Navigating the therapeutic itinerary: Access to healthcare services and medications for endometriosis

Background: Endometriosis is a chronic condition causing pain and fertility issues. This study aimed to evaluate access to health services and medication among patients with endometriosis in Brazil. Methods: A cross-sectional study was conducted from March to June 2022, collecting data on clinical diagnosis, access to health services, medications used, and potential barriers to access. Exploratory descriptive analysis was conducted and associated factors were identified through multivariate logistic regression. Results: Eight hundred eighty-five valid responses were obtained. 29.6% of patients took 1–5 years for diagnosis, with private services being the most used for diagnosis (57.6%) and follow-up (52.8%). 90.1% had difficulty finding specialists. Main medication access was through direct purchase (91.2%). People with health insurance were more likely to have full access to medicines than people without (OR = 1.94; 95%CI 1.36–2.77). Older people were less likely to have full access (45–59 years: OR = 0.39 (95%CI 0.19–0.81)) than young adults aged 18–24. Black people were less likely to have full access than white people (OR = 0.61 (95%CI 0.37–0.99)). People with higher incomes were more likely to have full access than poorer people (2–4 minimum wages: OR = 2.10 (95%CI 1.41–3.12)). The most used drugs were sex hormones and modulators of the genital system (90.5%), especially hormonal contraceptives for systemic use. Off-label use of antidepressants and antiepileptics was commonly observed for the treatment of endometriosis. Conclusion: The study revealed that patients with endometriosis face significant challenges in accessing treatment in Brazil, particularly due to the limited therapeutic options and off-label use of medications.