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Xu W, Zhang X, Xu F, Yuan Y, Tang Y, Shi Q. WeChat assisted electronic symptom measurement for patients with adenomyosis. BMC Med Inform Decis Mak 2024; 24:168. [PMID: 38886791 PMCID: PMC11181603 DOI: 10.1186/s12911-024-02570-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024] Open
Abstract
PURPOSE Symptom assessment is central to appropriate adenomyosis management. Using a WeChat mini-program-based portal, we aimed to establish a valid symptom assessment scale of adenomyosis (AM-SAS) to precisely and timely identify needs of symptom management and ultimately, to alert disease recurrence. METHODS A combination of intensive interviews of patients with adenomyosis and natural language processing on WeChat clinician-patient group communication was used to generate a pool of symptom items-related to adenomyosis. An expert panel shortened the list to form the provisional AM-SAS. The AM-SAS was built in a Wechat mini-programmer and sent to patients to exam the psychotically validity and clinical applicability through classic test theory and item response theory. RESULTS Total 338 patients with adenomyosis (29 for interview, 179 for development, and 130 for external validation) and 86 gynecologists were included. The over 90% compliance to the WeChat-based symptom evaluate. The AM-SAS demonstrated the uni-dimensionality through Rasch analysis, good internal consistency (all Cronbach's alphas above 0.8), and test-retest reliability (intraclass correlation coefficients ranging from 0.65 to 0.84). Differences symptom severity score between patients in the anemic and normal hemoglobin groups (3.04 ± 3.17 vs. 5.68 ± 3.41, P < 0.001). In external validation, AM-SAS successfully detected differences in symptom burden and physical status between those with or without relapse. CONCLUSION Electronic PRO-based AM-SAS is a valuable instrument for monitoring AM-related symptoms. As an outcome measure of multiple symptoms in clinical trials, the AM-SAS may identify patients who need extensive care after discharge and capture significant beneficial changes of patients may have been overlooked. TRIAL REGISTRATION This trial was approved by the institutional review board of the Chongqing Medical University and three participating hospitals (Medical Ethics Committee of Nanchong Central Hospital, Medical Ethics Committee of Affiliated Hospital of Southwest Medical University, and Medical Ethics Committee of Haifu Hospital) and registered in the Chinese Clinical Trial Registry (registration number ChiCTR2000038590), date of registration was 26/10/2020.
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Affiliation(s)
- Wei Xu
- College of Public Health, Chongqing Medical University, Chongqing, China
| | - Xin Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Fan Xu
- Department of Obstetrics and Gynecology, Nanchong Central Hospital, Second Clinical Medical College, North Sichuan Medical University, Nanchong, Sichuan, China
| | - Yuan Yuan
- Department of Obstetrics and Gynecology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Ying Tang
- Department of Obstetrics and Gynecology, Nanchong Central Hospital, Second Clinical Medical College, North Sichuan Medical University, Nanchong, Sichuan, China
| | - Qiuling Shi
- College of Public Health, Chongqing Medical University, Chongqing, China.
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.
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Medina-Perucha L, López-Jiménez T, Pujolar-Díaz G, Martínez-Bueno C, Munrós-Feliu J, Valls-Llobet C, Jacques-Aviñó C, Holst AS, Pinzón-Sanabria D, Vicente-Hernández MM, García-Egea A, Berenguera A. Menstrual characteristics and associations with sociodemographic factors and self-rated health in Spain: a cross-sectional study. BMC Womens Health 2024; 24:88. [PMID: 38310222 PMCID: PMC10838449 DOI: 10.1186/s12905-023-02840-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/12/2023] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Evidence on how menstrual characteristics may differ based on socioeconomic factors and self-rated health is significantly scarce. The main aim of this study was to investigate the associations between menstrual characteristics, sociodemographic factors and self-rated health among women and people who menstruate (PWM) aged 18-55 in Spain. METHODS This cross-sectional study includes data from an online survey collected in March-July 2021 across Spain. Descriptive statistical analyses and multivariate logistic regression models were performed. RESULTS The analyses included a total of 19,358 women and PWM. Mean age at menarche was 12.4 (SD = 1.5). While 20.3% of our participants experienced a menstrual abundance over 80 ml, 64.1% reported having menstrual blood clots; 6.4% menstruated for longer than 7 days. 17.0% had menstrual cycles that were shorter than 21 days or longer than 35 days. Reports of moderate (46.3%) and high (22.7%) intensity menstrual pain were common. 68.2% of our participants experienced premenstrual symptoms in all or most cycles. The odds for lighter menstrual flow, shorter bleeding days and menstrual cycles were higher as age increased, and amongst participants with less educational attainment. Caregivers presented higher odds for abundant menstrual flow and longer menstruations. Reporting financial constraints and a poorer self-rated health were risk factors for abundant menstrual flow, menstrual blood clots, shorter/longer menstruations and menstrual cycles, premenstrual symptoms, moderate and intense menstrual pain. CONCLUSIONS This study suggests that age, educational attainment, caregiving, experiencing financial hardship and a poorer self-rated health may shape or mediate menstrual characteristics. It thus highlights the need to investigate and address social inequities of health in menstrual research.
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Affiliation(s)
- Laura Medina-Perucha
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
- Universitat Autonoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain.
| | - Tomàs López-Jiménez
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autonoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
| | - Georgina Pujolar-Díaz
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autonoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
| | - Cristina Martínez-Bueno
- Servei d'Atenció a la Salut Sexual i Reproductiva (ASSIR). Direcció Assistencial d'Atenció Primària, Institut Català de la Salut, Barcelona, Spain
- Sexual and Reproductive Health Care Research Group (GRASSIR), Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Jordina Munrós-Feliu
- Sexual and Reproductive Health Care Research Group (GRASSIR), Barcelona, Spain
- Atenció a la Salut Sexual i Reproductiva (ASSIR) Muntanya/La Mina, Institut Català de la Salut, Barcelona, Spain
| | | | - Constanza Jacques-Aviñó
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autonoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
| | - Anna Sofie Holst
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | | | | | - Andrea García-Egea
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autonoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
| | - Anna Berenguera
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autonoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
- Departament d'Infermeria, Universitat de Girona, Girona, Spain
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Taylor MA, Croudace TJ, McBride M, Muir FE. Women's experiences of the diagnostic journey in uterine adenomyosis: a scoping review protocol. BMJ Open 2024; 14:e075316. [PMID: 38238180 PMCID: PMC10806690 DOI: 10.1136/bmjopen-2023-075316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Uterine adenomyosis is a benign gynaecological disease that causes physical and psychological problems, impacting on relationships. It is poorly understood and consequently may be diagnosed late. This protocol describes the process of conducting a systematic scoping review to retrieve and describe literature examining the daily experience and impact of living with uterine adenomyosis. It will explore the journey to diagnosis (and perceptions of what this process is like); identify the main concepts currently used in the literature and highlight gaps in knowledge for future research in relevant populations. METHODS AND ANALYSIS Using the Joanna Briggs Institute methodology, the population-concept-context approach is used to form clear review questions. A three-phase search strategy will locate published and unpublished evidence from multiple sources. All articles reporting on the personal experiences of women diagnosed with uterine adenomyosis will be considered. Findings from qualitative, quantitative and mixed-method study designs from all settings will be included, not limited by geography but restricted to English. Documents will be screened by the primary researcher, supported by university supervisors. Search outputs will be presented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flow diagram. No formal quality appraisal will be conducted. Review findings will be descriptively collated and reported consistent with the Scoping Review Extension of the PRISMA checklist. Patient and public involvement engagement reflected a positive response for the project that this protocol supports. ETHICS AND DISSEMINATION As primary data will not be collected, formal ethical approval is not required. Prepared as part of a professional doctorate thesis, the findings of this study will be disseminated via peer-reviewed publications, conference presentations, support groups and social media networks.
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Affiliation(s)
| | - Tim J Croudace
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Margot McBride
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Fiona E Muir
- School of Medicine, University of Dundee, Dundee, UK
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Huang Y, Su X, Chen K, Zhang L, Xu W, Pu Y, Xu F, Gong R, Zhang J, Nie Y, Shi Q. Epidemiological characteristics of suspected adenomyosis in the Chinese physical examination population: a nested case-control study. BMJ Open 2024; 14:e074488. [PMID: 38216177 PMCID: PMC10806687 DOI: 10.1136/bmjopen-2023-074488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 11/27/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES We aimed to explore the epidemiological characteristics of suspected adenomyosis within a physical examination population in China. DESIGN A retrospective, nested case-control study; we matched healthy people and those with potential adenomyosis on a 1:2 ratio by age. SETTING A tertiary hospital health management centre. PARTICIPANTS We included 15-60 years old women who underwent at least one uterine examination from October 2017 to December 2020, excluding those who had undergone hysterectomy and menopause. PRIMARY AND SECONDARY OUTCOME MEASURES We estimated the incidence and prevalence rate of suspected adenomyosis. Conditional logistic regression was used to estimate associations between serum biomarkers and potential adenomyosis. Areas under the receiver-operating characteristic curves (AUC) were used to determine the cut-off point of the cancer antigen 125 (CA125) level for suspected adenomyosis. RESULTS A total of 30 629 women had uterus-related imaging examinations; 877 had suspected adenomyosis. The standardised incidence and prevalence of suspected adenomyosis was 1.32% and 2.35%, respectively, for all age groups. The conditional logistic regression analysis results showed that total bilirubin≥18.81 µmol/L (HR: 2.129; 95% CI 1.067 to 4.249; p<0.0321) and CA125 levels (HR: 1.014; 95% CI 1.002 to 4.731; p<0.0273) were positively correlated with onset of suspected adenomyosis; body mass index>24 kg/m2 (HR: 1.262; 95% CI 1.055 to 1.511; p<0.0109), CA125 levels (HR: 1.007; 95% CI 1.006 to 1.009; p<0.0001), and blood platelet levels (HR: 1.002; 95% CI 1 to 1.003; p<0.0141) were positively correlated with potential adenomyosis. The optimal cut-off of CA125 for new suspected adenomyosis was 10.714 U/mL, with a sensitivity of 77.42%, specificity of 53.76%, and AUC of 0.7841 (95% CI 0.7276 to 0.8407). CONCLUSIONS The disease burden of suspected adenomyosis remains huge and can be informed by biomarkers. The disease-specific threshold of CA125 will support further preventive strategy development in population. TRIAL REGISTRATION NUMBER ChiCTR2100049520, 2021/8/2.
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Affiliation(s)
| | - Xueyao Su
- Chongqing Medical University, Chongqing, China
| | - Ke Chen
- Nanchong Central Hospital, North Sichuan Medical University, Nanchong, China
| | - Lijun Zhang
- Chongqing Medical University, Chongqing, China
| | - Wei Xu
- Chongqing Medical University, Chongqing, China
| | - Yang Pu
- Chongqing Medical University, Chongqing, China
| | - Fan Xu
- Nanchong Central Hospital, North Sichuan Medical University, Nanchong, China
| | - Ruoyan Gong
- Chongqing Medical University, Chongqing, China
| | | | - Yuxian Nie
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, China
| | - Qiuling Shi
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, China
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
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Marcellin L, Legay L, Santulli P, Millischer AE, Bordonne C, Maitrot Mantelet L, Maignien C, Bourdon M, Gaudet Chardonnet A, Borghese B, Goffinet F, Chapron C. Magnetic resonance imaging presentation of diffuse and focal adenomyosis before and after pregnancy. Reprod Biomed Online 2023; 47:121-128. [PMID: 37137789 DOI: 10.1016/j.rbmo.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 02/05/2023] [Accepted: 02/20/2023] [Indexed: 02/26/2023]
Abstract
RESEARCH QUESTION Is there a change in magnetic resonance imaging (MRI) criteria of diffuse and focal phenotypes of adenomyosis before and after pregnancy? DESIGN A retrospective, monocentric, observational study in a single academic tertiary referral centre for endometriosis diagnosis and management. Women were followed for symptomatic adenomyosis, and without a prior history of surgery who give birth after 24+0 weeks. For each patient, pelvic MRI pre- and post-pregnancy was performed by two experienced radiologists with the same image acquisition protocol. Diffuse and focal adenomyosis MRI presentation were analysed before and after pregnancy. RESULTS Between January 2010 and September 2020, of the 139 patients analysed, 96 (69.1%) had adenomyosis at MRI distributed as follow: 22 (15.8%) presented diffuse adenomyosis, 55 (39.6%) focal adenomyosis and 19 (13.7%) both phenotypes. The frequency of isolated diffuse adenomyosis on MRI was significantly lower before versus after pregnancy (n = 22 [15.8%] versus n = 41 [29.5%], P = 0.01). The frequency of isolated focal adenomyosis was significantly higher before pregnancy than after pregnancy (n = 55 [39.6%] versus n = 34 [24.5%], P = 0.01). The mean volume of all focal adenomyosis lesions on MRI decreased significantly after pregnancy, from 6.7 ± 2.5 mm3 to 6.4 ± 2.3 mm3, P = 0.01. CONCLUSION The current data indicate that, based on MRI, there is an increase in diffuse adenomyosis and a decrease in focal adenomyosis after pregnancy.
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Affiliation(s)
- Louis Marcellin
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Service de Chirurgie Gynécologie Obstétrique II et Médecine de la Reproduction, Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Oxidative Stress, Cellular Proliferation and Inflammation Team, Department of Development, Reproduction and Cancer, INSERM U1016, Paris, France.
| | | | - Pietro Santulli
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Service de Chirurgie Gynécologie Obstétrique II et Médecine de la Reproduction, Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Genomics, Epigenetics and Physiopathology of Reproduction Team, Department of Development, Reproduction and Cancer, INSERM U1016, Paris, France
| | - Anne Elodie Millischer
- Centre de Radiologie IMPC Bachaumont Pole Femme-Mère-Enfant, 75002 Paris, France; Institut de la Femme et de l'Endométriose (IFEEN), 75003 Paris, France
| | - Corinne Bordonne
- Centre de Radiologie IMPC Bachaumont Pole Femme-Mère-Enfant, 75002 Paris, France; Institut de la Femme et de l'Endométriose (IFEEN), 75003 Paris, France
| | - Lorraine Maitrot Mantelet
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Service de Chirurgie Gynécologie Obstétrique II et Médecine de la Reproduction, Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - Chloé Maignien
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Service de Chirurgie Gynécologie Obstétrique II et Médecine de la Reproduction, Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - Mathilde Bourdon
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Service de Chirurgie Gynécologie Obstétrique II et Médecine de la Reproduction, Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - Antoine Gaudet Chardonnet
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Service de Chirurgie Gynécologie Obstétrique II et Médecine de la Reproduction, Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - Bruno Borghese
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Service de Chirurgie Gynécologie Obstétrique II et Médecine de la Reproduction, Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Genomics, Epigenetics and Physiopathology of Reproduction Team, Department of Development, Reproduction and Cancer, INSERM U1016, Paris, France
| | - François Goffinet
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Maternité Port-Royal, Paris, France
| | - Charles Chapron
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Service de Chirurgie Gynécologie Obstétrique II et Médecine de la Reproduction, Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Oxidative Stress, Cellular Proliferation and Inflammation Team, Department of Development, Reproduction and Cancer, INSERM U1016, Paris, France; Genomics, Epigenetics and Physiopathology of Reproduction Team, Department of Development, Reproduction and Cancer, INSERM U1016, Paris, France
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Joachim GE, Bohnert KM, As-Sanie S, Harris HR, Upson K. Cannabis smoking, tobacco cigarette smoking, and adenomyosis risk. Fertil Steril 2023; 119:838-846. [PMID: 36716812 PMCID: PMC10900224 DOI: 10.1016/j.fertnstert.2023.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To investigate cannabis smoking and tobacco cigarette smoking in relation to adenomyosis risk. DESIGN We used data from a case-control study of adenomyosis conducted among enrollees ages 18-59 years of an integrated health care system in Washington State. The case-control study used 2 control groups given the challenge of selecting noncases when cases are diagnosed by hysterectomy. SUBJECTS Cases (n = 386) were enrollees with incident, pathology-confirmed adenomyosis diagnosed between April 1, 2001, and March 31, 2006. The 2 control groups comprised hysterectomy controls (n = 233) with pathology-confirmed absence of adenomyosis and population controls (n = 323) with an intact uterus selected randomly from the health care system population and frequency matched to cases on age. EXPOSURE Detailed data on cannabis and tobacco cigarette smoking history were ascertained through in-person structured interviews, allowing estimation of joint-years of cannabis smoking and pack-years of tobacco cigarette smoking. MAIN OUTCOME MEASURES Odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between cannabis smoking, tobacco cigarette smoking, and adenomyosis were estimated using multivariable unconditional logistic regression. Analyses were adjusted for age, reference year, menarche age, education, and pack-years of cigarette smoking (or joint-years of cannabis smoking). RESULTS No association was observed between cannabis smoking history and adenomyosis risk. However, we did observe the suggestion of an association between ever tobacco cigarette smoking and adenomyosis risk, comparing cases to hysterectomy controls (OR, 1.3; 95% CI, 0.9-1.9) and population controls (OR, 1.2; 95% CI, 0.8-1.8). Our data suggested a 50% increased odds of adenomyosis with >15 pack-years of smoking (vs. never smoking), comparing cases to hysterectomy controls (OR, 1.5; 95% CI, 0.9-2.6; Ptrend=.135). The suggestion of a 40% increased adenomyosis odds was observed with smoking >5-15 pack-years (vs. never smoking), comparing cases to population controls (OR, 1.4; 95% CI, 0.8-2.4; Ptrend=0.136). CONCLUSION In the first study of cannabis smoking and adenomyosis risk, no association was observed. However, our data suggested an increased odds of adenomyosis with history of tobacco cigarette smoking. Further research is warranted to replicate our results given the substantial morbidity with adenomyosis and frequency of cigarette smoking and recreational and medical cannabis use.
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Affiliation(s)
- Grace E Joachim
- Department of Microbiology and Molecular Genetics, Lyman Briggs College, Michigan State University, East Lansing, Michigan; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan.
| | - Kipling M Bohnert
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Sawsan As-Sanie
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Holly R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | - Kristen Upson
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan
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Efficacy of Transabdominal Ultrasound-guided Percutaneous Microwave Ablation in the Treatment of Symptomatic Adenomyosis: A Retrospective Cohort Study. J Minim Invasive Gynecol 2023; 30:137-146. [PMID: 36384213 DOI: 10.1016/j.jmig.2022.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To evaluate and compare the clinical efficacy of transabdominal ultrasound-guided percutaneous microwave ablation (PMWA) in the treatment of symptomatic focal and nonfocal adenomyosis. DESIGN Retrospective cohort study. SETTING Longyan First Affiliated Hospital of Fujian Medical University. PATIENTS From May 2019 to October 2021, 107 patients with symptomatic adenomyosis who refused hysterectomy received PMWA. INTERVENTIONS Patients were divided into a focal group (n = 47, including 40 focal adenomyosis and 7 adenomyoma cases) and a nonfocal group (n = 60, including 36 diffuse and 24 mixed adenomyosis cases) according to the extent of lesion involvement. MEASUREMENTS AND MAIN RESULTS We collected and analyzed preoperative baseline data on patient characteristics; postoperative efficacy measures at 3, 6, and 12 months; and intraoperative and postoperative complications. There was a significant post-treatment reduction in the uterine corpus volume and cancer antigen 125 levels, an increase in hemoglobin levels, and an improvement in the Uterine Fibroid Symptom and Health-related Quality of Life scores (consisting of the Symptom Severity Scale and the Health-related Quality of Life scale), dysmenorrhea visual analog scale, and menstrual volume score (MVS) (all p <.05). One patient had recurrence. Most adverse events (72.0%) were mild. Although the nonfocal group had significantly greater anemia severity, higher Symptom Severity Scale and MVS, lower Health-related Quality of Life scale, greater extent and severity of myometrial involvement, and larger uterine corpus volume, after treatment, the uterine corpus volume, uterine corpus reduction rate, cancer antigen 125 levels, hemoglobin levels, Uterine Fibroid Symptom and Health-related Quality of Life score, dysmenorrhea visual analog scale, MVS score, and clinical response rate were similar between the groups (p >.05). CONCLUSION PMWA had good, similar, short-term efficacy for symptomatic focal and nonfocal adenomyosis.
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Zhao Y, Luo S, Liu Y, He Y, Liu X, Guohua H, He J. High intensity focused ultrasound treatment for adenomyosis: comparison of efficacy based on MRI features. Int J Hyperthermia 2023; 40:2197574. [PMID: 37031960 DOI: 10.1080/02656736.2023.2197574] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023] Open
Abstract
OBJECTIVE To compare the clinical efficacy of High intensity-focused ultrasound(HIFU) for different types of adenomyosis classified by magnetic resonance imaging (MRI). METHODS A total of 227 patients with adenomyosis who underwent HIFU treatment in Suining Central Hospital from January 2014 to December 2019 were included. Based on the preoperative pelvic MRI examination and Kishi isometric classification method, the patients were divided into 4 types according to the location of lesions. There were 82 cases of type I (endogenous type), 75 cases of type II (exogenous type), 34 cases of type III (nodular type), and 36 cases of type IV (heterogeneous type). The results of HIFU treatment for four types of adenomyosis and intraoperative adverse effects were analyzed. The changes of lesion size, dysmenorrhea, and menstrual volume were analyzed at 3 and 6 months after the operation. RESULT (1) adverse effects: All patients successfully accepted HIFU treatment under sedation and analgesia. Grade A adverse effects occurred in 51 cases (22.47%) and grade B adverse effects in 3 cases (1.32%). The incidence of adverse effects in type I-IV patients was 21.95%, 22.66%, 23.53%, and 30.56%, respectively. There was no significant difference in the incidence of grade A and B adverse effects in all types, and no grade C-F adverse effects occurred. (2) Ablation effect: The ablation rate of type III(nodular type)patients was (74.7 ± 20.3) %, which was significantly higher than that of the other three types (p < .05). (3) Changes in lesion size: the lesion size of all patients decreased after treatment and the reduction rate gradually increased with time. At 6 months after the operation, the lesion reduction rate of type III patients was (70.8 ± 14.8) %, higher than that of the other three types patients (p < .05). There was no significant difference in the reduction rate of type I, type II and type IV. (4) Remission of menorrhagia: At 6 months after the operation, the total remission rate of type III patients was 100%, while the total remission rate of type IV patients (65.4%, 17/26) that was lower than that of type I, II and III patients(p < .05). (5) Dysmenorrhea relief: At 6 months after the operation, the total dysmenorrhea relief rate of type III patients was 100% and the complete relief rate (28.1%, 18/31) was higher than that of the other three types, which was significant differences (p < .05). CONCLUSIONS HIFU is safe and effective in the treatment of different types of adenomyosis, the therapeutic effect of HIFU in patients with type III adenomyosis is better than that of the other three types.
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Affiliation(s)
- Yi Zhao
- Department of Gynecology, Suining Central Hospital, Suinig, Sichuan, China
| | - Shuang Luo
- Department of Gynecology, Suining Central Hospital, Suinig, Sichuan, China
| | - Yanglu Liu
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese, Chengdu, Sichuan, China
| | - Yuchun He
- Department of Gynecology, Suining Municipal Hospital of Traditional Chinese Medicine, Suining, Sichuan, China
| | - Xiaofang Liu
- Department of Gynecology, Suining Central Hospital, Suinig, Sichuan, China
| | - Huang Guohua
- Department of Gynecology, Suining Central Hospital, Suinig, Sichuan, China
| | - Jia He
- Department of Gynecology, Suining Municipal Hospital of Traditional Chinese Medicine, Suining, Sichuan, China
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9
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Li Z, Li X, Lin M, Qiu S, Wang L, Lai L, Luo X, Mo Z, Dong G, Lyu G, Li S. Clinical efficacy of myometrial and endometrial microwave ablation in the treatment of patients with adenomyosis who had anemia. Int J Hyperthermia 2022; 39:1335-1343. [PMID: 36257919 DOI: 10.1080/02656736.2022.2131001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE This study evaluated the clinical efficacy of myometrial and endometrial microwave ablation (MEWA) for treating adenomyosis in patients with anemia. METHODS This retrospective study enrolled 64 patients with adenomyosis who had anemia treated with either MEWA (MEWA group) or myometrial microwave ablation (MMWA group) between May 2019 and May 2021. The uterine volumes, uterine-volume reduction rates, hemoglobin (Hb) levels, cancer antigen 125 (CA125) levels, dysmenorrhea visual analog scale (VAS) scores, uterine fibroblast symptoms and health-related quality of life (UFS-QOL) scores, menstrual flow scores (MFS) before and 3, 6, and 12 months post-treatment, and adverse events and complications in both groups were collected to assess clinical efficacy. RESULTS No statistically significant preoperative differences were observed in any measured factors. Postoperatively, there was a significant reduction in uterine volume and CA125 level, an increase in Hb level, and improvement in the UFS-QOL, dysmenorrhea VAS score, and MFS. No differences were observed in postoperative uterine volume, CA125 level, overall response rate, and adverse event rate during the follow-up period until 12 months postoperatively. However, the MEWA group showed a better uterine-volume reduction rate 6 months postoperatively and improvement in Hb level, USF-QOL score, dysmenorrhea VAS score, and MFS postoperatively. CONCLUSION MEWA and MMWA demonstrated high clinical efficacy in treating adenomyosis and anemia. However, MEWA is a more effective therapy that successfully improves anemia, resulting in improved quality of life.
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Affiliation(s)
- Zuolin Li
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Xiaolian Li
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Min Lin
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Sihua Qiu
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Liangqin Wang
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Liping Lai
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Xuefen Luo
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Zunyu Mo
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Gang Dong
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guorong Lyu
- Collaborative Innovation Centre for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Quanzhou, China.,Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Shuiping Li
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
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10
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Spontaneous Uterine Rupture and Adenomyosis, a Rare but Possible Correlation: Case Report and Literature Review. Diagnostics (Basel) 2022; 12:diagnostics12071574. [PMID: 35885480 PMCID: PMC9317678 DOI: 10.3390/diagnostics12071574] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Uterine rupture during pregnancy is a serious obstetric complication with a high incidence of maternal morbidity and mortality. (2) Methods: The present case is a rare event of a uterine rupture occurring in an unscarred uterus in a nonlaboring primigravida woman in the second trimester. The only risk factor in this case was adenomyosis found in the preconceptional phase. (3) Results: The diagnosis of adenomyosis can often be difficult, so patients should be evaluated by a specialized gynecologist. After careful amnestic collection, a gynecological examination and II level ultrasound should be performed in accordance with the Morphological Uterus Sonographic Assessment classification. (4) Conclusions: This evaluation allows us to identify classes of patients at high risk of uterine rupture who, therefore, must be properly informed of the risks both during preconceptional counseling and during pregnancy.
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11
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Higher Risk of Anxiety and Depression in Women with Adenomyosis as Compared with Those with Uterine Leiomyoma. J Clin Med 2022; 11:jcm11092638. [PMID: 35566763 PMCID: PMC9099604 DOI: 10.3390/jcm11092638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 02/06/2023] Open
Abstract
The main symptoms of adenomyosis may adversely affect physical and mental health and quality of life (QOL). However, studies are few on this topic. This study evaluated the effect of adenomyosis on anxiety, depression, and QOL. Participants with adenomyosis (n = 90) or leiomyoma (n = 59) completed questionnaires, including the visual analog scale (VAS) for pain, Hospital Anxiety and Depression Scale (HADS), and Short Form (SF)-36. HADS anxiety and depression positive rates, physical (PCS) and mental (MCS) component summary scores, and eight subscale scores of SF-36 were compared between the two groups. Among patients with adenomyosis, the incidence of anxiety symptoms was 28.9% (control group, 10.2%; OR = 3.589, 95%CI: 1.375–9.367), with 10% of patients showing moderate-to-severe symptoms. The incidence of depressive symptoms was 14.4% (control group, 3.4%; OR = 4.812, 95%CI: 1.044–22.168). The case group had significantly lower PCS and MCS scores than the control group. In patients with adenomyosis, being employed (OR = 6.393, 95%CI: 1.153–35.440) and perianal pain (OR = 25.419, 95%CI: 2.504–258.024) were risk factors for anxiety, and perianal pain (OR = 15.208, 95%CI: 3.050–75.836) was a risk factor for depression. Compared with leiomyoma, adenomyosis is associated with a higher risk of anxiety and depression, with a poorer QOL.
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12
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Celik E, Goksever Celik H, Sozen H, Onder S, Tosun OA, Topuz S, Salihoglu MY. The effect of adenomyosis on endometrial cancer: a university hospital-based cohort study. J OBSTET GYNAECOL 2021; 42:158-165. [PMID: 34895006 DOI: 10.1080/01443615.2021.1980508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Endometrial cancer (EC) can coexist with gynaecological diseases including adenomyosis which can be defined as the location of endometrial cells within the myometrium. Our aim was to clarify the impact of adenomyosis on the clinical and survival outcomes of EC. We included the patients who underwent an operation for EC and had concurrent adenomyosis in this retrospective cohort study. All clinicodemographical and tumour characteristics with survival outcomes of the patients were analysed comparatively. A total of 763 patients who met the eligibility criteria were included. Of those, 591 patients in the non-adenomyosis group and 172 patients in the adenomyosis group were examined. Disease-specific survival (DSS) was significantly prolonged while progression-free survival (PFS) was not affected by the presence of adenomyosis (p = .004 vs. p = .161). However, adenomyosis did not remain as an independent prognostic factor for EC in multivariate analysis (p = .341). These patients with coexistent adenomyosis and EC have better clinicopathological characteristics and less advanced tumour. Although adenomyosis is associated with prolonged DSS, it has no prognostic importance for survival outcomes of the patients with EC.IMPACT STATEMENTWhat is already known on this subject? Endometrial cancer (EC) can coexist with other gynaecological diseases including uterine adenomyosis. Adenomyosis is typically diagnosed by the pathological evaluation of the uterus following hysterectomy, although diagnosis is possible with imaging methods However, the coexistence of adenomyosis and EC is controversial in the literature.What do the results of this study add? To the best of our knowledge, our study is the largest study performed at a single university hospital. All potential confounding factors including clinicodemographical characteristics of the patients, examination of histopathology slides by the experienced gynaecological pathologists, evaluation of all included factors that may affect the survival outcomes of EC by multivariate analysis were examined. Although adenomyosis is associated with prolonged disease-specific survival (DSS), it has no prognostic importance for survival outcomes of the patients with EC.What are the implications of these findings for clinical practice and/or further research? Women having coexistent adenomyosis and EC should be informed about the impact of adenomyosis on the survival outcomes of EC.
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Affiliation(s)
- Engin Celik
- Department of Gynecological Oncology, University of Health Sciences Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Hale Goksever Celik
- Department of Obstetrics and Gynecology, University of Health Sciences Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Hamdullah Sozen
- Department of Gynecological Oncology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Semen Onder
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozgur Aydin Tosun
- Department of Obstetrics and Gynecology, Medeniyet University, Istanbul, Turkey
| | - Samet Topuz
- Department of Gynecological Oncology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Yavuz Salihoglu
- Department of Gynecological Oncology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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13
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Huang R, Li X, Jiang H, Li Q. Barriers to self-management of patients with adenomyosis: A qualitative study. Nurs Open 2021; 9:1086-1095. [PMID: 34859610 PMCID: PMC8859064 DOI: 10.1002/nop2.1148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/16/2021] [Indexed: 12/03/2022] Open
Abstract
Aim This study aims to explore the barriers to self‐management of patients with adenomyosis. Design Phenomenological qualitative methodology. Methods Totally, 18 patients with diagnosis of adenomyosis participated in this study. We used purposive sampling for recruitment until data saturation. A qualitative research was conducted using in‐depth interviews, which were tape recorded and transcribed verbatim. Colaizzi's method was used to analyse the contents of interviews. Results This study presented important information about the barriers to self‐management of patients with adenomyosis in China. Four themes were identified: “lack of disease knowledge,” “challenges and dilemmas of daily life,” “multidimensional negative emotions” and “personalized supporting requirements.” Conclusion The study provided new insights into the barriers to self‐management of patients with adenomyosis, including physical, psychological, daily life and self‐image problems, and the patients need emotional and social support, which recommended that professionals should provide authoritative health education and multiple support.
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Affiliation(s)
- Rong Huang
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaohan Li
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hui Jiang
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Quanlei Li
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
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Vannuccini S, Rossi E, Cassioli E, Cirone D, Castellini G, Ricca V, Petraglia F. Menstrual Distress Questionnaire (MEDI-Q): a new tool to assess menstruation-related distress. Reprod Biomed Online 2021; 43:1107-1116. [PMID: 34753680 DOI: 10.1016/j.rbmo.2021.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 08/15/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Abstract
RESEARCH QUESTION Menstruation is a physiological event often associated with subjective distress. Is there a tool that assesses and objectively evaluates the global distress experienced by women during their period? DESIGN An observational cross-sectional study conducted between June 2019 and May 2020 at Careggi University Hospital, Florence, Italy. A new questionnaire, The Menstrual Distress Questionnaire (MEDI-Q), was developed and administered to a group of healthy women (n = 418) of fertile age (18-50 years), without known uterine, psychiatric disorders, or both. The MEDI-Q investigated 25 items, covering the following areas: pain, discomfort, psychic or cognitive changes, gastrointestinal symptoms and changes in physiological functions. MEDI-Q Total Score and the three sub-scales, Menstrual Symptoms (MS), Menstrual Symptoms Distress (MSD) and Menstrual Specificity Index (MESI) were evaluated. The validation of MEDI-Q was achieved by testing test-retest reliability and internal consistency, convergent and concurrent validity. RESULTS The MEDI-Q produced reliable results with good internal consistency, convergent and concurrent validity. MEDI-Q Total Score, MS and MSD all positively correlated with general psychopathology and premenstrual symptoms. A receiver operating characteristic analysis was used to determine the cut-off value of 20 (inclusive) and to identify the women with clinically relevant menstrual distress (area under the curve 0.90, 95% CI 0.86 to 0.93; P < 0.001). CONCLUSION MEDI-Q is a new tool for evaluating menstruation-related distress, and provides a representative score of stress perception. MEDI-Q may be added to routine women's healthcare to help identify and adequately monitor menstruation-related disorders, and their effect on wellbeing, promptly.
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Affiliation(s)
- Silvia Vannuccini
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital Florence, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence Florence, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence Florence, Italy
| | - Donatello Cirone
- General Management Staff, Careggi University Hospital Florence, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence Florence, Italy
| | - Felice Petraglia
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital Florence, Italy.
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15
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Muneyyirci-Delale O, Archer DF, Owens CD, Barnhart KT, Bradley LD, Feinberg E, Gillispie V, Hurtado S, Kim JH, Wang A, Wang H, Stewart EA. Efficacy and safety of elagolix with add-back therapy in women with uterine fibroids and coexisting adenomyosis. F S Rep 2021; 2:338-346. [PMID: 34553161 PMCID: PMC8441572 DOI: 10.1016/j.xfre.2021.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 04/28/2021] [Accepted: 05/20/2021] [Indexed: 10/28/2022] Open
Abstract
Objective To determine if coexisting adenomyosis limits the efficacy of elagolix, an oral gonadotropin-releasing hormone antagonist, with hormonal add-back therapy in reducing heavy menstrual bleeding in women with uterine fibroids. Design Pooled analysis of two identical, double-blind, randomized, placebo-controlled, 6-month phase 3 trials (Elaris Uterine Fibroids [UF]-1 and UF-2). Setting A total of 153 gynecological clinical care settings in the United States and Canada. Patients Premenopausal women (18-51 years) with >80 mL of menstrual blood loss (MBL)/cycle and uterine fibroids with and without coexisting adenomyosis diagnosed by ultrasound and/or magnetic resonance imaging at baseline. Interventions Participants were randomized 1:1:2 to placebo, elagolix 300 mg twice daily alone, or elagolix 300 mg twice daily with estradiol 1 mg/norethindrone acetate 0.5 mg once daily. Main Outcome Measures The primary endpoint was the proportion of women who had <80 mL of MBL during the final month and ≥50% reduction in MBL from baseline to the final month. Adverse events were monitored. Results Of 786 women treated across the two trials, 16% (126 women) had coexisting adenomyosis. Among this subset, a significantly greater proportion of women who received elagolix with add-back therapy (77.1% [95% confidence interval, 66.2, 88.0]) met both primary endpoint criteria compared with women who received placebo (12.2% [95% confidence interval, 1.0, 23.4]). Adverse events most frequently reported in the elagolix with add-back adenomyosis subset were hot flushes (18.3%), nausea (11.7%), and night sweats (8.3%). Conclusions Elagolix with add-back therapy significantly reduced heavy menstrual bleeding in women with uterine fibroids and coexisting adenomyosis, suggesting that elagolix efficacy was not adversely affected by the presence of adenomyosis (Elaris UF-1 and UF-2 Clinical-Trials.gov numbers, NCT02654054 and NCT02691494).
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Affiliation(s)
- Ozgul Muneyyirci-Delale
- Department of Obstetrics & Gynecology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, New York
| | - David F Archer
- Department of Obstetrics & Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | | | - Kurt T Barnhart
- Division of Reproductive Endocrinology and Infertility, Perleman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Linda D Bradley
- Department of Obstetrics & Gynecology, Cleveland Clinic, Cleveland, Ohio
| | - Eve Feinberg
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Sandra Hurtado
- Department of Obstetrics & Gyneocology, University of Texas Health Science Center at Houston, Houston, Texas
| | - Jin Hee Kim
- Department of Obstetrics & Gyneocolgy, Columbia University, New York, New York
| | | | - Hui Wang
- AbbVie Inc., North Chicago, Illinois
| | - Elizabeth A Stewart
- Departments of Obstetrics & Gynecology & Surgery, Mayo Clinic and Mayo Medical School, Rochester, Minnesota
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16
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Kobayashi H, Matsubara S, Imanaka S. Relationship between magnetic resonance imaging-based classification of adenomyosis and disease severity. J Obstet Gynaecol Res 2021; 47:2251-2260. [PMID: 33908135 DOI: 10.1111/jog.14803] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/10/2021] [Indexed: 12/18/2022]
Abstract
AIMS The purpose of this study is to first investigate the correlation between image features and histological findings and the clinical severity of adenomyosis; second, search for imaging features to assess the type and locoregional extension of the disease; and finally, discuss the notation of image-based classification. METHODS This paper combines a review of the literature on adenomyosis with a series of cases who underwent surgery at Nara Medical University Hospital. RESULTS Currently, there has been a lack of clear, clinically relevant, and internationally acceptable definition and histological classification due to its diverse phenotype. A number of researchers have attempted to standardize the magnetic resonance imaging (MRI) features of adenomyosis. Some researchers have begun studies that relate the subtype classification using MRI to disease severity. There is evidence suggesting that diffuse adenomyosis and intrinsic adenomyosis are correlated with menstrual bleeding, while extrinsic adenomyosis and coexistence of deep infiltrating endometriosis (DIE) are related to pelvic pain. MRI-based classifications that are simple for use in the clinical setting are beginning to be proposed. However, the reliability and validity of these classifications have not yet been verified. A simplified notation is required to discuss the association between the classification and severity of adenomyosis. We introduce case reports using the notation of four items necessary for classification of adenomyosis. CONCLUSION There is an urgent need to determine the definitions of terms used in subtype classification and to create and validate a globally unified notation that can predict the severity of adenomyosis symptoms.
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Affiliation(s)
- Hiroshi Kobayashi
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara, Japan.,Ms.Clinic MayOne, Kashihara, Nara, Japan
| | - Sho Matsubara
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara, Japan
| | - Shogo Imanaka
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara, Japan.,Ms.Clinic MayOne, Kashihara, Nara, Japan
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17
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High-Intensity Focused Ultrasound Combined With Gonadotropin-Releasing Hormone Agonist or Levonorgestrel-Releasing Intrauterine System in Treating Dysmenorrhea of Severe Adenomyosis. J Comput Assist Tomogr 2021; 45:224-231. [PMID: 33661158 DOI: 10.1097/rct.0000000000001138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The objective of this study was to investigate the efficacy of high-intensity focused ultrasound (HIFU) combined with gonadotropin-releasing hormone agonist or levonorgestrel-releasing intrauterine system (LNG-IUS) in treating dysmenorrhea in patients with severe adenomyosis. METHODS A retrospective analysis was performed on 243 patients diagnosed with severe adenomyosis. Patients were divided into H (received HIFU alone), H-G (received HIFU combined with gonadotropin-releasing hormone agonist), and H-L (received HIFU combined with LNG-IUS) groups. Their clinical results were compared at 3 months, 6 months, and 12 months after treatment. RESULTS The effective rates of dysmenorrhea relief in the 3 groups after 3 months were 95.24% in the H group, 98.8% in the H-G group, and 94.74% in the H-L group; those after 6 months were 88.10% in the H group, 95.18% in the H-G group, and 84.21% in the H-L group; those after 12 months were 77.38% in the H group, 79.52% in the H-G group, and 96.05% in the H-L group. There was significant difference in effective rates of dysmenorrhea relief among 3 groups after 12 months of treatment, but not 3 or 6 months. In addition, at 12 months after treatment, there were significant differences in the efficacy of dysmenorrhea between patients of different ages or different ablation rates in group H. However, there was no significant difference in the H-G group and the H-L group. CONCLUSIONS High-intensity focused ultrasound alone is effective in alleviating the symptoms of dysmenorrhea in short term. However, HIFU combined with LNG-IUS improves the therapeutic effect for a longer period.
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Alcalde A, Martínez-Zamora M, Carmona F. Adenomiosis. Una gran desconocida: ¿Qué debemos saber? CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2020.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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A Detailed Study in Adenomyosis and Endometriosis: Evaluation of the Rate of Coexistence Between Uterine Adenomyosis and DIE According to Imaging and Histopathology Findings. Reprod Sci 2021; 28:2387-2397. [PMID: 33725313 DOI: 10.1007/s43032-021-00527-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/01/2021] [Indexed: 01/11/2023]
Abstract
The current study was designed to evaluate the relationship between adenomyosis and its subtypes with endometriotic lesions (ovarian endometrioma (OMAs) and posterior deep infiltrative endometriosis (DIE)), to examine the probability of existence of a common cause of these mysterious diseases, and to evaluate the accuracy, sensitivity, and specificity of both transvaginal ultrasonography (TVS) and MRI in diagnosis of adenomyotic uterus. In this retrospective cross-sectional study, we selected 154 women with coexistence of endometriosis and adenomyosis according to their imaging, intraoperative, or pathological findings who were nominated for laparoscopic surgery. Eighty-six patients with just DIE resection without LH (laparoscopic hysterectomy) (group 1), and 68 patients with LH + DIE resection (group 2). The accuracy, sensitivity, and specificity of ultrasonographic and MRI findings for diagnosing adenomyosis were 72.1%, 77.6%, 40.0% and 49.2%, 41.5%, 90.0% respectively. So, TVS is a more sensitive diagnostic tool for diagnosing adenomyosis. However, MRI was more specific than TVS in the diagnosis of diffuse adenomyosis especially with simultaneous presence of uterine leiomyoma. Regarding the association of different types of adenomyosis (focal and diffuse) with different endometriosis lesions (OMA and posterior compartment DIE), we just found diffuse type of adenomyosis more frequent in the absence of rectal and rectovaginal septum (RVS) DIE (p ≤ 0.05). In addition to the questionable different nature of rectal and RVS DIE lesion, there is no relationship between adenomyosis subtypes and endometriotic lesions.
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20
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Alcalde AM, Martínez-Zamora MÁ, Gracia M, Ros C, Rius M, Nicolás I, Carmona F. Impact of Adenomyosis on Women's Psychological Health and Work Productivity: A Comparative Cross-Sectional Study. J Womens Health (Larchmt) 2021; 30:1653-1659. [PMID: 33464159 DOI: 10.1089/jwh.2020.8789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Quality of life in adenomyosis (AD) patients has been poorly investigated. Previous data suggest that AD has negative impact on the quality of life in these women. Methods: From September 2018 to December 2019, all consecutive female premenopausal patients aged ≥18 years diagnosed with AD by transvaginal ultrasound (TVU) were invited to participate in a comparative cross-sectional study. The Short Form-36-item (SF-36) health questionnaire and the Hospital Anxiety and Depression Scale (HADS) were administered. Work productivity and activity impairment were assessed using the Work Productivity and Activity Impairment Questionnaire: General Health version (WPAI:GH). Data obtained from these patients were compared with women with normal-appearing myometrium in the TVU recruited during routine gynecological visits. The study was approved by the Clinical Research Ethics Committee of the Hospital Clinic (reference HCB/2018/0919). Results: One hundred three patients with AD and 214 without AD were analyzed. Patients with AD compared to those without AD showed significantly lower scores in all domains of the SF-36 questionnaire and mean (SD) higher scores in the HADS questionnaire for anxiety (10.06 [3.04] vs. 6.92 [2.98], p < 0.001) and depression (6.39 [3.89] vs. 2.74 [2.01], p < 0.002). Significant differences (p < 0.001) were also found for the percentages of absenteeism (12.2% vs. 1.1%), presenteeism (31.1% vs. 11.4%), overall work productivity loss (38.2% vs. 12.4%), and activity impairment (55.7% vs. 9.9%). The presence of AD was associated with higher yearly estimated indirect costs of €5161.32 (€7928.0 vs. €2460.8, p < 0.001). Conclusions: AD negatively affects women's health-related quality of life, psychological health, and work productivity, with impairment at work and daily activities, and higher risk for anxiety and depression.
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Affiliation(s)
- Ana María Alcalde
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - María Ángeles Martínez-Zamora
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Meritxell Gracia
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Cristina Ros
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Mariona Rius
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Inmaculada Nicolás
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Francisco Carmona
- Gynecology Department, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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Abstract
Adenomyosis, characterized by the presence of endometrial glands and stroma within the myometrium, can have a substantial impact on the quality of women's lives. Despite this, the epidemiologic research on this condition lags considerably behind that of other noncancerous reproductive health conditions. The lack of progress and knowledge is due in part to the challenges in designing valid epidemiologic studies, since the diagnosis of adenomyosis historically has been limited to the examination of uterine specimens from hysterectomy. This review describes the available data on the frequency of this condition and the epidemiologic investigation thus far into the risk factors for disease-highlighting the methodologic and inference challenges primarily around study sample selection. We conclude with providing recommendations for approaches to future epidemiologic study that capitalize on the advancements in imaging technology to detect adenomyosis and provide a fuller picture of the occurrence and risk factors for disease.
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Affiliation(s)
- Kristen Upson
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Stacey A Missmer
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan.,Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, Michigan.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Focal adenomyosis of the outer myometrium and deep infiltrating endometriosis severity. Fertil Steril 2020; 114:818-827. [PMID: 32741618 DOI: 10.1016/j.fertnstert.2020.05.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/28/2020] [Accepted: 05/02/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine whether the presence of focal adenomyosis of the outer myometrium (FAOM) at preoperative magnetic resonance imaging is associated with the severity of deep infiltrating endometriosis. DESIGN Observational cross-sectional study involving 255 symptomatic deep infiltrating endometriosis patients. Comparisons were performed according to the presence of FAOM. SETTING University hospital. PATIENT(S) Women with a preoperative magnetic resonance imaging and complete surgical exeresis of endometriotic lesions with histologically documented deep infiltrating endometriosis. INTERVENTION(S) Surgical management for deep infiltrating endometriosis. MAIN OUTCOME MEASURE(S) The presence of multiple deep infiltrating endometriosis lesions, the mean number and location of deep infiltrating endometriosis lesions, and the mean total revised American Society for Reproductive Medicine scores. RESULT(S) The prevalence of FAOM at preoperative magnetic resonance imaging in the 255 patients with deep infiltrating endometriosis was 56.5%. The mean number of deep infiltrating endometriosis lesions was significantly higher in the FAOM(+) group than in the FAOM(-) group: 3.5 ± 2.1 vs. 2.2 ± 1.5. The mean total revised American Society for Reproductive Medicine score was higher in case of FOAM coexisting with deep infiltrating endometriosis. After adjusting for confounding factors, the presence of FAOM was significantly associated with multiple deep lesions. CONCLUSION(S) FAOM was significantly associated with greater deep infiltrating endometriosis severity. This needs to be integrated into the management strategy. Furthermore, a pathogenic link between deep infiltrating endometriosis and FAOM cannot be excluded.
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Chen Q, Li YW, Wang S, Fan QB, Shi HH, Leng JH, Sun DW, Lang JH, Zhu L. Clinical Manifestations Of Adenomyosis Patients With Or Without Pain Symptoms. J Pain Res 2019; 12:3127-3133. [PMID: 31814754 PMCID: PMC6861517 DOI: 10.2147/jpr.s212117] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 10/01/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Our study aims to investigate the distribution of pain symptoms and the association between pain symptoms and clinical parameters in patients with adenomyosis. Patients and methods The clinical and pathological data of 291 patients diagnosed with adenomyosis in the Obstetrics and Gynecology Department of Peking Union Medical College Hospital from March 2012 to September 2015 were collected, and analyzed in regard to the pain symptoms. Results The median age at disease onset was 34 years. 71.8% of the patients had pain symptoms (pain group) and 28.2% had no pain symptoms (painless group). Patients with symptoms accompanied by dysmenorrhea accounted for 68%, among which 30.3% were mild, 36.9% were moderate, and 32.8% severe, while 56.1% presented with progressive pain. Through comparison, significant differences were identified between the pain and painless groups with regard to age at diagnosis (P=0.009), age at onset of disease (P=0.008), and level of pre-surgical CA125 (P<0.001), as well as proportion of patients with rectal irritation (P=0.008), elevated CA125 level (P<0.001), thickened myometrial layer (P<0.001) and concurrent endometriosis (P=0.001). In the multivariable analysis, an elevated level of pre-surgical CA125 (P<0.001) and thickened posterior myometrial layer (P=0.023) were both independent risk factors for the morbidity of pain symptoms. Similar results except for the difference in rectal irritation were noticed when we made further comparison between the dysmenorrhea and non-dysmenorrhea groups in adenomyosis patients. Conclusion Our research analyzes the clinical features related to pain symptoms in patients with adenomyosis, which may provide clues for the possible presurgical diagnosis of adenomyosis, as well as references for pain management of adenomyosis.
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Affiliation(s)
- Qian Chen
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yun-Wei Li
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shu Wang
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Qing-Bo Fan
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hong-Hui Shi
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jin-Hua Leng
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Da-Wei Sun
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jing-He Lang
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Lan Zhu
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol 2019; 15:666-682. [PMID: 31488888 DOI: 10.1038/s41574-019-0245-z] [Citation(s) in RCA: 445] [Impact Index Per Article: 89.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2019] [Indexed: 02/08/2023]
Abstract
Endometriosis is a chronic inflammatory disease defined as the presence of endometrial tissue outside the uterus, which causes pelvic pain and infertility. This disease should be viewed as a public health problem with a major effect on the quality of life of women as well as being a substantial economic burden. In light of the considerable progress with diagnostic imaging (for example, transvaginal ultrasound and MRI), exploratory laparoscopy should no longer be used to diagnose endometriotic lesions. Instead, diagnosis of endometriosis should be based on a structured process involving the combination of patient interviews, clinical examination and imaging. Notably, a diagnosis of endometriosis often leads to immediate surgery. Therefore, rethinking the diagnosis and management of endometriosis is warranted. Instead of assessing endometriosis on the day of the diagnosis, gynaecologists should consider the patient's 'endometriosis life'. Medical treatment is the first-line therapeutic option for patients with pelvic pain and no desire for immediate pregnancy. In women with infertility, careful consideration should be made regarding whether to provide assisted reproductive technologies prior to performing endometriosis surgery. Modern endometriosis management should be individualized with a patient-centred, multi-modal and interdisciplinary integrated approach.
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Affiliation(s)
- Charles Chapron
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France.
- Department 'Development, Reproduction and Cancer', Institut Cochin, INSERM U1016, Université Paris Descartes, Paris, France.
| | - Louis Marcellin
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Department 'Development, Reproduction and Cancer', Institut Cochin, INSERM U1016, Université Paris Descartes, Paris, France
| | - Bruno Borghese
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Department 'Development, Reproduction and Cancer', Institut Cochin, INSERM U1016, Université Paris Descartes, Paris, France
| | - Pietro Santulli
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Department 'Development, Reproduction and Cancer', Institut Cochin, INSERM U1016, Université Paris Descartes, Paris, France
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