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Years of unjustified hypoestrogenism, fear, and stress will not improve the management of chronic pelvic pain!

      Agarwal et al
      • Agarwal S.K.
      • Chapron C.
      • Giudice L.C.
      • et al.
      Clinical diagnosis of endometriosis: a call to action.
      should be congratulated for emphasizing that patients with severe chronic pelvic pain should be managed actively. Indeed, years of inadequate treatment, with the assumption that this pain is normal, is deeply frustrating for these patients. Chronic pain may have significant negative impact on a patient’s quality of life, resulting in central sensitization, loss of self-confidence and trust in physicians, and making long-term management more difficult.
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      References

        • Agarwal S.K.
        • Chapron C.
        • Giudice L.C.
        • et al.
        Clinical diagnosis of endometriosis: a call to action.
        Am J Obstet Gynecol. 2019; 220: 354-364
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      Linked Article

      • Clinical diagnosis of endometriosis: a call to action
        American Journal of Obstetrics & GynecologyVol. 220Issue 4
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          Endometriosis can have a profound impact on women’s lives, including associated pain, infertility, decreased quality of life, and interference with daily life, relationships, and livelihood. The first step in alleviating these adverse sequelae is to diagnose the underlying condition. For many women, the journey to endometriosis diagnosis is long and fraught with barriers and misdiagnoses. Inherent challenges include a gold standard based on an invasive surgical procedure (laparoscopy) and diverse symptomatology, contributing to the well-established delay of 4–11 years from first symptom onset to surgical diagnosis.
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      • Reply
        American Journal of Obstetrics & GynecologyVol. 221Issue 2
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          Thank you for your letter entitled “Years of unjustified hypoestrogenism, fear, and stress will not improve the management of chronic pelvic pain!” The goal of our manuscript entitled “Clinical diagnosis of endometriosis: a call to action” 1 was to highlight the current unacceptable delay in diagnosis and to encourage a focus on pain, functioning, and quality of life, with or without a previous surgical diagnosis endometriosis. We agree with your statement “Even minimally invasive surgery is too invasive to manage minimal endometriosis, which is not always progressive and may heal during medical treatment or even spontaneously.”
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