TelehealthEndometriosis

Telehealth: Enhancing Access and Continuity of Care for Endometriosis Patients 

Introduction 

Endometriosis is a common condition that impacts around 1 out of every 10 women during their reproductive years. Women with endometriosis often experience pelvic pain, painful periods, and difficulty getting pregnant. However, the effects go beyond just physical pain. Endometriosis can disrupt daily activities, social life, mental health, and overall quality of life. Managing endometriosis symptoms and getting proper medical care can be challenging for many patients. This highlights the importance of providing comprehensive, personalized support for women with this condition. 

At MARCH Health, we are committed to revolutionizing women’s healthcare, with a particular focus on addressing the multifaceted nature of endometriosis. Our innovative Onion-Layer model offers escalating levels of personalized care to meet each woman’s unique needs. The model builds upon itself in layers, ensuring women get the right type and level of care at the right time based on their specific health situation and risk factors. As women’s needs change, they can seamlessly transition through the layers for more specialized care. 

Our mission goes beyond just addressing endometriosis – we are dedicated to comprehensively improving all aspects of women’s health worldwide. We recognize that women have diverse and multifaceted healthcare needs throughout their lives. Our innovative approach provides personalized, holistic care tailored to each woman’s unique health requirements. 

This white paper will outline our innovative approach to improving women’s healthcare globally. We’ll highlight our strategies for better managing endometriosis, as well as our broader commitment to advancing all aspects of women’s health worldwide. By making endometriosis a priority alongside other critical women’s health needs, our goal is to set a new higher standard for delivering excellent healthcare to women. Our mission is to ensure every woman receives the high-quality, personalized care and support she deserves. 

Telehealth: Enhancing Access and Continuity of Care for Endometriosis Patients 

Endometriosis, a chronic condition affecting millions of women worldwide, often presents challenges in accessing timely and specialized care. Telehealth and virtual meetings offer a promising solution to overcome these barriers, providing endometriosis patients with improved access, convenience, and continuity of care. By leveraging technology, healthcare providers can deliver comprehensive management strategies tailored to individual needs, regardless of geographic location. 

Benefits of Telehealth for Endometriosis Management 

  • Improved Access to Specialized Care 

Telehealth modalities, such as video consultations and remote monitoring, enable patients in rural or remote areas to receive care from endometriosis experts without the need for extensive travel. This is particularly beneficial given the delays and challenges many face in obtaining an accurate diagnosis and appropriate treatment. 

  • Continuity of Care and Follow-up 

Virtual visits allow for ongoing management, monitoring of symptoms, treatment adherence, and addressing concerns remotely after an initial in-person consultation. This continuity of care is crucial for effectively managing the chronic and often fluctuating nature of endometriosis. 

  • Delivery of Interventions and Education 

Telehealth platforms facilitate the virtual delivery of interventions such as exercise programs, pain management techniques, and educational sessions. Patients can participate in these activities from the comfort of their homes, enhancing engagement and adherence. 

  • Virtual Reality for Pain Relief 

Pilot studies suggest that virtual reality (VR) exercise sessions may be as effective as telehealth exercise in providing short-term pain alleviation for endometriosis patients. VR exercises can distract from and alter pain processing, offering a novel approach to pain management. 

  • Convenience and Flexibility 

Self-managed digital interventions like VR exercise allow patients to engage in their care on their own schedule, accommodating busy lifestyles and personal preferences. 

  • Multidisciplinary Care 

Telehealth platforms enable patients to connect virtually with various healthcare providers, such as physiotherapists, psychologists, and nutritionists, facilitating a comprehensive and multidisciplinary approach to endometriosis management. 

  • Triage and Appropriate Utilization 

Telehealth visits can address concerns that do not require physical examination, allowing for appropriate triage and utilization of in-person visits when necessary. 

By leveraging telehealth and virtual meeting technologies, healthcare providers can enhance access, provide specialized care, and deliver multi-modal interventions for endometriosis patients, particularly those facing geographic or logistical barriers. While telehealth cannot fully replace in-person care, it offers promising opportunities to improve the overall management and quality of life for those living with this debilitating condition. 

Evidence of Efficacy 

Based on the study by Lutfi et al. (2023), here are the key findings regarding the use of virtual reality (VR) exercise and telehealth exercise for providing short-term pain relief in women with endometriosis: 

  • This was a pilot randomized controlled study with 22 women with endometriosis experiencing pelvic pain. Participants were randomly assigned to one of three groups: VR-delivered exercise, telehealth-delivered exercise, or a control group. 
  • The VR exercise group completed a 1-hour unsupervised session consisting of a 10-minute VR pain-distraction experience followed by 50 minutes of exercise using a VR application of their choice (e.g., Fruit Ninja, Table Tennis VR, Dance Central). 
  • The telehealth exercise group underwent a 1-hour supervised exercise session via videoconference, including cardiorespiratory exercises, stretching, and stabilizing exercises for the lumbopelvic area. 
  • While there were no statistically significant differences in pain scores between the three groups after a single session, the study found a “medium-to-large” time interaction effect. This suggests more favorable changes in pain scores after one VR-delivered and telehealth-delivered exercise session compared to the control group. 
  • The authors note that these findings are consistent with previous research showing a 10–20 minute VR session can alleviate pain in participants with chronic pain and endometriosis, with one study reporting a 36.7% reduction in global pain scores for the VR group compared to control. 
  • A proposed mechanism is that VR and telehealth exercise may alter how pain is processed in the central nervous system, as performing an attention-demanding task like exercise reduces the capacity for pain processing. 
  • The availability of self-managed digital health tools like VR exercise is particularly beneficial for those with busy lifestyles or limited access to in-person healthcare, such as those living in rural/remote areas. 

This pilot study suggests that single sessions of VR-delivered and telehealth-delivered exercise may provide immediate, short-term relief from pelvic pain associated with endometriosis, potentially by altering pain processing. Self-managed digital interventions show promise as accessible options for endometriosis pain management. 

The study by Rosielle et al. (2021) provides insights into the efficacy of telehealth for endometriosis patients during the COVID-19 pandemic in the Netherlands. 

  • Positive Reception of Virtual Care: Both infertility and endometriosis patient groups viewed the use of telephone consultations as a good addition to regular care in the future, although not as a complete replacement for physical consultations. 
  • Video Consultations Preferred: All groups, including healthcare providers, were positive about video consultations, which were seen as more personal compared to telephone consultations. However, video consultations had not been widely implemented at the time of the study. 
  • Continuity of Care: The study highlights the importance of maintaining continuity of care for endometriosis patients during the pandemic. Healthcare providers were advised to ensure accessibility for endometriosis patients and make it clear how patients could reach them with questions or concerns about an increase in endometriosis-related complaints. 

The study by Rosielle et al. (2021) demonstrates the efficacy of telehealth, particularly video consultations, as a valuable addition to regular care for endometriosis patients. 

Understanding the User 

At MARCH Health, we understand the importance of a personalized approach to healthcare, especially when it comes to managing complex conditions like endometriosis. Our health coaching approach begins with a deep understanding of each user’s unique health profile, symptoms, and medical history. 

When women sign up for our app, they begin a journey of self-discovery and taking control of their health. The app allows them to easily input details about their symptoms, medical history, and experiences directly. With user-friendly features and intuitive interfaces, women can log check-ins in different categories, such as: 

  • Symptoms 
  • Feelings 
  • Breast Health 
  • Pain Areas and Levels 
  • Vaginal Health 
  • Sex Life 
  • Sleep Health 
  • Lifestyle & Habits 

The process of entering this personal health information into the app is straightforward and accessible. 

While women are entering their details into the app, our team is working behind the scenes to compile a comprehensive report of their full medical history. This report covers many important areas, including: 

  • Personal Information 
  • Reproductive History 
  • Past Gynecological History 
  • Past Medical History 
  • Family Medical History 
  • Pregnancy History 
  • Mental Health History 
  • Current Medication 
  • Social History 

By combining all this information into one report, we can build a complete, holistic profile of each user’s overall health background. This lays the groundwork for fully understanding their unique situation. 

The information women regularly provide through check-ins, combined with our algorithmic analysis of all their data, forms the core of our personalized health coaching approach. Our advanced algorithms carefully examine this wealth of information to: 

  • Identify patterns in their health data 
  • Spot potential trends over time 
  • Find possible connections between different check-ins 

Using these algorithmic insights, we develop customized care plans and interventions tailored specifically for each user’s individual needs. Their personalized recommendations are informed by patterns and connections identified in their own data. 

By analyzing the data women provide, we gain valuable insights into their unique health journey. This allows our trained health coaches to have direct interactions with users through messaging or video calls. 

During these one-on-one coaching sessions, our health experts can: 

  • Discuss their symptoms in more depth 
  • Review and clarify details from their medical history 
  • Get additional context about the data from the app 

Our coaching approach combines data analysis with these personal interactions. This ensures each user’s care plan is firmly grounded in evidence-based practices tailored specifically for their individual needs. 

Personalized coaching fosters trust, empowerment, and collaboration between users and our healthcare team. Our goal is to provide effective, customized interventions while making them an active partner in their own care. 

Engagement with Health Coaches 

At MARCH Health, our health coaches play a pivotal role in bridging the gap between users and our team of experienced midwives and healthcare specialists. Through personalized interactions and evidence-based guidance, our health coaches empower users to take control of their health and well-being. 

Previous studies have shown the benefits of health coaching in improving life habits and overall health.  According to Olsen and Nesbitt’s review: 

  • Health coaching increased physical activity levels by helping overcome barriers and enhancing self-efficacy for exercise. 
  • It improved dietary habits, such as increased fruit/vegetable intake and reduced unhealthy fat consumption, boosting confidence in making healthy food choices. 
  • Several studies found health coaching facilitated weight loss and BMI reductions by supporting lifestyle changes for weight management. 
  • Coaching interventions improved physiological markers like blood pressure, cholesterol, and glycemic control, reducing chronic disease risk. 
  • Participants developed greater self-efficacy and intrinsic motivation for sustaining healthy behaviors through the collaborative, patient-centered approach. 
  • Health coaching can be a cost-effective preventive care strategy by promoting lifestyle changes that may reduce the need for intensive medical interventions. 

Interpreting User Data 

Our health coaches utilize the extensive data collected from the symptoms and medical details users provide in the app. Combined with our algorithmic analysis, this gives a comprehensive view of their unique health profile. 

By interpreting all this data, our coaches can: 

  • Identify patterns in your symptoms and health status 
  • Spot potential trends over time 
  • Recognize possible triggers or risk factors 
  • Assess the severity and frequency of your symptoms 

This data-driven approach allows our coaches to tailor their guidance and recommendations specifically for your individual needs and concerns. They can track changes, understand impacts, and develop personalized interventions based on insights from your own data. 

Facilitating Direct Communication 

Direct communication between women and their health coaches happens through messaging or video calls within our application. These interactive sessions give women a platform to: 

  • Discuss their symptoms in depth 
  • Ask questions about their health 
  • Seek guidance from our healthcare professionals 

During these personal conversations, health coaches actively listen to women’s concerns with empathy and without judgment. Our coaches aim to create a supportive environment where women feel comfortable openly discussing their health issues. The open line of communication empowers women to take an active role in managing their health. 

Structured Framework for Interaction 

Health coaches follow a structured framework to guide their interactions with women, ensuring consistent and effective delivery of care and support. This framework outlines key questions and considerations based on each woman’s symptoms, medical history, and potential health concerns. 

Additionally, our health coaches are trained to recognize “red flags” that may indicate a woman requires further evaluation or intervention. In such cases, coaches will refer the woman to the appropriate level of care within our Onion-Layer model, such as: 

  • Virtual consultations with OB/GYN specialists 
  • In-person appointments with OB/GYNs 

By following this structured approach and leveraging their expertise, health coaches provide personalized care tailored to each woman’s unique health needs and goals. Through compassionate guidance and continuous monitoring, coaches empower women to make informed decisions about their health and well-being, ultimately improving their quality of life. 

Symptom Assessment and Refinement 

At MARCH Health, we prioritize thorough symptom assessment and refinement to ensure that our users receive the most accurate and personalized care possible. Our health coaching approach involves a systematic process of gathering, analyzing, and refining user check-ins to develop tailored care plans and interventions. 

Process of Symptom Assessment 

The symptom assessment process begins when women input their symptoms and medical history into our application. This includes common endometriosis symptoms such as: 

  • Pelvic pain 
  • Painful periods 
  • Gastrointestinal issues 
  • Painful sex 
  • Pain during urination 
  • Fatigue 
  • Other related symptoms 

Women can provide detailed descriptions of each symptom, noting severity, duration, and any potential triggers or factors that make symptoms worse. 

Once these symptom details are recorded, our advanced algorithms analyze the data to identify patterns and trends. Health coaches then review the compiled data to gain a comprehensive understanding of each woman’s unique symptom profile and overall health status. 

Interactive Sessions for Refinement 

To further refine the symptom assessment, health coaches have direct communication with women through messaging or video calls in the app. During these interactive sessions, coaches ask targeted questions to clarify symptom details and gather any additional information needed. 

Health coaches provide an empathetic, supportive environment where women feel comfortable openly discussing their symptoms and concerns. By actively involving women in this refinement process, coaches ensure that personalized care plans and interventions directly address each woman’s specific needs and goals. 

Through open dialogue and active listening, a clear understanding of the woman’s unique symptom experience is achieved. This collaborative approach results in highly tailored, individualized care. 

Significance of Continuous Monitoring 

Continuous monitoring is essential for tracking changes in women’s symptoms and overall well-being over time. To facilitate this, we provide regular questionnaires focused on: 

  • Mental Health 
  • Medical Health 
  • Lifestyle Factors 

These questionnaires are given initially when a woman begins, then at 1-month, 3-month, and 6-month intervals. The questionnaires allow women to reflect on their current symptoms, mood, lifestyle habits, and overall quality of life. 

By systematically tracking these factors over time, we gain invaluable insights into how effective our interventions are and how each woman’s overall health status is progressing. This ongoing monitoring ensures we can adapt care plans as needed based on changes. 

Benefits of Symptom Assessment and Refinement 

By prioritizing in-depth symptom assessment and refinement, MARCH Health ensures women receive personalized care and support tailored to their unique health needs and goals. Through continuous symptom monitoring and refinement, care plans and interventions can be adapted as a woman’s situation changes. This optimizes positive outcomes and improves the overall quality of life for women affected by endometriosis. The detailed symptom focus allows for highly individualized care that addresses each woman’s specific circumstances. 

Holistic Care Approach  

At MARCH Health, we take a holistic approach to women’s healthcare. We address not only the visible, obvious symptoms but also uncover any underlying or hidden issues that may impact a woman’s overall well-being. 

Our health coaching team is vital to this comprehensive care approach. Coaches proactively identify both overt and subtle symptoms, guiding women toward accurate diagnoses. They facilitate complete care through telehealth physical examinations in addition to coaching. 

Our goal is to provide whole-person care that treats the entire individual, not just manage surface-level symptoms. This holistic methodology supports women’s total health and well-being. 

Uncovering Latent Symptoms 

Endometriosis can cause a wide range of symptoms beyond just pelvic pain and irregular periods. These subtle, underlying symptoms, if left undetected, can significantly impact a woman’s quality of life and overall health. 

Our health coaches are trained to actively listen, ask probing questions, and recognize potential signs of underlying issues. Through empathetic communication and in-depth symptom discussions, coaches create a safe, supportive environment for women to openly share any concerns. 

By building trust and collaboration, coaches empower women to disclose symptoms they may not have initially recognized or felt comfortable mentioning. This proactive approach allows coaches to uncover hidden symptom patterns, identify potential red flags, and guide women toward appropriate interventions and treatments to address all aspects of their condition. 

Guidance Towards Accurate Diagnoses 

Receiving an accurate diagnosis is essential for effectively managing endometriosis and other health conditions. Health coaches collaborate closely with women to gather comprehensive information about their symptoms, medical history, and lifestyle factors. With this holistic understanding, coaches work alongside women to navigate the diagnostic process. 

Coaches advocate for further evaluation or testing as needed based on evidence-based practices. They facilitate referrals to appropriate healthcare providers and specialists through MARCH Health’s network. This may involve coordinating diagnostic tests, arranging virtual consultations, or guiding women through the healthcare system. 

Health coaches ensure women receive timely and accurate diagnoses. This lays the foundation for developing targeted, effective treatment and management plans tailored to each woman’s specific condition and needs. 

Telehealth-Enabled Physical Examinations 

Physical examinations are a crucial part of the diagnostic process and ongoing management of endometriosis. However, accessing in-person healthcare services can be challenging for some women, especially those in remote areas or with limited mobility. To overcome these barriers, MARCH Health leverages telehealth technology to provide virtual physical examinations conducted by qualified healthcare professionals. 

Our health coaches coordinate these telehealth-enabled physical exams, guiding women through the process so they can receive comprehensive care from the comfort of their own homes. Through secure video conferencing, women can undergo physical assessments, including pelvic exams, under the guidance of experienced clinicians. 

These virtual exams enhance accessibility to healthcare services and promote continuity of care. Women can receive timely evaluations and interventions without needing to schedule in-person appointments. 

By integrating virtual physical exams into our holistic approach, we ensure women receive comprehensive, timely healthcare services regardless of their geographic location or personal circumstances. This innovative telehealth solution exemplifies our commitment to providing personalized, accessible, and effective endometriosis care. 

Empowerment and Support 

At the core of our health coaching approach is empowering women to take ownership of their health and well-being. Our coaches act as supportive guides and allies on each woman’s journey toward better health outcomes through personalized care, education, and advocacy. 

Coaches provide the knowledge, tools, and support women need to make informed decisions about their health. Through collaborative discussions and shared decision-making, women gain a sense of control and confidence to actively participate in managing their care. 

Our coaches understand the importance of addressing physical symptoms as well as the emotional and psychological aspects of health. They create a supportive, non-judgmental environment where women feel heard, understood, and valued. This builds trust and rapport for meaningful interactions. 

Coaches offer compassionate guidance tailored to each woman’s unique needs and goals. This includes developing coping strategies, navigating treatment options, and addressing emotional concerns. Coaches provide continuous encouragement, reassurance, and practical assistance every step of the way. 

In this nurturing environment, women feel empowered to advocate for themselves, ask questions, and express their preferences. Open communication and mutual respect enable women to become active partners in their own healthcare journey. 

At MARCH Health, we believe true empowerment comes from within. By equipping women with the right knowledge, skills, and support, we empower them to take control of their lives and reach their full potential. Together, we strive to make a meaningful difference in women’s lives, one empowering interaction at a time. 

Evolution of Health Coaching 

At MARCH Health, we are committed to continuously enhancing our services to better meet the evolving needs of women. As part of our ongoing efforts to elevate the Health Coaching layer, our vision for the future includes having licensed healthcare professionals play a central role in delivering virtual general medical sessions. 

Our goal is to build upon the foundation of our initial health coaching model and expand our services to provide even greater value to women. We believe every woman deserves access to high-quality, personalized healthcare support tailored to their individual needs. 

By evolving our health coaching offerings, we aim to provide a more comprehensive and enriching experience for women on their health journeys. 

Transition to Licensed Healthcare Professionals 

To enhance our health coaching services, we are transitioning to include licensed nurses, midwives, and general practitioners in the USA as integral members of the coaching team. These licensed healthcare professionals bring extensive expertise and clinical knowledge to our virtual general medical sessions. Their involvement ensures women receive comprehensive support and guidance throughout their treatment journey with MARCH Health. 

Enhanced Support and Guidance 

With licensed healthcare professionals joining our coaching team, our virtual general medical sessions will provide enhanced, comprehensive support and guidance across various healthcare aspects. From discussing medication management and treatment side effects to providing advice on lifestyle changes, our healthcare professionals will empower and support women throughout their treatment experience. 

These licensed professionals will offer tailored advice aligned with each woman’s individual treatment plan and preferences. Leveraging their clinical expertise and adherence to high standards of care, they ensure personalized recommendations to optimize health outcomes. 

Through user-friendly telehealth technology, we aim to create a seamless, accessible platform for women to access this personalized healthcare support from the comfort of homes. Our virtual medical sessions empower women to feel informed, supported, and in control on their journey toward improved health and well-being. 

Expanding our health coaching layer with licensed professionals reflects our commitment to innovation and providing excellent, woman-centered care. This evolution allows us to deliver comprehensive, personalized support, ensuring the highest quality care every step of the way.  

Enhanced Support and Accessibility 

At MARCH Health, we understand the importance of accessible healthcare support. By integrating telehealth technologies into our Health Coaching services, we are revolutionizing how women access personalized medical guidance. Telehealth bridges the gap, offering seamless virtual connections with licensed healthcare professionals from the comfort of home. 

With telehealth, women no longer need to worry about scheduling challenges, traveling to clinics, or waiting in crowded rooms. They can connect with licensed professionals at a convenient time and place. This enhanced accessibility ensures timely support and guidance when it’s needed most, without the barriers often faced in traditional healthcare settings. 

Our virtual general medical sessions are led by licensed healthcare experts who provide an elevated level of support. These professionals offer tailored advice aligned with each woman’s individual treatment plan and preferences. Whether discussing medication, managing side effects, or providing lifestyle guidance, our experts empower women throughout their treatment experience. 

By combining telehealth technology with licensed professionals in our Health Coaching layer, we are improving accessibility to personalized healthcare while raising the standard of care. Women can receive the expert support they need on their healthcare journey. 

Conclusion 

At MARCH Health, we provide personalized, accessible healthcare solutions that empower women to take control of their health and well-being. Our commitment to innovation and excellence shapes our vision for enhanced health coaching and virtual medical sessions within our app. 

By combining telehealth technology with licensed healthcare professionals in our Health Coaching services, we are setting a new standard for healthcare delivery. Our goal is for women to have seamless access to expert medical guidance and support, enabling them to confidently navigate their healthcare journeys. 

MARCH Health’s clear mission is to make personalized healthcare accessible to all women. Through continuous innovation and a steadfast focus on woman-centered care, we are pioneering the future of healthcare, one empowering virtual session at a time. 

References 

  1. Nnoaham KE, Hummelshoj L, Webster P, et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril. 2011;96(2):366-373. 
  1. Ballard K, Lowton K, Wright J. What’s the delay? A qualitative study of women’s experiences of reaching a diagnosis of endometriosis. Fertil Steril. 2006;86(5):1296-1301. 
  1. Davenport, S., Smith, D., & Green, D. J. (2023). Barriers to a Timely Diagnosis of Endometriosis: A Qualitative Systematic Review. Obstetrics and gynecology, 142(3), 571–583.  
  1. Ye, L., Whitaker, L. H. R., Mawson, R. L., & Hickey, M. (2022). Endometriosis. BMJ (Clinical research ed.), 379, e068950.  
  1. Balci B. K. (2022). Is Endometriosis Telemedicine Friendly?. Gynecology and minimally invasive therapy, 11(4), 224–230. 
  1. Lutfi, M., Dalleck, L. C., Drummond, C., Drummond, M., Paparella, L., Keith, C. E., Kirton, M., Falconer, L., Gebremichael, L., Phelan, C., Barry, C., Roscio, K., Lange, B., & Ramos, J. S. (2023). A Single Session of a Digital Health Tool-Delivered Exercise Intervention May Provide Immediate Relief from Pelvic Pain in Women with Endometriosis: A Pilot Randomized Controlled Study. International journal of environmental research and public health, 20(3), 1665.  
  1. Rosielle, K., Bergwerff, J., Schreurs, A. M. F., Knijnenburg, J., De Bie, B., Maas, J. W. M., Nap, A. W., van Wely, M., Lambalk, C. B., Goddijn, M., Custers, I. M., van Loendersloot, L. L., & Mijatovic, V. (2021). The impact of the COVID-19 pandemic on infertility patients and endometriosis patients in the Netherlands. Reproductive biomedicine online, 43(4), 747–755.  
  1. Olsen, J. M., & Nesbitt, B. J. (2010). Health coaching to improve healthy lifestyle behaviors: an integrative review. American journal of health promotion : AJHP, 25(1), e1–e12.  
  1. Dennison L, Morrison L, Conway G, et al. Opportunities and challenges for smartphone applications in supporting health behavior change: qualitative study. J Med Internet Res. 2013;15(4):e86. 
  1. Wolever RQ, Simmons LA, Sforzo GA, et al. A systematic review of the literature on health and wellness coaching: defining a key behavioral intervention in healthcare. Glob Adv Health Med. 2013;2(4):38-57. 
  1. Johnson NP, Hummelshoj L; World Endometriosis Society Montpellier Consortium. Consensus on current management of endometriosis. Hum Reprod. 2013;28(6):1552-1568. 
  1. Zondervan KT, Becker CM, Koga K, et al. Endometriosis. Nat Rev Dis Primers. 2018;4(1):9. 
  1. Dorsey ER, Topol EJ. State of telehealth. N Engl J Med. 2016;375(2):154-161. 
  1. Vidal VL, Acuña R, Murillo JM, et al. The role of telemedicine in the care of patients with chronic conditions in the context of the COVID-19 pandemic in Latin America: viewpoint. J Med Internet Res. 2021;23(1):e19477. 
  1. Bodenheimer T, Handley MA. Goal-setting for behavior change in primary care: an exploration and status report. Patient Educ Couns. 2009;76(2):174-180. 
  1. Deci EL, Ryan RM. Self-determination theory: a macrotheory of human motivation, development, and health. Can Psychol. 2008;49(3):182-185. 
  1. Ventura AS, Ganz ML, Granger E, et al. Assessment of the economic burden of endometriosis in the United States: a systematic review. J Manag Care Spec Pharm. 2019;25(7):823-836. 
  1. Chapron C, Marcellin L, Borghese B, et al. Associated ovarian endometrioma is a marker for greater severity of deeply infiltrating endometriosis. Fertil Steril. 2009;92(2):453-457. 
  1. Shokrnejad-Namin, T.; Amini, E.; Amoozgar, M.; Hariri, A. Evaluating the Prognostic Potential of CA-125 and miRNA Levels in Endometriosis: A Narrative Review . Preprints 2024, 2024041261. https://doi.org/10.20944/preprints202404.1261.v1 

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