The Curbsiders Internal Medicine Podcast #436 Endometriosis for the Internist with Dr. Cope & Dr. Green
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Apr 22, 2024 
Drs. Cope and Green from Mayo Clinic discuss endometriosis, touching on symptoms, imaging, hormonal treatments, surgical options, and pain management. They emphasize the importance of early diagnosis and patient-centered care in managing this complex condition.
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Use Ultrasound To Triage Severity
- Start with a screening pelvic ultrasound to rule out large endometriomas or signs of severe disease before referral.
- Remember a normal ultrasound does not rule out endometriosis and should not invalidate patient symptoms.
Begin Hormonal Suppression In Primary Care
- For non–pregnancy-seeking patients, start hormonal suppression (combined OCPs or progestin options) and adjust by preference.
- Use shared decision-making and consider fertility goals before initiating treatments that impair conception.
Try Continuous Contraceptives For Better Control
- Offer continuous combined OCPs (skip placebo week) if cyclic dosing fails; counsel on breakthrough bleeding and VTE considerations.
- Tailor route (pill, ring, patch, IUD, implant) to patient tolerability and risk profile.