higher usage due to the Chronic Disease Management program in Australia which grants patients access to five subsidised AH sessions per year [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] but does not provide this for CM services. Previous studies have shown that less than one in five women with endometriosis in Australia actually have a chronic disease management plan [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and therefore it\u0026rsquo;s unclear how much of a contributor this would be to differences in AH vs CM usage.\u003c/p\u003e \u003cp\u003eDespite their popularity, there is limited high-quality evidence for each therapy accessed, including physiotherapy/physical therapy techniques such as pelvic floor muscle down-training[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], acupuncture [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] and psychological therapies [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. There is no current research on naturopathy as a whole systems therapy but some evidence to suggest that supplements such as palmitoylethanolamide (PEA) that may be prescribed by a naturopath could be useful in managing pain [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Considering the popularity of these therapies within our cohort, as well as the significant cost burden associated, resources should be allocated into exploring the effectiveness of these therapies. In Australia, the National Action Plan for Endometriosis[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] acknowledges that endometriosis research into AH and complementary therapies should be prioritised. Our research suggests five key areas could be prioritised based on current usage: physiotherapy, psychology, acupuncture, massage and naturopathy.\u003c/p\u003e \u003cp\u003eOur study found an association between increasing income and education levels and greater AH/CM therapy usage, consistent with other studies which found that education levels are positively correlated with complementary therapy usage [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. There is conflicting evidence about whether income is associated with CM usage, however most studies report there is either a positive relationship or no relationship [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This suggests there may be equity and accessibility issues for patients with lower levels of education and/or income.\u003c/p\u003e \u003cp\u003eIn Australia, the Australian government acknowledges increasing accessibility to CM therapies as a priority in the National Action Plan for Endometriosis, but no such guidance exists for those with CPP from other causes. These significant rates of CM therapy usage in managing chronic pelvic pain are not specific to Australia [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] and therefore given the significant out of pocket costs associated with endometriosis in other countries [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], it is likely that issues of cost and accessibility are present across a wide variety of geographical locations.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eThe main strengths of our study are that the results are consistent with the literature, there is a diverse range of respondents, and it uses the EndoCost tool which provides a large amount of comparable data. However, there are some important limitations that need to be outlined. Firstly, responses were self-reported and due to the anonymous nature of the survey no confirmation of diagnosis could be sought. However, a self-reported diagnosis of endometriosis is accurate in most cases[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Secondly, information about private health insurance was not collected. This may confound results as having private health insurance with extra cover has been shown to be associated with CM usage in Australian women with endometriosis [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and therefore it is unclear if the costs found reflect a full fee or out-of-pocket cost. Finally, our sample had a high proportion of Caucasian respondents, which may have influenced the prevalence as there is some evidence to suggest CM usage is higher in Caucasian populations [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study found that women with CPP, regardless of cause, have high rates of CM and AH usage, associated with a high cost to patients. Common therapies accessed within this population include physiotherapy, mental health care, acupuncture, massage therapy and naturopathy. Key drivers for seeking out CM or AH may be lack of effective medical treatment options or side effects. There was a positive association between usage of CM and/or AH and education and income levels. Given the high rate of usage, further research into the efficacy of specific treatments may be warranted. Moreover, the high cost and associations with income and education levels may warrant a change to policy to improve equitable access to these services.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval: \u003c/strong\u003eEthical approval was obtained from Western Sydney University Human Ethics Committee H12019 (approved 21\u003csup\u003est\u003c/sup\u003e January 2017). All research complied with the relevant guidelines and regulations outlined in the National Statement on Ethical Conduct in Human Research (2018). Informed consent was gained prior to participants completing the survey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e AM, JS, CS, MA are part of NICM Health Research Institute. As a medical research institute, NICM receives research grants and donations from foundations, universities, government agencies, individuals and industry. Sponsors and donors provide untied funding for work to advance the vision and mission of the Institute. The project that is the subject of this article was not undertaken as part of a contractual relationship with any organisation other than the funding declared in the Acknowledgements. It should also be noted that NICM Health Research Institute conducts clinical trials relevant to this topic area, for which further details can be provided on request. MA is a clinical advisory board member for Endometriosis Australia. JA is the medical director for Endometriosis Australia. CN reports nothing to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e Thank you to all the endometriosis organisations who distributed this survey including Endometriosis Australia, EndoActive and the Pelvic Pain Foundation of Australia. Thank you to the World Endometriosis Research Federation (WERF) for providing the EndoCost tool.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions: \u003c/strong\u003eConceived and designed the study MA, CS, JA Data collection MA. Data analysis AM, MA. Project supervision MA. Contributed to writing the manuscript; Original draft AM, MA, JS. Review and editing MA, AM, JS, CN, JA, CS. All authors approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material: \u003c/strong\u003eThe datasets used and/or analysed during the current study are not publicly available due to ethical restrictions available from the corresponding author on reasonable request.\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclaimers:\u003c/strong\u003e The views, opinions, findings, and conclusions or recommendations expressed in this \u003cem\u003epaper\u003c/em\u003e are strictly those of the \u003cem\u003eauthor\u003c/em\u003e(s).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding: \u003c/strong\u003eNo external funding was provided. AM was funded by an internal Western Sydney University Summer Scholarship. \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDaniels JP, Khan KS: \u003cb\u003eChronic pelvic pain in women\u003c/b\u003e. \u003cem\u003eBMJ\u003c/em\u003e 2010, \u003cb\u003e341\u003c/b\u003e:c4834.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhangari A: \u003cb\u003ePrevalence of chronic pelvic pain among women: an updated review\u003c/b\u003e. \u003cem\u003ePain Physician\u003c/em\u003e 2014, \u003cb\u003e17\u003c/b\u003e(2):E141-147.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u003cb\u003eEAU Guidelines on Chronic Pelvic Pain\u003c/b\u003e [https://\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003euroweb.org/wp-content/uploads/EAU-Guidelines-on-Chronic-Pelvic-Pain-2020\u003c/span\u003e\u003c/span\u003e.pdf]\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChapron C, Marcellin L, 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\u003cb\u003e38\u003c/b\u003e(2):260\u0026ndash;271.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen L, Michalsen A: \u003cb\u003eManagement of chronic pain using complementary and integrative medicine\u003c/b\u003e. \u003cem\u003eBmj\u003c/em\u003e 2017, \u003cb\u003e357\u003c/b\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimoens S, Dunselman G, Dirksen C, Hummelshoj L, Bokor A, Brandes I, Brodszky V, Canis M, Colombo GL, DeLeire T \u003cem\u003eet al\u003c/em\u003e: \u003cb\u003eThe burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres\u003c/b\u003e. \u003cem\u003eHum Reprod\u003c/em\u003e 2012, \u003cb\u003e27\u003c/b\u003e(5):1292\u0026ndash;1299.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShafrir AL, Wise LA, Palmer JR, Shuaib ZO, Katuska LM, Vinayak P, Kvaskoff M, Terry KL, Missmer SA: \u003cb\u003eValidity of self-reported endometriosis: a comparison across four cohorts\u003c/b\u003e. \u003cem\u003eHum Reprod\u003c/em\u003e 2021, \u003cb\u003e36\u003c/b\u003e(5):1268\u0026ndash;1278.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"complementary medicine, allied health, endometriosis, pelvic pain, cost of illness","lastPublishedDoi":"10.21203/rs.3.rs-1164738/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1164738/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground \u003c/strong\u003eChronic pelvic pain (CPP) causes non-cyclical pelvic pain, period pain, fatigue and other painful symptoms. Current medical and surgical management strategies are often not sufficient to manage these symptoms and may lead to uptake of other therapies. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAims \u003c/strong\u003eTo determine the prevalence of allied health (AH) and complementary therapy (CM) use, the cost burden of these therapies and explore predictive factors for using allied health or complementary medicines.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMaterials and Methods \u003c/strong\u003eAn online cross-sectional questionnaire using the WERF EndoCost tool was undertaken between February to April 2017. People were eligible to participate in the survey if they were aged 18-45, living in Australia and had chronic pelvic pain. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eFrom 409 responses, 340/409 (83%) of respondents reported a diagnosis of endometriosis. One hundred and five (30%) women with self-reported endometriosis, and thirteen (18%) women with other forms of CPP saw at least one AH or CM practitioner in the previous two months, with physiotherapists and acupuncturists the most common. Women who accessed CM or AH services spent an average of $480.32 AUD in the previous two months. A positive correlation was found between education and number of AH or CM therapies accessed in the past two months (p\u0026lt;0.001) and between income level and number of therapists (p=0.028).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions \u003c/strong\u003eWomen with CPP commonly access AH and CM therapies, with a high out of pocket cost. The high cost and associations with income and education levels may warrant a change to policy to improve equitable access to these services.\u003c/p\u003e","manuscriptTitle":"Allied Health and Complementary Therapy Usage in Australian Women With Chronic Pelvic Pain: a Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-12-29 22:18:41","doi":"10.21203/rs.3.rs-1164738/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2022-01-07T15:17:39+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-12-28T13:39:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"78a60429-df39-4ea2-9cff-d5fcf0b4d145","date":"2021-12-28T13:37:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"428a1ffe-d274-440d-802a-ab5745dab951","date":"2021-12-28T13:37:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2021-12-28T11:28:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2021-12-23T12:18:56+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2021-12-23T11:10:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2021-12-23T11:05:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2021-12-13T01:19:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"35baf62d-692d-451d-949e-013cac4ab3f3","owner":[],"postedDate":"December 29th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":9414740,"name":"Obstetrics \u0026 Gynecology"},{"id":9414741,"name":"Sexual \u0026 Reproductive Medicine"}],"tags":[],"updatedAt":"2022-02-11T07:49:18+00:00","versionOfRecord":{"articleIdentity":"rs-1164738","link":"https://doi.org/10.1186/s12905-022-01618-z","journal":{"identity":"bmc-womens-health","isVorOnly":false,"title":"BMC Women's Health"},"publishedOn":"2022-02-11 07:49:18","publishedOnDateReadable":"February 11th, 2022"},"versionCreatedAt":"2021-12-29 22:18:41","video":"","vorDoi":"10.1186/s12905-022-01618-z","vorDoiUrl":"https://doi.org/10.1186/s12905-022-01618-z","workflowStages":[]},"version":"v1","identity":"rs-1164738","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1164738","identity":"rs-1164738","version":["v1"]},"buildId":"B-jG_2CBjPDmsCi4Wdhf-","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}