2043 Where do Women Draw the Line? Choosing Surgery for Endometriosis After Hormonal Medication Use.

Identify the number and duration of hormonal management modalities utilized by patients with endometriosis prior to undergoing initial surgical evaluation. Cross-sectional study. Tertiary care academic hospital. Forty-four patients with pathology proven endometriosis. Patients were provided with a standardized questionnaire regarding the use of preoperative hormonal medical therapy. Medical therapy categories included: combined oral contraceptive pills (COCP), progesterone only pills (POPs), progesterone intrauterine devices (IUD), injections, implants, gonadotropin releasing hormone agonists (GnRH), selective progesterone receptor modulators, aromatase inhibitors, danazol, and GnRH antagonists. Of 111 patients screened with pathology proven endometriosis, 52 patients met eligibility criteria. The response rate was 84.62% (n=44). Median age of patients was 33 years old. Mean number of gynecologic procedures patients had was 2.6. The mean use of medication was <1 (0.8) prior to undergoing initial surgery for endometriosis (p=0.87). Mean use according to age by decade were the following: 1.1 (20-29 years), 0.7 (30-39 years), 0.6 (40-50 years). Of patients surveyed, 50% used 1 or more hormonal medications whereas 50% did not use any. The mean length of time from the first medication use to initial surgery was 8.1 years. Patients who reported medication use prior to surgery used at least one of the following (N=22): COCP, POP, progesterone IUDs, injections, implants, and selective progesterone receptor modulators. Despite available medical management options for endometriosis treatment, many patients do not use any hormonal medications before choosing surgical intervention. Although multiple modalities exist for medical management, this cohort mainly used progesterone based methods. These medications are used for many years and patients with endometriosis are at high risk for multiple gynecologic procedures. [ABSTRACT FROM AUTHOR]