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Vercellini P, Facchin F, Buggio L, Barbara G, Berlanda N, Frattaruolo MP, Somigliana E. Management of Endometriosis: Toward Value-Based, Cost-Effective, Affordable Care. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:726-749.e10. [DOI: 10.1016/j.jogc.2017.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/12/2017] [Indexed: 12/13/2022]
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52
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25-Hydroxyvitamin D Serum Levels and Endometriosis: Results of a Case–Control Study. Reprod Sci 2018; 26:172-177. [DOI: 10.1177/1933719118766259] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
The management of chronic pelvic pain poses a significant challenge to both physicians and patients. Patients should be evaluated for both gynecologic and nongynecologic conditions, and >1 source may be identified. Treatment involves medical as well as surgical options, and it is important to set realistic goals with patients. Treatment may not be curative, but should improve the patient's quality of life.
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Legendre G, Delbos L, Hudon E, Chabbert-Buffet N, Geoffron S, Sauvan M, Fernandez H, Bouet PE, Descamps P. [New medical treatments for painful endometriosis: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018. [PMID: 29530558 DOI: 10.1016/j.gofs.2018.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this work is to evaluate the place of new treatments in the management of endometriosis outside the context of infertility. METHODS A review of the literature was conducted by consulting Medline data until July 2017. RESULTS Dienogest is effective compared to placebo in short term (NP2) and long term (NP4) for the treatment of painful endometriosis. In comparison with GnRH agonists, dienogest is also effective in terms of decreased pain and improved quality of life in non-operated patients (NP2) as well as for recurrence of lesions and symptomatology postoperatively (NP2). Data on GnRH antagonists, selective progesterone receptor modulators as well as selective inhibitors (anti-TNF-α, matrix metalloprotease inhibitors, angiogenesis growth factor inhibitors) are insufficient to provide evidence of interest in clinical practice for the management of painful endometriosis (NP3). CONCLUSION Dienogest is recommended as second-line therapy for the management of painful endometriosis (Grade B). Because of lack of evidence, aromatase inhibitors, elagolix, SERM, SPRM and anti-TNF-α are not recommended for the management of painful endometriosis (Grade C).
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Affiliation(s)
- G Legendre
- Service de gynécologie-obstétrique, CHU Angers, 4, rue Larrey, 49033 Angers cedex 01, France; CESP-Inserm, U1018, équipe 7, genre, santé sexuelle et reproductive, UVSQ, université Paris-Saclay, université Paris Sud, 94807 Villejuif, France.
| | - L Delbos
- Service de gynécologie-obstétrique, CHU Angers, 4, rue Larrey, 49033 Angers cedex 01, France
| | - E Hudon
- Service de gynécologie-obstétrique, CHU Angers, 4, rue Larrey, 49033 Angers cedex 01, France
| | - N Chabbert-Buffet
- Service de gynécologie-obstétrique et médecine de la reproduction, Sorbonne université, centre de recherche Saint-Antoine, GRC-6 centre expert en endométriose (CE3), Assistance publique-Hôpitaux de Paris, hôpitaux universitaires Est parisien-Tenon, 75020 Paris, France
| | - S Geoffron
- Service de gynécologie-obstétrique et médecine de la reproduction, Sorbonne université, centre de recherche Saint-Antoine, GRC-6 centre expert en endométriose (CE3), Assistance publique-Hôpitaux de Paris, hôpitaux universitaires Est parisien-Tenon, 75020 Paris, France
| | - M Sauvan
- Service de gynécologie-obstétrique, Assistance publique-Hôpitaux de Paris, hôpital de Bicêtre, 94276 Le Kremlin Bicêtre cedex, France
| | - H Fernandez
- Service de gynécologie-obstétrique, Assistance publique-Hôpitaux de Paris, hôpital de Bicêtre, 94276 Le Kremlin Bicêtre cedex, France
| | - P-E Bouet
- Service de gynécologie-obstétrique, CHU Angers, 4, rue Larrey, 49033 Angers cedex 01, France
| | - P Descamps
- Service de gynécologie-obstétrique, CHU Angers, 4, rue Larrey, 49033 Angers cedex 01, France
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Vercellini P, Ottolini F, Frattaruolo MP, Buggio L, Roberto A, Somigliana E. Shifting from Oral Contraceptives to Norethisterone Acetate, or Vice Versa, because of Drug Intolerance: Does the Change Benefit Women with Endometriosis? Gynecol Obstet Invest 2018; 83:275-284. [PMID: 29486468 DOI: 10.1159/000486335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 12/14/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIMS Oral contraceptives (OC) and norethisterone acetate (NETA) are among first-line medical therapies for symptomatic endometriosis, but their use is sometimes associated with intolerable side effects. We investigated whether shifting from low-dose OC to NETA (2.5 mg/day), or vice versa, improved tolerability. METHODS Sixty-seven women willing to discontinue their treatment because of intolerable side effects despite good pain relief, were enrolled in a self-controlled study, and shifted from OC to NETA (n = 35) or from NETA to OC (n = 32). The main study outcome was satisfaction with treatment 12 months after the change. Tolerability, pain symptoms, health-related quality of life, psychological status, and sexual functioning were also evaluated. RESULTS After treatment change, good tolerability was reported by 37% of participants who shifted to NETA, and by 52% of those who shifted to OC. At 12-month assessment, 51% of women intolerant to OC were satisfied with NETA, and 65% of those intolerant to NETA were satisfied with OC (intention-to-treat analysis). Other study variables did not vary substantially. CONCLUSIONS In selected endometriosis patients, shifting from OC to NETA, or vice versa, because of side effects, improved tolerability. Better results were observed when substituting NETA with OC rather than the other way round.
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Affiliation(s)
- Paolo Vercellini
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,Gynaecological Surgery and Endometriosis Departmental Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Ottolini
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Maria Pina Frattaruolo
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,Gynaecological Surgery and Endometriosis Departmental Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Buggio
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,Gynaecological Surgery and Endometriosis Departmental Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Roberto
- Department of Public Health, IRCCS Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Edgardo Somigliana
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,Gynaecological Surgery and Endometriosis Departmental Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Vercellini P, Ottolini F, Frattaruolo MP, Buggio L, Roberto A, Somigliana E. Is Shifting to a Progestin Worthwhile When Estrogen-Progestins Are Inefficacious for Endometriosis-Associated Pain? Reprod Sci 2018; 25:674-682. [PMID: 29303056 DOI: 10.1177/1933719117749759] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The purpose of this study was to assess the proportion of patients satisfied with their treatment after a change from a low-dose oral contraceptive (OC) to norethisterone acetate (NETA) because of inefficacy of OC on pain symptoms. To this end, prospective, self-controlled study was conducted on 153 women using OC as a treatment for endometriosis and with persistence of one or more moderate or severe pain symptoms. At baseline and during 12 months after a shift from OC to oral NETA, 2.5 mg/d, pelvic pain was measured by means of a 0- to 10-point numerical rating scale and a multidimensional categorical rating scale. Variations in health-related quality of life, psychological status, and sexual function were also evaluated with validated scales. At the end of the study period, participants indicated the degree of satisfaction with their treatment according to a 5-degree scale from very satisfied to very dissatisfied. A total of 28 women dropped out of the study, the main reason was intolerable side effects (n = 15). At 12-month assessment, 70% of participants were very satisfied or satisfied with NETA treatment (intention-to-treat analysis). Statistically significant improvements were observed in health-related quality of life, psychological status, and sexual function. At per-protocol analysis, almost half of the patients (58/125) reported suboptimal drug tolerability. However, complaints were not severe enough to cause dissatisfaction, drug discontinuation, or request for surgery. These encouraging results could be used to counsel women with symptomatic endometriosis not responding to OC and to inform their decisions on modifications of disease management.
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Affiliation(s)
- Paolo Vercellini
- 1 Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,2 Department of Health of Woman, Child, and Newborn, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Ottolini
- 1 Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Maria Pina Frattaruolo
- 2 Department of Health of Woman, Child, and Newborn, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Buggio
- 2 Department of Health of Woman, Child, and Newborn, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Roberto
- 3 Department of Public Health, IRCCS Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Edgardo Somigliana
- 1 Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,2 Department of Health of Woman, Child, and Newborn, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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57
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Vercellini P, Frattaruolo MP, Rosati R, Dridi D, Roberto A, Mosconi P, De Giorgi O, Cribiù FM, Somigliana E. Medical treatment or surgery for colorectal endometriosis? Results of a shared decision-making approach. Hum Reprod 2017; 33:202-211. [DOI: 10.1093/humrep/dex364] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 11/20/2017] [Indexed: 12/27/2022] Open
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Vercellini P, Frattaruolo MP, Buggio L. Toward minimally disruptive management of symptomatic endometriosis: reducing low-value care and the burden of treatment. Expert Rev Pharmacoecon Outcomes Res 2017; 18:1-4. [PMID: 29186995 DOI: 10.1080/14737167.2018.1411803] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Paolo Vercellini
- a Department of Clinical Sciences and Community Health , Università degli Studi di Milano , Milan , Italy.,b Department of Health of Woman, Child, and Newborn , Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Maria Pina Frattaruolo
- a Department of Clinical Sciences and Community Health , Università degli Studi di Milano , Milan , Italy.,b Department of Health of Woman, Child, and Newborn , Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Laura Buggio
- a Department of Clinical Sciences and Community Health , Università degli Studi di Milano , Milan , Italy.,b Department of Health of Woman, Child, and Newborn , Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
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Role of medical therapy in the management of deep rectovaginal endometriosis. Fertil Steril 2017; 108:913-930. [DOI: 10.1016/j.fertnstert.2017.08.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/29/2017] [Accepted: 08/30/2017] [Indexed: 12/17/2022]
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Geoffron S, Legendre G, Daraï E, Chabbert-Buffet N. [Medical treatment of endometriosis: Hormonal treatment of pain, impact on evolution and future perspectives]. Presse Med 2017; 46:1199-1211. [PMID: 29133081 DOI: 10.1016/j.lpm.2017.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 11/30/2022] Open
Abstract
CONTEXT Endometriosis is a chronic painful disease, for which hormone therapy is usually offered as a first line option to women not willing to conceive. OBJECTIVES To analyse and synthesize the literature, from 2006 onwards, on pain control, and disease evolution in oemn using combined hormonal contraceptives, progestins and GnRH analogs. Data on other current and future treatment perspectives is included as well. SOURCES Medline (Pubmed), the Cochrane Library, and endometriosis treatment recommendations published by European Society of Human Reproduction and Embryology (ESHRE), National Institute for health and Care Excellence (NICE), American College of Obstetricians and Gynecologists (ACOG), Royal College of Obstetricians and Gynaecologists (RCOG) and Société des Obstétriciens et Gynécologues du Canada (SOGC). STUDY SELECTION Meta-analysis and clinical trials are included. RESULTS Study quality is heterogeneous in general. Hormone therapy inconstantly allows pain relief and prevention of endometrioma and rectovaginal wall nodules recurrence. Available molecules and routes of administration as well as risk benefit balance are evaluated. Data on future perspectives are limited to date and do not allow use in routine. CONCLUSION Hormonal treatment of endometriosis relies on combined hormonal contraceptives (using different routes of administration), progestins and particularly the levonorgestrel-releasing IUS, and GnRH analogs as a last option, in combination with an add-back therapy. Promising alternatives are currently under preclinical and clinical evaluation.
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Affiliation(s)
- Sophie Geoffron
- AP-HP, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, service de gynécologie-obstétrique, médecine de la reproduction, 75020 Paris, France
| | - Guillaume Legendre
- CHU d'Angers, service de gynécologie-obstétrique, 49000 Angers, France; Université Paris Sud, CESP-Inserm, U1018, équipe 7, genre, santé sexuelle et reproductive, 75000 Paris, France
| | - Emile Daraï
- AP-HP, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, service de gynécologie-obstétrique, médecine de la reproduction, 75020 Paris, France; AP-HP, hôpital Tenon, centre expert en endométriose (C3E), 75020 Paris, France; UPMC, groupe de recherche clinique GRC-6, 75020 Paris, France
| | - Nathalie Chabbert-Buffet
- AP-HP, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, service de gynécologie-obstétrique, médecine de la reproduction, 75020 Paris, France; AP-HP, hôpital Tenon, centre expert en endométriose (C3E), 75020 Paris, France; UPMC, groupe de recherche clinique GRC-6, 75020 Paris, France.
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61
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Buggio L, Somigliana E, Barbara G, Frattaruolo MP, Vercellini P. Oral and depot progestin therapy for endometriosis: towards a personalized medicine. Expert Opin Pharmacother 2017; 18:1569-1581. [DOI: 10.1080/14656566.2017.1381086] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Laura Buggio
- Fondazione Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Edgardo Somigliana
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Infertility Unit, Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giussy Barbara
- Fondazione Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Pina Frattaruolo
- Fondazione Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Paolo Vercellini
- Fondazione Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Grandi G, Mueller MD, Bersinger NA, Facchinetti F, McKinnon BD. The association between progestins, nuclear receptors expression and inflammation in endometrial stromal cells from women with endometriosis. Gynecol Endocrinol 2017; 33:712-715. [PMID: 28412861 DOI: 10.1080/09513590.2017.1314458] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Endometriosis is an inflammatory disease and nuclear receptors play a crucial role in mediating the inflammatory response. In endometrial stromal cells (ESC), nuclear receptors expression can be influenced by the local environment. Progestins are first-line, on-label treatments of endometriosis that may have direct effects on endometriotic lesions through these nuclear receptors. Therefore, we investigated whether there was an association between nuclear receptors expression and the influence of progestins on inflammatory cytokines production in a preliminary, in vitro study with primary cultures. ESC from endometrial biopsies of six subjects with histologically confirmed endometriosis were treated for 6 h with medium alone or with TNF-α (10 or 100 ng/ml) in the presence of dienogest (DNG), medroxyprogesterone acetate (MPA) and norethisterone acetate (NETA) 10-5 M. The progestin-mediated change in IL6, IL8 and MCP-1 mRNA transcription was measured, as was the PRA, PRB, GR, AR and MCR protein expression. The change (medium versus TNF-α 10 ng/ml and medium versus TNF-α 100 ng/ml) in IL6 mRNA transcription was positively associated with the change in PRB, but not PRA with both DNG and NETA treatment. The change in IL8 mRNA was negatively associated with AR expression in the presence of NETA. The change in MCP-1 mRNA expression was positively associated with GR expression and negatively associated with MCR after MPA treatment. The associations between the change in cytokines mRNA expression and nuclear receptors protein expression in response to progestins activity may indirectly suggest different activities of these compounds at a local level worthy of further investigations.
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Affiliation(s)
- Giovanni Grandi
- a Department of Medical and Surgical Sciences for Mother , Child and Adult, University of Modena and Reggio Emilia , Modena , Italy
| | - Michael D Mueller
- b Department of Clinical Research , University of Berne , Berne , Switzerland , and
- c Department of Obstetrics and Gynaecology , Inselspital, Berne University Hospital , Berne , Switzerland
| | - Nick A Bersinger
- b Department of Clinical Research , University of Berne , Berne , Switzerland , and
- c Department of Obstetrics and Gynaecology , Inselspital, Berne University Hospital , Berne , Switzerland
| | - Fabio Facchinetti
- a Department of Medical and Surgical Sciences for Mother , Child and Adult, University of Modena and Reggio Emilia , Modena , Italy
| | - Brett D McKinnon
- b Department of Clinical Research , University of Berne , Berne , Switzerland , and
- c Department of Obstetrics and Gynaecology , Inselspital, Berne University Hospital , Berne , Switzerland
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Becker CM, Gattrell WT, Gude K, Singh SS. Reevaluating response and failure of medical treatment of endometriosis: a systematic review. Fertil Steril 2017; 108:125-136. [PMID: 28668150 PMCID: PMC5494290 DOI: 10.1016/j.fertnstert.2017.05.004] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 05/04/2017] [Accepted: 05/04/2017] [Indexed: 11/17/2022]
Abstract
Objective To assess patient response rates to medical therapies used to treat endometriosis-associated pain. Design A systematic review with the use of Medline and Embase. Setting Not applicable. Patient(s) Women receiving medical therapy to treat endometriosis. Interventions(s) None. Main Outcome Measure(s) The proportions of patients who: experienced no reduction in endometriosis-associated pain symptoms; had pain symptoms remaining at the end of the treatment period; had pain recurrence after treatment cessation; experienced an increase or no change in disease score during the study; were satisfied with treatment; and discontinued therapy owing to adverse events or lack of efficacy. The change in pain symptom severity experienced during and after treatment, as measured on the visual analog scale, was also assessed. Result(s) In total, 58 articles describing 125 treatment arms met the inclusion criteria. Data for the response of endometriosis-associated pain symptoms to treatment were presented in only 29 articles. The median proportions of women with no reduction in pain were 11%–19%; at the end of treatment, 5%–59% had pain remaining; and after follow-up, 17%–34% had experienced recurrence of pain symptoms after treatment cessation. After median study durations of 2–24 months, the median discontinuation rates due to adverse events or lack of efficacy were 5%–16%. Conclusion(s) Few studies of medical therapies for endometriosis report outcomes that are relevant to patients, and many women gain only limited or intermittent benefit from treatment.
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Affiliation(s)
- Christian M Becker
- Endometriosis Care Centre, Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, United Kingdom.
| | - William T Gattrell
- Research Evaluation Unit, Oxford Pharmagenesis, Oxford, United Kingdom; Department of Mechanical Engineering and Mathematical Sciences, Oxford Brookes University, Oxford, United Kingdom
| | - Kerstin Gude
- Medical Affairs Women's Healthcare, Bayer, Berlin, Germany
| | - Sukhbir S Singh
- Department of Obstetrics and Gynaecology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Abstract
INTRODUCTION Much research has gone into developing medications that can be used to alleviate endometriosis-associated symptoms. In addition to already established medications, a new GnRH antagonist, elagolix, is in development. The novelty of this drug compared to other GnRH antagonists, is its nonpeptide structure, allowing it to be administered orally. Areas covered: We analyzed several Phase I, II and III clinical trials that have evaluated the safety and efficacy of this new medication. Expert opinion: Since many medications have been put on the market and have gained popularity for the treatment of endometriosis-associated symptoms, the demonstration of equality or superiority of effect, tolerability, as well as patient compliance should be assessed when introducing a new drug. While elagolix may have an advantage over established GnRH agonists, in that it does not lead to a 'flare-up' effect, it too, takes a toll on bone mineral density. Nevertheless, studies have shown that this new oral GnRH antagonist is well tolerated, and the side effects have been described as 'mild or moderate'. However, in order to examine whether elagolix can compete with or even surpass established gold-standard medical treatments in this field, further studies that directly compare elagolix to said treatments, might be necessary.
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Affiliation(s)
- Alexandra Perricos
- a Department of Obstetrics and Gynecology , Medical University of Vienna , Vienna , Austria
| | - René Wenzl
- a Department of Obstetrics and Gynecology , Medical University of Vienna , Vienna , Austria
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Efficacy and acceptability of long-term norethindrone acetate for the treatment of rectovaginal endometriosis. Eur J Obstet Gynecol Reprod Biol 2017; 213:4-10. [DOI: 10.1016/j.ejogrb.2017.03.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/05/2017] [Accepted: 03/25/2017] [Indexed: 01/01/2023]
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Barbara G, Facchin F, Buggio L, Somigliana E, Berlanda N, Kustermann A, Vercellini P. What Is Known and Unknown About the Association Between Endometriosis and Sexual Functioning: A Systematic Review of the Literature. Reprod Sci 2017; 24:1566-1576. [PMID: 28558521 DOI: 10.1177/1933719117707054] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
It is well known that endometriosis is associated with an increase in the risk of deep dyspareunia, with potential negative effects on global female sexual functioning and couple relationship. The aims of this study were to review the literature on the impact of endometriosis on female sexual functioning and to suggest new avenues for future research and treatment strategies. An electronic database research was performed to identify all the studies on the relation between endometriosis and sexual functioning published in the period 2000 to 2016. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. After the screening process, a total of 9 studies investigating the relation between endometriosis and female sexual functioning were considered. Overall, these studies indicated that around two thirds of women with endometriosis have some form of sexual dysfunction not limited to deep dyspareunia. These findings suggest that the global sexual impact of endometriosis requires further investigation, focusing not only on pain during intercourse but also on psychological and relational dimensions, including partner's sexual functioning. Because sexual functioning is a complex, multidimensional phenomenon, the ideal treatment for endometriosis-related sexual dysfunctions should be conducted by a multidisciplinary team composed of gynecologists, sexologists, and psychologists/psychotherapists.
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Affiliation(s)
- Giussy Barbara
- 1 Department of Women's and Children's Health and Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Facchin
- 2 Faculty of Psychology, Catholic University of Milan, Milan, Italy
| | - Laura Buggio
- 3 Department of Women's and Children's Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Edgardo Somigliana
- 4 Infertility Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Nicola Berlanda
- 3 Department of Women's and Children's Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Kustermann
- 1 Department of Women's and Children's Health and Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Vercellini
- 5 Unità Operativa Dipartimentale di Ginecologia Chirurgica ed Endometriosi, Università degli Studi di Milano, Milan, Italy.,6 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Patel BG, Rudnicki M, Yu J, Shu Y, Taylor RN. Progesterone resistance in endometriosis: origins, consequences and interventions. Acta Obstet Gynecol Scand 2017; 96:623-632. [DOI: 10.1111/aogs.13156] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 04/12/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Bansari G. Patel
- Department of Obstetrics and Gynecology; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Martin Rudnicki
- Department of Obstetrics and Gynecology; Odense University Hospital; Odense Denmark
| | - Jie Yu
- Department of Obstetrics and Gynecology; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Yimin Shu
- Department of Obstetrics and Gynecology; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Robert N. Taylor
- Department of Obstetrics and Gynecology; Wake Forest School of Medicine; Winston-Salem NC USA
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Sarais V, Paffoni A, Pagliardini L, Filippi F, Martinelli F, Mangili G, Candiani M, Papaleo E. Long-acting recombinant follicle-stimulating hormone in random-start ovarian stimulation protocols for fertility preservation in women with cancer. Acta Obstet Gynecol Scand 2017; 96:949-953. [PMID: 28382680 DOI: 10.1111/aogs.13146] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/31/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The objective of this study was to assess the effectiveness and potential benefits of the use of long-acting recombinant follicle-stimulating hormone (FSH) in a random-start protocol for fertility preservation in women with cancer. MATERIAL AND METHODS This is a retrospective before-and-after study performed between February 2013 and December 2015 in women who underwent ovarian hyperstimulation for oocyte cryobanking using a random-start approach. In the first part of the study period, the women were treated with daily recombinant FSH whereas in the second part the stimulation was initiated with long-acting recombinant FSH. The primary aim of the study was to compare the number of oocytes stored in the two study periods. In all, 140 women were ultimately selected. RESULTS Compared with daily recombinant FSH, the use of the long-acting compound was associated with a reduced number of injections (12.5 ± 3.5 vs. 16.4 ± 0.3; p < 0.001) and a longer duration of stimulation (11.4 ± 1.9 vs. 10.6 ± 1.9, p = 0.01). Conversely, the number of oocytes collected (13.7 ± 9.5 vs. 11.3 ± 7.0, p = 0.10) as well as those cryopreserved (11.0 ± 8.0 vs. 9.5 ± 5.8, p = 0.21) did not differ. CONCLUSIONS The use of long-acting recombinant FSH in random-start protocols for fertility preservation appears to be a valuable option.
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Affiliation(s)
- Veronica Sarais
- Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Milan, Italy
| | - Alessio Paffoni
- Department of Obstetrics and Gynecology, Fondazione Ca' Granda, Ospedale Maggiore Policlinic, Milan, Italy
| | - Luca Pagliardini
- Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Filippi
- Department of Obstetrics and Gynecology, Fondazione Ca' Granda, Ospedale Maggiore Policlinic, Milan, Italy
| | - Fabio Martinelli
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy
| | - Giorgia Mangili
- Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Candiani
- Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Milan, Italy
| | - Enrico Papaleo
- Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Milan, Italy
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Long-term medical management of endometriosis with dienogest and with a gonadotropin-releasing hormone agonist and add-back hormone therapy. Fertil Steril 2017; 107:537-548. [DOI: 10.1016/j.fertnstert.2016.12.024] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 12/19/2016] [Accepted: 12/22/2016] [Indexed: 11/22/2022]
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Progestin-only pills may be a better first-line treatment for endometriosis than combined estrogen-progestin contraceptive pills. Fertil Steril 2017; 107:533-536. [DOI: 10.1016/j.fertnstert.2017.01.003] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/01/2017] [Accepted: 01/06/2017] [Indexed: 11/23/2022]
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Surgery versus hormonal therapy for deep endometriosis: is it a choice of the physician? Eur J Obstet Gynecol Reprod Biol 2017; 209:67-71. [DOI: 10.1016/j.ejogrb.2016.07.513] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 07/05/2016] [Accepted: 07/26/2016] [Indexed: 11/24/2022]
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Estrogen-progestins and progestins for the management of endometriosis. Fertil Steril 2016; 106:1552-1571.e2. [DOI: 10.1016/j.fertnstert.2016.10.022] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 02/08/2023]
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Barbara G, Facchin F, Meschia M, Berlanda N, Frattaruolo MP, VercellinI P. When love hurts. A systematic review on the effects of surgical and pharmacological treatments for endometriosis on female sexual functioning. Acta Obstet Gynecol Scand 2016; 96:668-687. [DOI: 10.1111/aogs.13031] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 09/24/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Giussy Barbara
- Department of Women's and Children's Health; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
| | - Federica Facchin
- Faculty of Psychology; Catholic University of Milan; Milan Italy
| | - Michele Meschia
- Department of Obstetrics and Gynecology; “G. Fornaroli” Hospital; Milan Italy
| | - Nicola Berlanda
- Department of Women's and Children's Health; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
| | - Maria P. Frattaruolo
- Department of Women's and Children's Health; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
| | - Paolo VercellinI
- Department of Clinical Science and Community Health, Università degli Studi di Milano; and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
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Benagiano G, Guo SW, Bianchi P, Puttemans P, Gordts S, Petraglia F, Brosens I. Pharmacologic treatment of the ovarian endometrioma. Expert Opin Pharmacother 2016; 17:2019-31. [PMID: 27615386 DOI: 10.1080/14656566.2016.1229305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Treatment of ovarian endometriomas is commonly achieved through laparoscopic surgery and this can be effective in eliminating the disease, although a majority of recent trials documented an adverse effect of surgery on ovarian reserve markers. With the advancement in imaging techniques, ovarian endometriomas are increasingly diagnosed at an earlier stage when the endometrioma may be smaller, less fibrotic and more responsive to medical treatment, making an evaluation of medical options critically important. AREAS COVERED The review focuses on currently utilized pharmacologic therapies for endometrioma (oral contraceptives, the levonorgestrel-releasing IUS, the hormone-releasing subdermal implant, Implanon); experimental and future treatments are also mentioned (GnRH antagonists, progesterone receptor modulators, antioestrogens, newer subdermal implants and intracystic administration of pharmacologic agents). Finally, the usefulness of post-operative adjuvant medical treatments is discussed Expert opinion: Today, reliable, non-invasive diagnostic procedures of an ovarian endometrioma are available and should be utilized to identify its presence and type of pathology. In a young patient, classic medical therapies such as oral contraceptives and synthetic progestins should be tried first to alleviate symptoms. Only when these regimens fail, should a minimally invasive surgery be envisaged. Following endoscopic surgery, adjuvant medical treatment may reduce recurrence of both symptoms and the lesion.
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Affiliation(s)
- Giuseppe Benagiano
- a Department of Gynaecology, Obstetrics and Urology , Sapienza University of Rome , Rome , Italy
| | - Sun-Wei Guo
- b Department of Gynecology, Shanghai Obstetrics and Gynecology Hospital , Fudan University , Shanghai , People's Republic of China
| | - Paola Bianchi
- c Department of Surgical and Medical Sciences and Traslational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology , Sapienza University of Rome , Rome , Italy
| | | | - Stephan Gordts
- d Leuven Institute for Fertility and Embryology , Leuven , Belgium
| | - Felice Petraglia
- e Department of Molecular and Developmental Medicine, Obstetrics and Gynecology , University of Siena , Siena , Italy
| | - Ivo Brosens
- f Department of Obstetrics and Gynaecology , Catholic University of Leuven , Leuven , Belgium
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Pluchino N, Wenger JM, Petignat P, Tal R, Bolmont M, Taylor HS, Bianchi-Demicheli F. Sexual function in endometriosis patients and their partners: effect of the disease and consequences of treatment. Hum Reprod Update 2016; 22:762-774. [PMID: 27591248 DOI: 10.1093/humupd/dmw031] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/11/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Sexual function is an important aspect of health and quality of life and is influenced by both medical conditions and health-care interventions, especially when gynecologic disorders are involved. Coital pain is among the main factors that affect sexual functioning, and this symptom is reported by almost half of women suffering from endometriosis. However, sexuality is a complex phenomenon driven by social, psychological and biological/hormonal factors and the presence of endometriosis might further affect domains of sexual function and the quality of a sexual relationship. OBJECTIVE AND RATIONALE The objective of this report is to review the current state of knowledge on the impact that endometriosis and its treatments have on the sexual function of women and their sexual partners. SEARCH METHODS A systematic literature search was performed to identify studies evaluating sexual function in endometriosis patients, and a narrative analysis of results is presented. The review discusses relevant quantitative and qualitative studies analyzing the effect of endometriosis and its hormonal and surgical treatments on measures of sexual function and quality of sexual relationship. OUTCOMES Endometriosis negatively affects different domains of sexual function, and the presence of dyspareunia is not the only determinant of sexual health in these women. Chronic pelvic pain, advanced stages of disease and the presence of physical and mental comorbidities affect sexual function, as well as personality traits and women's expectations. Although a number of studies have evaluated the effect of surgery and hormonal treatment on deep dyspareunia, overall sexual function and quality of the relationship with the partner are often under-investigated. WIDER IMPLICATIONS Multiple clinical and personal determinants affect sexual function in women with endometriosis, with potentially negative consequences on the sexual function of partners and quality of the relationship. Additional prospective and longitudinal investigations are warranted using specific instruments to analyze biopsychosocial variables of sexual pain in endometriosis patients and the effects that actual treatments have on measures of quality of sexual function and relationship.
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Affiliation(s)
- Nicola Pluchino
- Department of Obstetrics and Gynecology, University Hospital of Geneva, 30, Boulevard de la Cluse, 1211 Geneva, Switzerland .,Department of Gynecology, Obstetrics and Reproductive Sciences, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510 New Haven, USA
| | - Jean-Marie Wenger
- Department of Obstetrics and Gynecology, University Hospital of Geneva, 30, Boulevard de la Cluse, 1211 Geneva, Switzerland
| | - Patrick Petignat
- Department of Obstetrics and Gynecology, University Hospital of Geneva, 30, Boulevard de la Cluse, 1211 Geneva, Switzerland
| | - Reshef Tal
- Department of Gynecology, Obstetrics and Reproductive Sciences, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510 New Haven, USA
| | - Mylene Bolmont
- Department of Obstetrics and Gynecology, University Hospital of Geneva, 30, Boulevard de la Cluse, 1211 Geneva, Switzerland
| | - Hugh S Taylor
- Department of Gynecology, Obstetrics and Reproductive Sciences, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510 New Haven, USA
| | - Francesco Bianchi-Demicheli
- Department of Obstetrics and Gynecology, University Hospital of Geneva, 30, Boulevard de la Cluse, 1211 Geneva, Switzerland
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Nirgianakis K, Grandi G, McKinnon B, Bersinger N, Cagnacci A, Mueller M. Dienogest mediates midkine suppression in endometriosis. Hum Reprod 2016; 31:1981-6. [DOI: 10.1093/humrep/dew180] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 06/20/2016] [Indexed: 01/22/2023] Open
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