FATIGUE–ENDO: Decision Gate

Fatigue is frequently reported by people with endometriosis, yet it is rarely assessed as a separate clinical problem and is often attributed to pain or inflammation alone. This protocol presents FATIGUE–ENDO™: Decision Gate, an author-developed conceptual pathway that structures the consultation for persistent fatigue in a patient with endometriosis into five sequential decision gates: (1) safety and alternative causes, (2) fatigue phenotype, (3) differential assessment, (4) mechanism and treatment priority, (5) response monitoring by function. The pathway draws on published observational studies, systematic reviews and the NICE guideline on myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). It gives working definitions, a specification for each gate, an intervention review matrix, a minimum documentation set and a proposed validation sequence. To give clinicians a transparent, repeatable order of questions for a patient with endometriosis and persistent fatigue, so that fatigue is assessed in its own right and is not reduced to a by-product of pelvic pain.