InsideHer Clinician Aid

Clinician Endometriosis Treatment Decision Aid

A printable clinical aid for matching the dominant presentation to initial management, referral, surgery, fertility-priority care, and persistent-pain follow-up.

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Start Here

Name the dominant management aim before choosing the next step.

The main decision is rarely “medicine or surgery?” in the abstract. It is more often: empirical symptom suppression, diagnostic clarification, specialist referral, fertility progression, or persistent-pain reframing.

Empirical medical management Referral logic Surgery framing Fertility priority

Best Shortcut

Use the lowest-burden coherent step, then define the review trigger.

Decision quality improves when the note makes the treatment goal, likely gain, time horizon, and escalation criteria visible from the start.

Main Pathway

Early pain-dominant consult

Consider analgesia plus an appropriate hormonal option when symptoms are cyclical and fertility is not the immediate priority.

Main Pathway

Possible deep disease

Escalate imaging and specialist referral when bowel, bladder, ureter, deep dyspareunia, or endometrioma features suggest disease complexity.

Main Pathway

Fertility-priority care

Reframe away from routine suppression when conception timing, reserve, ART planning, or prior surgery now drive the decision.

Main Pathway

Persistent pain after prior treatment

Reassess pain phenotype, function, and multidisciplinary support rather than relying on serial treatment cycling alone.

When Empirical Medical Management Fits

  • Pain is clearly cyclical and function-limiting.
  • Prior hormonal exposure has not already been exhausted.
  • There is no strong suspicion of organ-involving deep disease.
  • Pregnancy is not the immediate goal.

When To Escalate Imaging Or Referral

  • Cyclical bowel or urinary symptoms suggest deeper disease.
  • Deep dyspareunia or anatomical concern is prominent.
  • Persistent high-impact symptoms remain after reasonable empirical treatment.
  • Endometrioma or extra-pelvic concern is present or suspected.

When Fertility Overrides Usual Logic

  • The patient is trying to conceive now or soon.
  • Another suppressive trial is likely to delay a more useful fertility step.
  • Endometrioma surgery needs reserve-aware reasoning.
  • ART or fertility referral may be more coherent than routine escalation.

What To Document Clearly

  • The dominant symptom pattern and functional burden
  • Current fertility position
  • The treatment being trialed and its intended goal
  • How response will be judged
  • What would trigger referral, imaging, surgery discussion, or pain-service input

Reopen The Pathway If

The patient is technically treated but still substantially impaired.