Most women with endometriosis-associated pelvic pain who chose a stepped-care approach were satisfied with OC and a low-cost progestin for the treatment of their symptoms. The need to step up to an expensive progestin or surgery was marginal.
Aims: The economic burden of endometriosis and pelvic pain involves direct and indirect healthcare costs due to work loss and decreased productivity. However, the relation between endometriosis, pelvic pain, and employment remains underinvestigated. This study aimed at providing preliminary insights into this topic. Methods: We compared the employment status (having vs. not having a job) in 298 consecutive endometriosis patients and in 332 women without a history of endometriosis (control group). We also examined the association between pelvic pain and employment status. Results: Women with endometriosis were less likely to be employed compared to women without endometriosis (OR 0.508; 95% CI 0.284–0.908; p = 0.022). Women with symptomatic endometriosis were less likely to be employed relative to controls (OR 0.345; 95% CI 0.184–0.650; p = 0.001), as well as to asymptomatic endometriosis patients (OR 0.362; 95% CI 0.167–0.785; p = 0.01). No significant differences emerged between asymptomatic endometriosis and the control group (p > 0.05). Greater severity of dysmenorrhea, dyspareunia, chronic pelvic pain, and dyschezia was found in unemployed endometriosis patients (vs. employed endometriosis participants). Conclusion: Endometriosis symptoms may significantly affect women’s professional life, with important socioeconomic, legal, and political implications. Community-based participatory research is encouraged.
In a period of generalized economic crisis, it seems particularly appropriate to try to manage a continuing growing sector such as healthcare in the best possible way. The crucial aim of optimization of available healthcare resources is obtaining the maximum possible benefit with the minimum expenditure. This has important social implications, whether individual citizens or tax-funded national health services eventually have to pay the bill. The keyword here is efficiency, which means either, maximizing the benefit from a fixed sum of money, or minimizing the resources required for a defined benefit. In order to achieve these objectives, economic evaluation is a helpful tool. Five different types of economic evaluation exist in the health-care field: cost-minimization, cost-benefit, cost-consequences, cost-effectiveness and cost-utility analysis. The objective of this narrative review is to provide an overview of the principal methods used for economic evaluation in healthcare. Economic evaluation represents a starting point for the allocation of resources, the decision of the valuable investments and the division of budgets across different health programs. Moreover, economic evaluation allows the comparison of different procedures in terms of quality of life and life expectancy, bearing in mind that cost-effectiveness is only one of multiple facets in the decision making-process. Economic evaluation is important to critically evaluate clinical interventions and ensure that we are implementing the most cost-effective management protocols. Clinicians are called to fulfill the complex task of optimizing the use of resources, and, at the same time, improving the quality of healthcare assistance.
The purpose of this study was to assess the proportion of patients satisfied with their treatment after a change from a low-dose oral contraceptive (OC) to norethisterone acetate (NETA) because of inefficacy of OC on pain symptoms. To this end, prospective, self-controlled study was conducted on 153 women using OC as a treatment for endometriosis and with persistence of one or more moderate or severe pain symptoms. At baseline and during 12 months after a shift from OC to oral NETA, 2.5 mg/d, pelvic pain was measured by means of a 0- to 10-point numerical rating scale and a multidimensional categorical rating scale. Variations in health-related quality of life, psychological status, and sexual function were also evaluated with validated scales. At the end of the study period, participants indicated the degree of satisfaction with their treatment according to a 5-degree scale from very satisfied to very dissatisfied. A total of 28 women dropped out of the study, the main reason was intolerable side effects (n = 15). At 12-month assessment, 70% of participants were very satisfied or satisfied with NETA treatment (intention-to-treat analysis). Statistically significant improvements were observed in health-related quality of life, psychological status, and sexual function. At per-protocol analysis, almost half of the patients (58/125) reported suboptimal drug tolerability. However, complaints were not severe enough to cause dissatisfaction, drug discontinuation, or request for surgery. These encouraging results could be used to counsel women with symptomatic endometriosis not responding to OC and to inform their decisions on modifications of disease management.
La distanza anogenitale (AGD) (ovvero la distanza misurata dall'ano al tubercolo genitale) è una caratteristica corporea androgeno-dipendente, che risente dell'esposizione ormonale intrauterina. Studi sull'uomo hanno evidenziato che alterazioni della AGD possono essere associate a malattie dell'apparato riproduttivo, sia negli uomini che nelle donne. In particolare, studi recenti suggeriscono una correlazione tra differenze nella lunghezza della AGD e presenza di patologie ginecologiche, come l'endometriosi e la sindrome dell'ovaio policistico (PCOS). In queste condizioni, infatti, l'esposizione ormonale prenatale (in particolare a ormoni steroidei) può rappresentare un fattore di rischio per lo sviluppo della malattia in età adulta. In questa review narrativa della letteratura vengono riportate le più attuali evidenze sulla relazione tra AGD e la presenza di endometriosi e PCOS. I risultati degli studi a disposizione suggeriscono che una AGD più corta possa essere correlata alla presenza di endometriosi, mentre una AGD più lunga ad un aumentato rischio di PCOS. Alla luce di questi risultati viene discusso il ruolo della misurazione dell'AGD in donne adulte, quale potenziale biomarker (semplice e facilmente riproducibile) di endometriosi e PCOS. Tuttavia, le evidenze scientifiche a disposizione appaiono insufficienti, e sono necessari studi per confermare i limitati risultati attuali.
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