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Zugaj MR, Germeyer A, Kranz K, Züger A, Keßler J. Experiences of patients with endometriosis with a digital health application: a qualitative analysis. Arch Gynecol Obstet 2024; 310:2253-2263. [PMID: 39066952 DOI: 10.1007/s00404-024-07651-7] [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: 03/28/2024] [Accepted: 07/12/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Endometriosis is a frequent disease in women of reproductive age in which the endometrium occurs outside the uterine cavity. Multimodal treatment approaches are necessary due to loss of quality of life and the chronic nature of the disease. Digital health applications (DiGa) are becoming increasingly important. This research project investigates how a healthcare app can influence the subjective experience of illness in patients with endometriosis. METHODS Empiric data were collected through semi-structured interviews. Data analysis was carried out using qualitative focussed interview analysis. Reliability was ensured by joint interdisciplinary and interprofessional evaluation of the interviews by experts and those affected. RESULTS Ten patients with endometriosis and the prescribed healthcare app Endo-App© were examined. Categories were defined from the superordinate categories "Factors influencing the experience of illness" and "Evaluation of the app". The app provided reliable information, promoted self-efficacy through exercises and strengthened the perception of the individuality of the illness. It helped to minimise nocebo effects from internet research and enabled a positive change of perspective. Patients criticised the time required for data input and had data protection concerns. The educational elements were often seen as redundant. Some patients only used the app briefly, or not at all. CONCLUSION Once a DiGa has been prescribed, it may be useful to explain its use on an outpatient basis and validate regular use. Blind re-prescribing of DiGas should be avoided. Younger patients with a recent diagnosis or patients following rehabilitation may benefit more from prescribing.
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Affiliation(s)
- Marco Richard Zugaj
- Medical Faculty Heidelberg, Department of Anaesthesiology, Pain Medicine Section, Heidelberg University, Heidelberg, Germany.
| | - Ariane Germeyer
- Medical Faculty Heidelberg, Heidelberg Women's Clinic, Department of Gynaecological Endocrinology and Fertility Disorders, Heidelberg University, Heidelberg, Germany
| | - Karina Kranz
- Medical Faculty Heidelberg, Center for Psychosocial Medicine, Institute for Medical Psychology, Heidelberg University, Heidelberg, Germany
| | - Andrea Züger
- Institute for History, Theory and Ethics of Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - Jens Keßler
- Medical Faculty Heidelberg, Department of Anaesthesiology, Pain Medicine Section, Heidelberg University, Heidelberg, Germany
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Björk E, Israelsson P, Nagaev I, Nagaeva O, Lundin E, Ottander U, Mincheva-Nilsson L. Endometriotic Tissue-derived Exosomes Downregulate NKG2D-mediated Cytotoxicity and Promote Apoptosis: Mechanisms for Survival of Ectopic Endometrial Tissue in Endometriosis. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2024; 213:567-576. [PMID: 38984872 PMCID: PMC11335327 DOI: 10.4049/jimmunol.2300781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 06/17/2024] [Indexed: 07/11/2024]
Abstract
Endometriosis, affecting 10% of women, is defined as implantation, survival, and growth of endometrium-like/endometriotic tissue outside the uterine cavity, causing inflammation, infertility, pain, and susceptibility to ovarian cancer. Despite extensive studies, its etiology and pathogenesis are poorly understood and largely unknown. The prevailing view is that the immune system of endometriosis patients fails to clear ectopically disseminated endometrium from retrograde menstruation. Exosomes are small extracellular vesicles that exhibit immunomodulatory properties. We studied the role of endometriotic tissue-secreted exosomes in the pathophysiology of endometriosis. Two exosome-mediated mechanisms known to impair the immune response were investigated: 1) downregulation of NKG2D-mediated cytotoxicity and 2) FasL- and TRAIL-induced apoptosis of activated immune cells. We showed that secreted endometriotic exosomes isolated from supernatants of short-term explant cultures carry the NKG2D ligands MICA/B and ULBP1-3 and the proapoptotic molecules FasL and TRAIL on their surface, i.e., signature molecules of exosome-mediated immune suppression. Acting as decoys, these exosomes downregulate the NKG2D receptor, impair NKG2D-mediated cytotoxicity, and induce apoptosis of activated PBMCs and Jurkat cells through the FasL- and TRAIL pathway. The secreted endometriotic exosomes create an immunosuppressive gradient at the ectopic site, forming a "protective shield" around the endometriotic lesions. This gradient guards the endometriotic lesions against clearance by a cytotoxic attack and creates immunologic privilege by induction of apoptosis in activated immune cells. Taken together, our results provide a plausible, exosome-based mechanistic explanation for the immune dysfunction and the compromised immune surveillance in endometriosis and contribute novel insights into the pathogenesis of this enigmatic disease.
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Affiliation(s)
- Emma Björk
- Division of Obstetrics and Gynecology/Örnsköldsvik Hospital, Örnsköldsvik, Sweden
- Department of Clinical Microbiology/Infection and Immunology, Umeå University, Umeå, Sweden
- Department of Clinical Sciences/Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Pernilla Israelsson
- Department of Diagnostics and Intervention/Oncology, Umeå University, Umeå, Sweden
| | - Ivan Nagaev
- Department of Clinical Microbiology/Infection and Immunology, Umeå University, Umeå, Sweden
| | - Olga Nagaeva
- Department of Clinical Microbiology/Infection and Immunology, Umeå University, Umeå, Sweden
| | - Eva Lundin
- Department of Medical Biosciences/Pathology, Umeå University, Umeå, Sweden
| | - Ulrika Ottander
- Department of Clinical Sciences/Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Lucia Mincheva-Nilsson
- Department of Clinical Microbiology/Infection and Immunology, Umeå University, Umeå, Sweden
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Obern C, Olovsson M, Tydén T, Sundström-Poromaa I. Endometriosis risk and hormonal contraceptive usage: A nationwide cohort study. BJOG 2024; 131:1352-1359. [PMID: 38511416 DOI: 10.1111/1471-0528.17812] [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: 12/12/2023] [Revised: 02/23/2024] [Accepted: 03/03/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To investigate whether an early need of hormonal contraceptive (HC), or a failure to find a suitable method, are warning signs for endometriosis. DESIGN A retrospective cohort study. SETTING Sweden. POPULATION The cohort consisted of 720 805 women aged 12-27 years during the period 2005-2017. All women, regardless of whether they received a diagnosis of endometriosis or not (reference group), were included. METHODS We used data from Swedish national registers. Risks are expressed as crude and adjusted hazard ratios (HRs and aHRs, respectively) with 95% confidence intervals (95% CIs), adjusted for age, education level, civil status, parity, country of birth, and diagnoses of infertility, dysmenorrhea or depression. MAIN OUTCOME MEASURES A diagnosis of endometriosis between 12 and 27 years of age. RESULTS During this period, 3268 women were diagnosed with endometriosis (0.45%). Women who started HC at the ages of 12-14 years had a higher risk of receiving the diagnosis (aHR 2.53, 95% CI 2.21-2.90) than those who began at age 17 years or older. Having tried more types of HCs was associated with a twofold increased risk of endometriosis (more that three types of HC, aHR 2.31, 95% CI 1.71-3.12). Using HC for more than 1 year was associated with a decreased risk of endometriosis (>1 year, aHR 0.53, 95% CI 0.48-0.59). Women with endometriosis more commonly had dysmenorrhea, depression or infertility. CONCLUSIONS The use of HCs at an early age and a failure to find a suitable HC were identified as warning signs of later receiving an endometriosis diagnosis. A longer duration of HC usage reduced the risk of receiving the diagnosis.
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Affiliation(s)
- Cerisa Obern
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Tanja Tydén
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Fleischer K, Bachi A, Kam J, Narayanan P, Nair R, Khazali S. Bladder Endometriosis: What do we know and what is left to find out? A narrative review. Best Pract Res Clin Obstet Gynaecol 2024; 96:102536. [PMID: 39112342 DOI: 10.1016/j.bpobgyn.2024.102536] [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: 04/30/2024] [Revised: 07/04/2024] [Accepted: 07/29/2024] [Indexed: 09/10/2024]
Abstract
Bladder endometriosis accounts for 70-85% of urinary tract endometriosis cases. Urinary tract endometriosis occurs in approximately 1% of those living with endometriosis. Underlying aetiology and pathogenesis are not fully understood, but there are several plausible theories. As well as the typical pain symptoms, those with bladder endometriosis can experience several urinary tract symptoms. The manifestation of these symptoms can have complex pathways and processes. Imaging is accurate in the diagnosis of bladder endometriosis and clinicians should be mindful of the risk of silent kidney loss. Management should be guided by symptoms; both medical and surgical options are feasible. Surgical management offers potentially definitive treatment. Excisional surgery via bladder shave or partial cystectomy offers good improvement in symptoms with relatively low rates of serious complications and recurrence.
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Affiliation(s)
- Kyle Fleischer
- Centre for Endometriosis and Minimally Invasive Gynaecology CEMIG London, HCA the Lister Hospital, Chelsea Bridge Road, London, England, SW1W 8RH, UK; Faculty of Health and Medical Sciences, University of Surrey, Stag Hill, University Campus, Guildford, Surrey, England, GU2 7XH, UK.
| | - Averyl Bachi
- East Surrey Hospital, Surrey and Sussex NHS Foundation Trust, Canada Avenue, Redhill, Surrey, England, RH1 5RH, UK
| | - Jonathan Kam
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, England, SE1 9RT, UK
| | - Priya Narayanan
- Centre for Endometriosis and Minimally Invasive Gynaecology CEMIG London, HCA the Lister Hospital, Chelsea Bridge Road, London, England, SW1W 8RH, UK; Department of Radiology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, England, NW1 2PG, UK
| | - Rajesh Nair
- Centre for Endometriosis and Minimally Invasive Gynaecology CEMIG London, HCA the Lister Hospital, Chelsea Bridge Road, London, England, SW1W 8RH, UK; Department of Urology, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, England, SE1 9RT, UK
| | - Shaheen Khazali
- Centre for Endometriosis and Minimally Invasive Gynaecology CEMIG London, HCA the Lister Hospital, Chelsea Bridge Road, London, England, SW1W 8RH, UK; Royal Holloway, University of London, Egham, Surrey, TW20 0EX, UK
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Khan R, Baksh R, Wallace TJ, Aimable M, Bujhawan V, Cumberbatch J, Marbella EJ, Phagoo D, Ramjattan S, Shavili A. A cross-sectional study on the quality of life of women with endometriosis in Trinidad and Tobago. Front Glob Womens Health 2024; 5:1359741. [PMID: 39238609 PMCID: PMC11374614 DOI: 10.3389/fgwh.2024.1359741] [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: 12/21/2023] [Accepted: 08/02/2024] [Indexed: 09/07/2024] Open
Abstract
Introduction Endometriosis is a chronic gynecological condition that lacks a definitive cure and adversely impacts the quality of life (QoL) of those affected. This study delves into the experiences of individuals with endometriosis in Trinidad and Tobago, focusing on their quality of life, pain severity, and acceptance of illness. Methods Surveys were distributed among 160 members of the Trinidad and Tobago Endometriosis Association. The survey instrument utilized was the WHOQOL-BREF, which measures QoL, pain severity, and acceptance of illness [the Acceptance of Illness Scale (AIS)]. Results The average age of respondents was 38.65 years. Quality of life scores averaged 3.41, with the "environment" aspect scoring highest (12.84) and "social relationships" scoring lowest (11.88). Cronbach's alpha indicated excellent internal consistency for "environment" (ɑ = 0.909) and the "AIS" (ɑ = 0.882). The independent samples t-test revealed lower mean QoL scores for unemployed participants. Analysis of variance revealed significant differences in mean QoL scores for "health status" and "years since endometriosis diagnosis." All the QoL domains were positively correlated with each other. There were moderate positive correlations between the physical health and social relationships domains (ρ = 0.558). All other domains were strongly correlated with each other (0.6 < ρ < 0.8). Pain intensity and acceptance of illness had mean scores of 24.15 and 6.57, respectively. Variations in quality of life were observed for health status and duration since diagnosis, impacting mostly on the domain of physical health. Acceptance of illness emerged as a significant influencer of overall quality of life, assisting individuals in navigating the challenges posed by endometriosis. Discussion The findings underscore the importance of understanding determinants, such as pain severity to improve care and support for those with endometriosis. Exploring acceptance of illness is critical in improving the quality of life of these individuals, highlighting the need for tailored interventions that encompass psychological and social support alongside medical treatment. This study demonstrates the pivotal role of acceptance of illness in the overall quality of life of endometriosis patients. Improving the quality of care requires a comprehensive understanding of the factors influencing quality of life, particularly pain severity and the need for a holistic approach to support individuals grappling with endometriosis.
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Affiliation(s)
- Raveed Khan
- Department of Para-Clinical Sciences, Unit of Public Health & Primary Care, Faculty of Medical Sciences, The University of the West Indies St. Augustine, St. Augustine, Trinidad and Tobago
| | - Rameez Baksh
- Department of Mathematics and Statistics, The University of the West Indies St. Augustine, St. Augustine, Trinidad and Tobago
| | - Terika J Wallace
- Department of Para Clinical Sciences, Faculty of Medical Sciences, The University of the West Indies St. Augustine, St. Augustine, Trinidad and Tobago
| | - Mikael Aimable
- Department of Para Clinical Sciences, Faculty of Medical Sciences, The University of the West Indies St. Augustine, St. Augustine, Trinidad and Tobago
| | - Vineeta Bujhawan
- Department of Para Clinical Sciences, Faculty of Medical Sciences, The University of the West Indies St. Augustine, St. Augustine, Trinidad and Tobago
| | - Justin Cumberbatch
- Department of Para Clinical Sciences, Faculty of Medical Sciences, The University of the West Indies St. Augustine, St. Augustine, Trinidad and Tobago
| | - Enrie Julian Marbella
- Department of Para Clinical Sciences, Faculty of Medical Sciences, The University of the West Indies St. Augustine, St. Augustine, Trinidad and Tobago
| | - Dana Phagoo
- Department of Para Clinical Sciences, Faculty of Medical Sciences, The University of the West Indies St. Augustine, St. Augustine, Trinidad and Tobago
| | - Sanathkumar Ramjattan
- Department of Para Clinical Sciences, Faculty of Medical Sciences, The University of the West Indies St. Augustine, St. Augustine, Trinidad and Tobago
| | - Akshita Shavili
- Department of Para Clinical Sciences, Faculty of Medical Sciences, The University of the West Indies St. Augustine, St. Augustine, Trinidad and Tobago
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Jasinski V, Voltolini Velho R, Sehouli J, Mechsner S. Cannabis use in endometriosis: the patients have their say-an online survey for German-speaking countries. Arch Gynecol Obstet 2024:10.1007/s00404-024-07652-6. [PMID: 39162801 DOI: 10.1007/s00404-024-07652-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/12/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE Endometriosis is a chronic inflammatory disease that can cause various pain symptoms. Current therapy options do not always provide sufficient pain relief and often cause unpleasant side effects. Recent studies have shown that the endocannabinoid system is involved in the endometriosis pathophysiology, and using Cannabinoids may be a potential therapeutic option. We aimed to determine for the first time, the Cannabis use prevalence, self-rated effectiveness, and the possible reduction in medication in German-speaking countries. METHODS A cross-sectional online survey was distributed through endometriosis support and advocacy groups on social media. German-speaking endometriosis patients aged ≤ 18, residing in Germany, Austria, and Switzerland were eligible to participate. RESULTS Out of 912 participants who provided valid answers, 114 reported using cannabis for self-management. Cannabis was rated as the most effective self-management strategy to reduce symptom intensity (self-rated efficacy 7.6 out of 10). Additionally, ~ 90% of the participants were able to decrease their pain medication intake. The greatest improvement was observed in sleep (91%), menstrual pain (90%), and non-cyclic pain (80%). Apart from increased fatigue (17%), side effects were infrequent (≤ 5%). CONCLUSION At the time of the study, Cannabis consumption was still illegal in Germany, Austria, and Switzerland, with medical cannabis being rarely prescribed due to complex requirements. Results suggest that Cannabis has become a popular self-management method for treating endometriosis-related symptoms, leading to substantial symptom improvement. Further studies are needed to investigate the best administration methods, dosage, THC/CBD ratio, potential side effects, and long-term effects to provide official recommendations to patients and healthcare providers.
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Affiliation(s)
- Victoria Jasinski
- Department of Gynecology with Center of Oncological Surgery, Endometriosis Research Center Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Renata Voltolini Velho
- Department of Gynecology with Center of Oncological Surgery, Endometriosis Research Center Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology with Center of Oncological Surgery, Endometriosis Research Center Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sylvia Mechsner
- Department of Gynecology with Center of Oncological Surgery, Endometriosis Research Center Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
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Cipres DT, Whitley MY, Ward VL. Racial and Ethnic Equity, Diversity, and Inclusion in Pediatric and Adolescent Gynecology: A Call to Action From a North American Perspective. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00262-6. [PMID: 39103117 DOI: 10.1016/j.jpag.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 08/07/2024]
Affiliation(s)
- Danielle T Cipres
- Department of Surgery, Division of Gynecology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Melicia Y Whitley
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, Massachusetts
| | - Valerie L Ward
- Harvard Medical School, Boston, Massachusetts; Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, Massachusetts; Department of Radiology, Boston Children's Hospital, Boston, Massachusetts; Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, Massachusetts
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Shim JY, Garbo G, Grimstad FW, Scatoni A, Barrera EP, Boskey ER. Use of the Drospirenone-Only Contraceptive Pill in Adolescents with Endometriosis. J Pediatr Adolesc Gynecol 2024; 37:402-406. [PMID: 38395193 DOI: 10.1016/j.jpag.2024.02.003] [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: 12/01/2023] [Revised: 01/20/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024]
Abstract
STUDY OBJECTIVE To evaluate the efficacy and tolerability of a progestin-only pill containing 4 mg drospirenone (DRSP) as a hormonal therapy for the management of endometriosis-associated symptoms in adolescents and young adults. DESIGN Retrospective cohort study. METHODS A retrospective chart review was performed of all adolescents who were prescribed DRSP continuously (without placebo) for treatment of endometriosis at a single pediatric tertiary care center between 2019 and 2022. Electronic medical records were reviewed to obtain demographics and clinical characteristics of the patients. Measured outcomes included symptom resolution and medication discontinuation. The study was deemed IRB exempt. RESULTS A total of 61 patients with endometriosis were prescribed DRSP during the study period, with a median age of 18.9 years (SD 2.3). The majority (97%) were laparoscopically confirmed to have endometriosis, and 85% had stage I disease. Before DRSP use, the most common medications trialed were norethindrone (57%) and norethindrone acetate (68%), and 56% had at least one medical contraindication to receiving estrogen-containing therapy. Of those with follow-up, 52% established an absence of bleeding/spotting, and 67% reported less pain at follow-up. One in 4 patients discontinued DRSP during the study period, most commonly due to breakthrough bleeding. CONCLUSION DRSP is a well-tolerated and effective option for the treatment of endometriosis-associated symptoms in adolescents and young adults.
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Affiliation(s)
- Jessica Y Shim
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts.
| | - Garrett Garbo
- Department of Obstetrics, Gynecology, and Women's Heath, University of Minnesota, Minneapolis, Minnesota
| | - Frances W Grimstad
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Ava Scatoni
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Ellis P Barrera
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
| | - Elizabeth R Boskey
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts
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Violette CJ, Aberle LS, Anderson ZS, Komatsu EJ, Song BB, Mandelbaum RS, Matsuzaki S, Ouzounian JG, Matsuo K. Pregnancy with endometriosis: Assessment of national-level trends, characteristics, and maternal morbidity at delivery. Eur J Obstet Gynecol Reprod Biol 2024; 299:1-11. [PMID: 38815411 DOI: 10.1016/j.ejogrb.2024.05.011] [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: 02/27/2024] [Revised: 05/01/2024] [Accepted: 05/11/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To examine pregnancy characteristics and maternal morbidity at delivery among pregnant patients with a diagnosis of endometriosis. STUDY DESIGN This cross-sectional study queried the Healthcare Cost and Utilization Project's National Inpatient Sample. Study population was 17,796,365 hospital deliveries from 2016 to 2020, excluded adenomyosis and uterine myoma. The exposure was endometriosis diagnosis. Main outcome measures were clinical and pregnancy characteristics and severe maternal morbidity at delivery related to endometriosis, assessed with multivariable regression model. RESULTS Endometriosis was diagnosed in 17,590 patients. The prevalence of endometriosis increased by 24 % from one in 1,191 patients in 2016 to one in 853 patients in 2020 (adjusted-odds ratio [aOR] 1.24, 95% confidence interval [CI] 1.19-1.30). Clinical and pregnancy characteristics that had greater than two-fold association to endometriosis included polycystic ovary syndrome, placenta previa, cesarean delivery, maternal age of ≥30 years, prior pregnancy loss, and anxiety disorder. Pregnant patients with endometriosis were more likely to have the diagnosis of measured severe maternal morbidity during the index hospitalization for delivery (47.8 vs 17.3 per 1,000 deliveries, aOR 1.91, 95%CI 1.78-2.06); these associations were more prominent following vaginal (aOR 2.82, 95%CI 2.41-3.30) compared to cesarean (aOR 1.85, 95%CI 1.71-2.00) deliveries. Among the individual morbidity indicators, endometriosis was most strongly associated with thromboembolism (aOR 5.05, 95%CI 3.70-6.91), followed by sepsis (aOR 2.39, 95%CI 1.85-3.09) and hysterectomy (aOR 2.18, 95%CI 1.85-2.56). When stratified for endometriosis anatomical site, odds of thromboembolism was increased in endometriosis at distant site (aOR 9.10, 95%CI 3.76-22.02) and adnexa (aOR 7.37, 95%CI 4.43-12.28); odds of sepsis was most increased in endometriosis at multi-classifier locations (aOR 7.33, 95%CI 2.93-18.31) followed by pelvic peritoneum (aOR 5.54, 95%CI 2.95-10.40); and odds of hysterectomy exceeded three-fold in endometriosis at adnexa (aOR 3.00, 95%CI 2.30-3.90), distant site (aOR 5.36, 95%CI 3.48-8.24), and multi-classifier location (aOR 4.46, 95%CI 2.11-9.41). CONCLUSION The results of this nationwide analysis suggest that pregnancy with endometriosis is uncommon but gradually increasing over time in the United States. The data also suggest that endometriosis during pregnancy is associated with increased risk of severe maternal morbidity at delivery, especially for thromboembolism, sepsis, and hysterectomy. These morbidity risks differed by the anatomical location of endometriosis.
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Affiliation(s)
- Caroline J Violette
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Laurel S Aberle
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Zachary S Anderson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Emi J Komatsu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Bonnie B Song
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Rachel S Mandelbaum
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Shinya Matsuzaki
- Department of Gynecology, Osaka International Cancer Institute, Osaka, Japan
| | - Joseph G Ouzounian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
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Senthilkumar S, Morgan T, Wasson MN. Posthysterectomy Retroperitoneal Endometrioma With Episodic Bleeding. J Minim Invasive Gynecol 2024; 31:635-637. [PMID: 38772439 DOI: 10.1016/j.jmig.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/04/2024] [Accepted: 05/06/2024] [Indexed: 05/23/2024]
Affiliation(s)
- Sanjanaa Senthilkumar
- Department of Medical and Surgical Gynecology (Ms. Senthilkumar and Dr. Wasson), Mayo Clinic in Arizona, Phoenix, Arizona; Mayo Clinic Alix School of Medicine (Ms. Senthilkumar), Mayo Clinic in Arizona, Phoenix, Arizona.
| | - Tara Morgan
- Department of Radiology (Dr. Morgan), Mayo Clinic in Arizona, Phoenix, Arizona
| | - Megan N Wasson
- Department of Medical and Surgical Gynecology (Ms. Senthilkumar and Dr. Wasson), Mayo Clinic in Arizona, Phoenix, Arizona
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Lin T, Allaire C, As-Sanie S, Stratton P, Vincent K, Adamson GD, Arendt-Nielsen L, Bush D, Jansen F, Longpre J, Rombauts L, Shah J, Toussaint A, Hummelshoj L, Missmer SA, Yong PJ. World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonization Project: V. Physical examination standards in endometriosis research. Fertil Steril 2024; 122:304-315. [PMID: 38508508 DOI: 10.1016/j.fertnstert.2024.03.007] [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: 03/06/2024] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE The World Endometriosis Research Foundation established the Endometriosis Phenome and Biobanking Harmonisation Project (EPHect) to create standardized documentation tools (with common data elements) to facilitate the comparison and combination of data across different research sites and studies. In 2014, 4 data research standards were published: clinician-reported surgical data, patient-reported clinical data, and fluid and tissue biospecimen collection. Our current objective is to create an EPHect standard for the clinician-reported physical examination (EPHect-PE) for research studies. DESIGN An international consortium involving 26 clinical and academic experts and patient partners from 11 countries representing 25 institutions and organizations. Two virtual workshops, followed by the development of the physical examination standards underwent multiple rounds of iterations and revisions. SUBJECTS N/A MAIN OUTCOME MEASURE(S): N/A RESULT(S): The EPHect-PE tool provides standardized assessment of physical examination characteristics and pain phenotyping. Data elements involve examination of back and pelvic girdle; abdomen including allodynia and trigger points; vulva including provoked vestibulodynia; pelvic floor muscle tone and tenderness; tenderness on unidigital pelvic examination; presence of pelvic nodularity; uterine size and mobility; presence of adnexal masses; presence of incisional masses; speculum examination; tenderness and allodynia at an extra-pelvic site (e.g., forearm); and recording of anthropometrics. CONCLUSION(S) The EPHect-PE standards will facilitate the standardized documentation of the physical examination, including the assessment and documentation of examination phenotyping of endometriosis-associated pelvic pain.
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Affiliation(s)
- Tinya Lin
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Catherine Allaire
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sawsan As-Sanie
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | | | - Katy Vincent
- Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - G David Adamson
- World Endometriosis Research Foundation (WERF); Department of Obstetrics & Gynecology, Stanford University, Palo Alto, California
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; Aalborg University Hospital, Mech-Sense, Aalborg, Denmark
| | | | - Femke Jansen
- World Endometriosis Organisations (WEO); EndoHome - Endometriosis Association Belgium, Belgium
| | - Jennifer Longpre
- Department of Obstetrics and Gynecology, Université de Montreal, Montreal, Quebec, Canada
| | - Luk Rombauts
- World Endometriosis Research Foundation (WERF); Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Jay Shah
- National Institutes of Health, Bethesda, Maryland
| | - Abeesha Toussaint
- World Endometriosis Organisations (WEO); Trinidad and Tobago Endometriosis Association, Port of Spain, Trinidad and Tobago
| | | | - Stacey A Missmer
- World Endometriosis Research Foundation (WERF); Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, Michigan
| | - Paul J Yong
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada.
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da Costa Porto BT, Ribeiro PA, Kuteken F, Ohara F, Abdalla Ribeiro HS. Levonorgestrel intrauterine system versus dienogest effect on quality of life of women with deep endometriosis: a randomized open-label clinical trial. Women Health 2024; 64:551-558. [PMID: 39111847 DOI: 10.1080/03630242.2024.2382418] [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: 01/22/2024] [Revised: 07/05/2024] [Accepted: 07/15/2024] [Indexed: 08/20/2024]
Abstract
Women with deep infiltrating endometriosis (DIE) can benefit from the use of progestins. Our aim is to explore if levonorgestrel-releasing intrauterine system (LNG-IUS) non inferior to dienogest (DNG) in improving deep endometriosis women's quality of life (QoL). This randomized open-label clinical trial included forty women with DIE assessed using clinical history and physical examination, transvaginal ultrasonography and magnetic resonance of the pelvis without any previous surgical treatment, with two treatments arms. The two groups underwent a 3-month washout of hormonal treatments, and then received either DNG or LNG-IUS for 6 months. QoL was assessed prior to and 6 months after the intervention, using the SF36 and the EHP30. DNG and LNG-IUS showed an increase on all domains of the SF36 (p < .001). There was no difference between treatments on the improvement observed (p > .05 for all domains). DNG and LNG-IUS, also, showed improvement on all domains of EHP30 (p < .001), except "relationship with children" and "feelings about pregnancy." However, there was no statistical difference between treatments for all sections scores (p > .05). The treatment of deep endometriosis symptoms using either DNG or LNG-IUS in women with no prior surgical treatment is associated with improvement in QoL.Trial Registration Number: This trial is registered on "The Brazilian Registry of Clinical Trials (ReBECID: RBR-8fjx2jp)," that is part of Primary Registries in the WHO Registry Network, under the title: "Dienogest versus Levonorgestrel IUS on deep endometriosis patient´s QoL without surgery" on June 14, 2021; https://ensaiosclinicos.gov.br/rg/RBR-8fjx2jp.
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Affiliation(s)
| | - Paulo Ayroza Ribeiro
- Gynecological Endoscopy and Endometriosis Division Clinic, Santa Casa de Misericórdia do Brasil, São Paulo, Brasil
| | - Fábio Kuteken
- Gynecological Endoscopy and Endometriosis Division Clinic, Santa Casa de Misericórdia do Brasil, São Paulo, Brasil
| | - Fábio Ohara
- Gynecological Endoscopy and Endometriosis Division Clinic, Santa Casa de Misericórdia do Brasil, São Paulo, Brasil
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13
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Orlov S, Sladkevicius P, Jokubkiene L. Evaluating the development of endometriosis and adenomyosis lesions over time: An ultrasound study of symptomatic women. Acta Obstet Gynecol Scand 2024; 103:1634-1644. [PMID: 38687177 PMCID: PMC11266643 DOI: 10.1111/aogs.14865] [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: 01/18/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION There is a gap in knowledge regarding development of endometriosis and adenomyosis lesions visible at transvaginal ultrasound. The objectives were to evaluate if women with symptoms suggestive of endometriosis or adenomyosis but normal ultrasound examination develop endometriosis or adenomyosis lesions visible at ultrasound over time and if alterations of symptoms over time are associated with ultrasound findings at follow-up. MATERIAL AND METHODS This was a prospective cohort study of 100 symptomatic women with normal initial ultrasound examination during 2014-2017 who underwent follow-up ultrasound examination in 2022. Symptoms suggestive of endometriosis were assessed using visual analog scale at both examinations and minimal clinically important difference of 10 mm was considered as a significant alteration. An examiner with expertise in advanced ultrasound examination of endometriosis performed transvaginal ultrasound examinations in accordance with the consensus protocol by the International Deep Endometriosis Analysis group. RESULTS At follow-up ultrasound examination of 100 women, 13 (13% [95% CI 7.1-21.2]) had visible endometriosis or adenomyosis lesions, 8 (8% [95% CI 3.5-15.2]) had endometriosis lesions, and 6 (6% [95% CI 2.2-12.6]) had adenomyosis. At follow-up, women with endometriosis or adenomyosis lesions reported lower intensity of dysmenorrhea and chronic pelvic pain compared to women without lesions (48 mm [IQR 16-79] vs. 73 mm [IQR 46-85] and 45 mm [IQR 26-57] vs. 57 mm [IQR 36-75], p = 0.087 and p = 0.026, respectively). None of the women with endometriosis or adenomyosis lesions reported increased intensity of dysmenorrhea at follow-up, compared to 32/86 women (37%) without lesions (p = 0.008). Increased intensity of chronic pelvic pain tended to be less common in women with lesions compared to those without (3/13 [23%] vs. 35/86 [41%], p = 0.223). CONCLUSIONS Our findings suggest that in symptomatic women, endometriosis and adenomyosis lesions visible at ultrasound may develop over time. However, majority of women remain having normal ultrasound examinations despite symptoms. Exacerbation of dysmenorrhea or chronic pelvic pain during follow-up was not associated with the development of endometriosis or adenomyosis lesions visible at ultrasound, suggesting that even women with less severe symptoms might benefit from a follow-up ultrasound when indicated.
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Affiliation(s)
- Sofie Orlov
- Obstetric, Gynecological and Prenatal Ultrasound Research, Department of Clinical Sciences MalmoLund UniversityMalmoSweden
- Department of Obstetrics and GynecologySkane University HospitalMalmoSweden
- Department of Obstetrics and GynecologyYstad HospitalYstadSweden
| | - Povilas Sladkevicius
- Obstetric, Gynecological and Prenatal Ultrasound Research, Department of Clinical Sciences MalmoLund UniversityMalmoSweden
- Department of Obstetrics and GynecologySkane University HospitalMalmoSweden
| | - Ligita Jokubkiene
- Obstetric, Gynecological and Prenatal Ultrasound Research, Department of Clinical Sciences MalmoLund UniversityMalmoSweden
- Department of Obstetrics and GynecologySkane University HospitalMalmoSweden
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Chapron C, Marcellin L, Maitrot-Mantelet L, Bourdon M, Maignien C, Parpex G, Santulli P. Questionnaire-based screening of adolescents and young adult women can identify markers associated with endometriosis. Hum Reprod 2024; 39:1664-1672. [PMID: 38901867 DOI: 10.1093/humrep/deae125] [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: 12/28/2023] [Revised: 05/04/2024] [Indexed: 06/22/2024] Open
Abstract
STUDY QUESTION Do adolescents and young adult women (YAW) with histologically proven endometriosis present a specific clinical history? SUMMARY ANSWER Questionnaire screening of adolescents and YAW can identify clinical markers associated with histologically proven endometriosis. WHAT IS KNOWN ALREADY Some validated questionaries can contribute to an earlier endometriosis diagnosis in adults. None of these scores, however, have been validated for adolescents or YAW. STUDY DESIGN, SIZE, DURATION This was an observational cross-sectional study using prospectively recorded data performed between January 2005 and January 2020 in a single university tertiary referral centre for endometriosis diagnosis and management. After a thorough surgical examination of the abdomino-pelvic cavity, women with histologically proven endometriosis were allocated to the endometriosis group, and symptomatic women without evidence of endometriosis were allocated to the endometriosis-free control group. The endometriotic patients were allocated into two sub-groups according to their age: adolescent (≤20 years) and YAW (21-24 years). PARTICIPANTS/MATERIALS, SETTING, METHODS Adolescents and YAW ≤24 years of age were operated for a symptomatic benign gynaecological condition with signed informed consent. A standardized questionnaire was prospectively completed in the month before the surgery and included epidemiological data, pelvic pain scores, family history of endometriosis, and symptoms experienced during adolescence. The study searched for correlations by univariate analysis to determine clinical markers of endometriosis in adolescents and YAW compared with endometriosis-free control patients. MAIN RESULTS AND THE ROLE OF CHANCE Of the 262 study participants, 77 women were adolescents (≤20 years of age) and 185 patients (70.6%) were YAW. The endometriosis group included 118 patients (45.0%) and 144 (55.0%) were assigned to the control group. A family history of endometriosis, absenteeism from school during menstruation, history of fainting spells during menstruation, and prescription of oral contraceptive pills for intense dysmenorrhea were significantly more frequently observed in the endometriotic patients. The prevalence and mean pain scores for dysmenorrhea, deep dyspareunia, non-cyclic chronic pelvic pain and gastrointestinal and lower urinary tract symptoms were significantly greater in the endometriosis group, as was experienced rectal bleeding. LIMITATIONS, REASONS FOR CAUTION The study was performed in a single referral centre that treats patients with potentially more severe disease. This questionnaire was evaluated on a population of patients with an indication for endometriosis surgery, which can also select patients with more severe disease. Women with asymptomatic endometriosis were not considered in this study. These factors can affect the external validity of this study. WIDER IMPLICATIONS OF THE FINDINGS Patient interviews are relevant to the diagnosis of endometriosis in adolescents and YAW. Combined with imaging and clinical examination, this approach will enable earlier diagnosis and treatment, while remaining non-invasive and rapid. STUDY FUNDING/COMPETING INTEREST(S) The study received no funding from external sources. There are no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Charles Chapron
- Faculté de Santé, Faculté de Médicine Paris Centre, Université Paris-Cité, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Department "Development, Reproduction and Cancer", Institut Cochin, INSERM U1016, Paris, France
| | - Louis Marcellin
- Faculté de Santé, Faculté de Médicine Paris Centre, Université Paris-Cité, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Department "Development, Reproduction and Cancer", Institut Cochin, INSERM U1016, Paris, France
| | - Lorraine Maitrot-Mantelet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
| | - Mathilde Bourdon
- Faculté de Santé, Faculté de Médicine Paris Centre, Université Paris-Cité, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Department "Development, Reproduction and Cancer", Institut Cochin, INSERM U1016, Paris, France
| | - Chloé Maignien
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
| | - Guillaume Parpex
- Faculté de Santé, Faculté de Médicine Paris Centre, Université Paris-Cité, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Department "Development, Reproduction and Cancer", Institut Cochin, INSERM U1016, Paris, France
| | - Pietro Santulli
- Faculté de Santé, Faculté de Médicine Paris Centre, Université Paris-Cité, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Department "Development, Reproduction and Cancer", Institut Cochin, INSERM U1016, Paris, France
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15
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Joseph K, Kite L, Grover S, Druitt M. Worth waiting for? Aust N Z J Obstet Gynaecol 2024. [PMID: 39058265 DOI: 10.1111/ajo.13869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024]
Affiliation(s)
- Karen Joseph
- Te Whatu Ora - Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
| | - Lauren Kite
- Women's Health and Research Institute of Australia, Sydney, New South Wales, Australia
| | - Sonia Grover
- Paediatric and Adolescent Gynaecology, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Obsterics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
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16
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Göbel B, Reiterer A, Möller K. Image-Based 3D Reconstruction in Laparoscopy: A Review Focusing on the Quantitative Evaluation by Applying the Reconstruction Error. J Imaging 2024; 10:180. [PMID: 39194969 DOI: 10.3390/jimaging10080180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 08/29/2024] Open
Abstract
Image-based 3D reconstruction enables laparoscopic applications as image-guided navigation and (autonomous) robot-assisted interventions, which require a high accuracy. The review's purpose is to present the accuracy of different techniques to label the most promising. A systematic literature search with PubMed and google scholar from 2015 to 2023 was applied by following the framework of "Review articles: purpose, process, and structure". Articles were considered when presenting a quantitative evaluation (root mean squared error and mean absolute error) of the reconstruction error (Euclidean distance between real and reconstructed surface). The search provides 995 articles, which were reduced to 48 articles after applying exclusion criteria. From these, a reconstruction error data set could be generated for the techniques of stereo vision, Shape-from-Motion, Simultaneous Localization and Mapping, deep-learning, and structured light. The reconstruction error varies from below one millimeter to higher than ten millimeters-with deep-learning and Simultaneous Localization and Mapping delivering the best results under intraoperative conditions. The high variance emerges from different experimental conditions. In conclusion, submillimeter accuracy is challenging, but promising image-based 3D reconstruction techniques could be identified. For future research, we recommend computing the reconstruction error for comparison purposes and use ex/in vivo organs as reference objects for realistic experiments.
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Affiliation(s)
- Birthe Göbel
- Department of Sustainable Systems Engineering-INATECH, University of Freiburg, Emmy-Noether-Street 2, 79110 Freiburg im Breisgau, Germany
- KARL STORZ SE & Co. KG, Dr.-Karl-Storz-Street 34, 78532 Tuttlingen, Germany
| | - Alexander Reiterer
- Department of Sustainable Systems Engineering-INATECH, University of Freiburg, Emmy-Noether-Street 2, 79110 Freiburg im Breisgau, Germany
- Fraunhofer Institute for Physical Measurement Techniques IPM, 79110 Freiburg im Breisgau, Germany
| | - Knut Möller
- Institute of Technical Medicine-ITeM, Furtwangen University (HFU), 78054 Villingen-Schwenningen, Germany
- Mechanical Engineering, University of Canterbury, Christchurch 8140, New Zealand
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17
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Mazur-Bialy A, Tim S, Pępek A, Skotniczna K, Naprawa G. Holistic Approaches in Endometriosis - as an Effective Method of Supporting Traditional Treatment: A Systematic Search and Narrative Review. Reprod Sci 2024:10.1007/s43032-024-01660-2. [PMID: 39043999 DOI: 10.1007/s43032-024-01660-2] [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: 01/13/2024] [Accepted: 07/16/2024] [Indexed: 07/25/2024]
Abstract
Endometriosis is one of the gynecological diseases where women suffer from pain, quality of life decreased. The aim of this review was to describe the most common non-medical methods used in the treatment of symptoms associated with endometriosis and to determine their effectiveness. The review was performed in PubMed, Embase and Web of Science databases. Randomized controlled trials, case studies, observational studies, retrospective studies, prospective studies, pilot studies, trails, publications in English or Polish were searched based on the Participant-Intervention-Comparator-Outcomes-Study design (PICOS) format. The criteria used to select studies were: women with endometriosis, no cancer, included any physiotherapeutic or non-medical intervention. 3706 articles were found, however only 26 met the inclusion criteria and were included in the review. Quality of the studies was assessed by Risk of Bias 2 tool and ROBINS-1 tool. The most holistic approach used in the treatment of symptoms of endometriosis include physical therapy, manual therapy, electrophysical agents acupuncture, diet and psychological interventions. Most research has focused on relieving pain and increasing quality of life. Non-medical methods showed reduction of symptoms of endometriosis. Physical activity, manual therapy, electrophysical agents, acupuncture, diet and cognitive behavioral therapy showed no negative side effects and reduced pain, what improved the quality of life and reduced the perceived stress.
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Affiliation(s)
- Agnieszka Mazur-Bialy
- Department of Biomechanics and Kinesiology, Faculty of Health Science, Jagiellonian University Medical College, Skawińska 8, Krakow, 31-066, Poland.
| | - Sabina Tim
- Department of Biomechanics and Kinesiology, Faculty of Health Science, Jagiellonian University Medical College, Skawińska 8, Krakow, 31-066, Poland
| | - Anna Pępek
- Student Scientific Group, Faculty of Health Science, Jagiellonian University Medical College, Krakow, Poland
| | - Kamila Skotniczna
- Student Scientific Group, Faculty of Health Science, Jagiellonian University Medical College, Krakow, Poland
| | - Gabriela Naprawa
- Student Scientific Group, Faculty of Health Science, Jagiellonian University Medical College, Krakow, Poland
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18
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Spinoni M, Porpora MG, Muzii L, Grano C. Pain Severity and Depressive Symptoms in Endometriosis Patients: Mediation of Negative Body Awareness and Interoceptive Self-Regulation. THE JOURNAL OF PAIN 2024:104640. [PMID: 39032583 DOI: 10.1016/j.jpain.2024.104640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 07/11/2024] [Accepted: 07/14/2024] [Indexed: 07/23/2024]
Abstract
Endometriosis-related pain may be associated with depressive symptoms. Although a growing body of evidence supports this association, the underlying mechanisms are still largely unclear. Impaired perceptions of bodily external and internal stimuli may be involved in this process. This study aims to assess the mediating role of 2 facets of interoception-the awareness of negative body signals and interoceptive self-regulation-in the association between pain severity and depressive symptoms among women with endometriosis. A total of 301 patients who reported a diagnosis of endometriosis were recruited from an endometriosis and chronic pelvic pain outpatient university clinic and through patient associations and completed self-reported instruments. A parallel mediation analysis was conducted. Almost half of women (48.2%) reported depressive symptoms above the self-rating scale cutoff values. Pain severity significantly predicted depressive symptoms (β = .39, 95% bootstrap confidence interval [CI] [.719, 1.333]). Negative body awareness (β = .121, 95% bootstrap CI [.174, .468]) and interoceptive self-regulation (β = .05, 95% bootstrap CI [.035, .252]) partially mediated this relationship. Our findings indicated that pain may interfere with the perception of the body as a source of calmness and safety, limiting the individual's ability to effectively regulate emotions. Future research should further explore these mechanisms and evaluate the efficacy of interventions focusing on interoceptive sensibility to enhance the psychological well-being of endometriosis patients. PERSPECTIVE: This article investigates for the first time the potential role of 2 facets of interoceptive sensibility in the relationship between pain severity and depressive symptoms in women with endometriosis. These findings may contribute to advancing knowledge about the mechanisms involved in the complex pain-depression cycle.
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Affiliation(s)
- Marta Spinoni
- Department of Psychology, Sapienza University, Rome, Italy
| | - Maria Grazia Porpora
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Caterina Grano
- Department of Psychology, Sapienza University, Rome, Italy.
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19
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Daoud E, Archer DF, Parazzini F, Herranz-Blanco B. Validation of an In Vitro Diagnostic Test for Endometriosis: Impact of Confounding Medical Conditions and Lesion Location. Int J Mol Sci 2024; 25:7667. [PMID: 39062909 PMCID: PMC11277503 DOI: 10.3390/ijms25147667] [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: 04/17/2024] [Revised: 07/01/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
With the aim to shorten the time for diagnosis and accelerate access to correct management, a non-invasive diagnostic test for endometriosis was developed and validated. The IVD test combines an ELISA test kit to quantify CA125 and BDNF concentrations in serum and a data treatment algorithm hosted in medical software processing results from the ELISA test and responses to six clinical variables. Serum samples and clinical variables extracted from psychometric questionnaires from 77 patients were collected from the Oxford Endometriosis CaRe Centre biobank (UK). Case/control classification was performed based on laparoscopy and histological verification of the excised lesions. Biomarkers serum concentrations and clinical variables were introduced to the software, which generates the qualitative diagnostic result ("positive" or "negative"). This test allowed the detection of 32% of cases with superficial endometriosis, which is an added value given the limited efficacy of existing imaging techniques. Even in the presence of various confounding medical conditions, the test maintained a specificity of 100%, supporting its suitability for use in patients with underlying medical conditions.
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Affiliation(s)
| | - David F. Archer
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA 23407, USA;
| | - Fabio Parazzini
- Department of Clinical Science and Community Medicine, University of Milan, 20122 Milan, Italy;
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20
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Rosenberger DC, Mennicken E, Schmieg I, Medkour T, Pechard M, Sachau J, Fuchtmann F, Birch J, Schnabel K, Vincent K, Baron R, Bouhassira D, Pogatzki-Zahn EM. A systematic literature review on patient-reported outcome domains and measures in nonsurgical efficacy trials related to chronic pain associated with endometriosis: an urgent call to action. Pain 2024:00006396-990000000-00641. [PMID: 38968394 DOI: 10.1097/j.pain.0000000000003290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 04/12/2024] [Indexed: 07/07/2024]
Abstract
ABSTRACT Endometriosis, a common cause for chronic pelvic pain, significantly affects quality of life, fertility, and overall productivity of those affected. Therapeutic options remain limited, and collating evidence on treatment efficacy is complicated. One reason could be the heterogeneity of assessed outcomes in nonsurgical clinical trials, impeding meaningful result comparisons. This systematic literature review examines outcome domains and patient-reported outcome measures (PROMs) used in clinical trials. Through comprehensive search of Embase, MEDLINE, and CENTRAL up until July 2022, we screened 1286 records, of which 191 were included in our analyses. Methodological quality (GRADE criteria), information about publication, patient population, and intervention were assessed, and domains as well as PROMs were extracted and analyzed. In accordance with IMMPACT domain framework, the domain pain was assessed in almost all studies (98.4%), followed by adverse events (73.8%). By contrast, assessment of physical functioning (29.8%), improvement and satisfaction (14.1%), and emotional functioning (6.8%) occurred less frequently. Studies of a better methodological quality tended to use more different domains. Nevertheless, combinations of more than 2 domains were rare, failing to comprehensively capture the bio-psycho-social aspects of endometriosis-associated pain. The PROMs used showed an even broader heterogeneity across all studies. Our findings underscore the large heterogeneity of assessed domains and PROMs in clinical pain-related endometriosis trials. This highlights the urgent need for a standardized approach to both, assessed domains and high-quality PROMs ideally realized through development and implementation of a core outcome set, encompassing the most pivotal domains and PROMs for both, stakeholders and patients.
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Affiliation(s)
| | - Emilia Mennicken
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Iris Schmieg
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Terkia Medkour
- INSERM U987, UVSQ-Paris-Saclay University, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Marie Pechard
- INSERM U987, UVSQ-Paris-Saclay University, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Juliane Sachau
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Fabian Fuchtmann
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Judy Birch
- Pelvic Pain Support Network, Poole, United Kingdom
| | - Kathrin Schnabel
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Katy Vincent
- Nuffield Department of Women's and Reproductive Health, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, United Kingdom
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Didier Bouhassira
- INSERM U987, UVSQ-Paris-Saclay University, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Esther Miriam Pogatzki-Zahn
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
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21
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Li HJ, Esencan E, Song Y, Taylor HS, Cho Y, Vash-Margita A. Medical Management of Endometriosis in Adolescent and Young Adult Women: A Review of 91 Cases of Biopsy-Confirmed Endometriosis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102562. [PMID: 38759792 DOI: 10.1016/j.jogc.2024.102562] [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: 12/12/2023] [Revised: 04/10/2024] [Accepted: 04/24/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVES To characterise contemporary trends in the hormonal management of endometriosis in adolescent and young adult patients with biopsy-proven endometriosis. METHODS Retrospective chart review of women aged 14-25 years who underwent laparoscopy for pelvic pain with biopsy-proven endometriosis between January 2011 and September 2020 at an academic tertiary hospital system. The final sample included 91 patients with biopsy-confirmed endometriosis. RESULTS Combined oral contraceptives (COCs) were the most common initial treatment (64% of patients). Progestin-only formulations (low- and high-dose norethindrone acetate) were offered to younger patients (age 15.9 ± 2.7 years) than those offered COCs (19.9 ± 3.3 years) and levonorgestrel intrauterine devices (LNG-IUDs) (21.9 ± 1.7 years). Current treatments varied widely and included COCs (32%), LNG-IUDs (18%), oral progestins (low- and high-dose norethindrone, medroxyprogesterone) (14%), elagolix (9%), and leuprolide (8%). Oral adjuncts to LNG-IUD were common: usually low- or high-dose norethindrone (37% of patients with an LNG-IUD), but also included progesterone, COCs, and elagolix. CONCLUSIONS Oral progestins, LNG-IUDs, and COCs were the mainstay of initial treatment. Subsequent treatments varied widely and included COCs, LNG-IUDs, oral progestins, elagolix, leuprolide, and combinations of these agents. We observed that most young women switched between therapies, suggesting that a personalised approach is often used to determine treatment plans among the wide range of options currently available. This study helps define the spectrum of treatment regimens for endometriosis in adolescent females.
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Affiliation(s)
- Howard J Li
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Ecem Esencan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Yue Song
- Yale School of Public Health, Yale University, New Haven, CT, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Yonghee Cho
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Alla Vash-Margita
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA.
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22
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GiglioAyers P, Ezike O, Foley CE, Brown BP. Demographic Correlates of Endometriosis Diagnosis Among United States Women Aged 15-50. J Minim Invasive Gynecol 2024; 31:607-612. [PMID: 38697259 DOI: 10.1016/j.jmig.2024.04.020] [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: 02/06/2024] [Revised: 04/10/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVE To compare demographic characteristics of women with and without a diagnosis of endometriosis. DESIGN Data were collected from the National Survey of Family Growth-a publicly available survey designed and administered by the Centers for Disease Control, which uses a nationally-representative sample of the United States population. Univariate data were reported as survey-weighted percentages and means and were analyzed using chi-square, t tests, and logistic regression. Analyses accounted for complex survey design. SETTING United States. PARTICIPANTS Interviews were conducted with 6141 female respondents, aged 15 to 50, between 2017 and 2019. INTERVENTIONS Data were collected through in-person interviews. RESULTS Nationally, 5.7% reported a diagnosis of endometriosis (95% CI 4.6-6.9%). Those with endometriosis were older, with a mean age of 39 (95% CI 38.1-39.9), compared to 31.7 (95% CI 31.2-32.2) among those without (p <.0005). Endometriosis diagnosis was significantly associated with race. Compared to non-Hispanic White women, Hispanic women had an adjusted odds ratio (aOR) of 0.37 (95% CI 0.21-0.65) for diagnosis of endometriosis, and non-Hispanic Black women had an aOR of 0.54 (95% CI 0.35-0.84). We also observed a difference in diagnosis by health insurance: compared to those with private insurance or Medi-Gap coverage, those with Medicare or military insurance had an aOR for endometriosis diagnosis of 2.49 (95% CI 1.36-4.55). Finally, compared to those with less than a high school education, those who had completed high school or greater had an aOR for endometriosis diagnosis of 2.84 (95% CI 1.15-6.99). CONCLUSION These disparities in endometriosis diagnosis suggest that intersecting barriers may preclude certain groups from accessing timely endometriosis diagnosis and management. Further studies are warranted to explore these hypothesis-generating data and to identify and address specific barriers to equitable endometriosis diagnosis and management.
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Affiliation(s)
- Patricia GiglioAyers
- Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, Rhode Island (all authors)..
| | - Ogechukwu Ezike
- Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, Rhode Island (all authors)
| | - Christine E Foley
- Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, Rhode Island (all authors)
| | - Benjamin P Brown
- Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, Rhode Island (all authors)
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23
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Condous G, Gerges B, Thomassin-Naggara I, Becker CM, Tomassetti C, Krentel H, van Herendael BJ, Malzoni M, Abrao MS, Saridogan E, Keckstein J, Hudelist G. Non-Invasive Imaging Techniques for Diagnosis of Pelvic Deep Endometriosis and Endometriosis Classification Systems: An International Consensus Statement. J Minim Invasive Gynecol 2024; 31:557-573. [PMID: 38819341 DOI: 10.1016/j.jmig.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and International Deep Endometriosis Analysis (IDEA) group, the European Endometriosis League (EEL), the European Society for Gynaecological Endoscopy (ESGE), the European Society of Human Reproduction and Embryology (ESHRE), the International Society for Gynecologic Endoscopy (ISGE), the American Association of Gynecologic Laparoscopists (AAGL) and the European Society of Urogenital Radiology (ESUR) elected an international, multidisciplinary panel of gynecological surgeons, sonographers and radiologists, including a steering committee, which searched the literature for relevant articles in order to review the literature and provide evidence-based and clinically relevant statements on the use of imaging techniques for non-invasive diagnosis and classification of pelvic deep endometriosis. Preliminary statements were drafted based on review of the relevant literature. Following two rounds of revisions and voting orchestrated by chairs of the participating societies, consensus statements were finalized. A final version of the document was then resubmitted to the society chairs for approval. Twenty statements were drafted, of which 14 reached strong and three moderate agreement after the first voting round. The remaining three statements were discussed by all members of the steering committee and society chairs and rephrased, followed by an additional round of voting. At the conclusion of the process, 14 statements had strong and five statements moderate agreement, with one statement left in equipoise. This consensus work aims to guide clinicians involved in treating women with suspected endometriosis during patient assessment, counseling and planning of surgical treatment strategies.
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Affiliation(s)
- George Condous
- Acute Gynaecology, Early Pregnancy & Advanced Endosurgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, NSW, Australia.
| | - Bassem Gerges
- Acute Gynaecology, Early Pregnancy & Advanced Endosurgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, NSW, Australia; Sydney West Advanced Pelvic Surgery (SWAPS), Blacktown Hospital, Blacktown, NSW, Australia
| | | | - Christian M Becker
- Endometriosis CaRe Centre Oxford, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Carla Tomassetti
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium; Faculty of Medicine, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Harald Krentel
- Department of Gynecology, Obstetrics and Gynecological Oncology, Bethesda Hospital, Duisburg, Germany
| | - Bruno J van Herendael
- Ziekenhuis Netwerk Antwerpen Campus Stuivenberg, Antwerp, Belgium; Università degli Studi dell'Insubria, Varese, Italy
| | - Mario Malzoni
- Endoscopica Malzoni, Centre for Advanced Pelvic Surgery, Avellino Italy
| | - Mauricio S Abrao
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ertan Saridogan
- Department of Obstetrics and Gynaecology, University College London Hospital, London, UK
| | | | - Gernot Hudelist
- Center for Endometriosis, Hospital St. John of God Vienna; Rudolfinerhaus Private Clinic & Campus, Vienna, Austria
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24
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Condous G, Gerges B, Thomassin-Naggara I, Becker C, Tomassetti C, Krentel H, van Herendael BJ, Malzoni M, Abrao MS, Saridogan E, Keckstein J, Hudelist G. Non-invasive imaging techniques for diagnosis of pelvic deep endometriosis and endometriosis classification systems: an International Consensus Statement. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 64:129-144. [PMID: 38808587 DOI: 10.1002/uog.27560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/03/2023] [Accepted: 11/17/2023] [Indexed: 05/30/2024]
Abstract
The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and International Deep Endometriosis Analysis (IDEA) group, the European Endometriosis League (EEL), the European Society for Gynaecological Endoscopy (ESGE), the European Society of Human Reproduction and Embryology (ESHRE), the International Society for Gynecologic Endoscopy (ISGE), the American Association of Gynecologic Laparoscopists (AAGL) and the European Society of Urogenital Radiology (ESUR) elected an international, multidisciplinary panel of gynecological surgeons, sonographers and radiologists, including a steering committee, which searched the literature for relevant articles in order to review the literature and provide evidence-based and clinically relevant statements on the use of imaging techniques for non-invasive diagnosis and classification of pelvic deep endometriosis. Preliminary statements were drafted based on review of the relevant literature. Following two rounds of revisions and voting orchestrated by chairs of the participating societies, consensus statements were finalized. A final version of the document was then resubmitted to the society chairs for approval. Twenty statements were drafted, of which 14 reached strong and three moderate agreement after the first voting round. The remaining three statements were discussed by all members of the steering committee and society chairs and rephrased, followed by an additional round of voting. At the conclusion of the process, 14 statements had strong and five statements moderate agreement, with one statement left in equipoise. This consensus work aims to guide clinicians involved in treating women with suspected endometriosis during patient assessment, counseling and planning of surgical treatment strategies. © 2024 The Authors. Published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology, by Universa Press, by The International Society for Gynecologic Endoscopy, by Oxford University Press on behalf of European Society of Human Reproduction and Embryology, by Elsevier Inc. on behalf of American Association of Gynecologic Laparoscopists and by Elsevier B.V.
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Affiliation(s)
- G Condous
- Acute Gynaecology, Early Pregnancy & Advanced Endosurgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, NSW, Australia
| | - B Gerges
- Acute Gynaecology, Early Pregnancy & Advanced Endosurgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, NSW, Australia
- Sydney West Advanced Pelvic Surgery (SWAPS), Blacktown Hospital, Blacktown, NSW, Australia
| | - I Thomassin-Naggara
- APHP Hopital Tenon, Department of Radiology, Sorbonne Université, Paris, France
| | - C Becker
- Endometriosis CaRe Centre Oxford, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - C Tomassetti
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
- Faculty of Medicine, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - H Krentel
- Department of Gynecology, Obstetrics and Gynecological Oncology, Bethesda Hospital, Duisburg, Germany
| | - B J van Herendael
- Ziekenhuis Netwerk Antwerpen Campus Stuivenberg, Antwerp, Belgium
- Università degli Studi dell'Insubria, Varese, Italy
| | - M Malzoni
- Endoscopica Malzoni, Centre for Advanced Pelvic Surgery, Avellino, Italy
| | - M S Abrao
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - E Saridogan
- Department of Obstetrics and Gynaecology, University College London Hospital, London, UK
| | - J Keckstein
- Stiftung Endometrioseforschung (SEF), Westerstede, Germany
| | - G Hudelist
- Center for Endometriosis, Hospital St. John of God Vienna; Rudolfinerhaus Private Clinic & Campus, Vienna, Austria
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25
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Lessey BA, Dong A, Deaton JL, Angress D, Savaris RF, Walker SJ. Inflammatory Changes after Medical Suppression of Suspected Endometriosis for Implantation Failure: Preliminary Results. Int J Mol Sci 2024; 25:6852. [PMID: 38999962 PMCID: PMC11241468 DOI: 10.3390/ijms25136852] [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: 04/22/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 07/14/2024] Open
Abstract
Unexplained euploid embryo transfer failure (UEETF) is a frustrating and unanswered conundrum accounting for 30 to 50% of failures in in vitro fertilization using preimplantation genetic testing for aneuploidy (PGT-A). Endometriosis is thought by many to account for most of such losses and menstrual suppression or surgery prior to the next transfer has been reported to be beneficial. In this study, we performed endometrial biopsy in a subset of women with UEETF, testing for the oncogene BCL6 and the histone deacetylase SIRT1. We compared 205 PGT-A cycles outcomes and provide those results following treatment with GnRH agonist versus controls (no treatment). Based on these and previous promising results, we next performed a pilot randomized controlled trial comparing the orally active GnRH antagonist, elagolix, to oral contraceptive pill (OCP) suppression for 2 months before the next euploid embryo transfer, and monitored inflammation and miRNA expression in blood, before and after treatment. These studies support a role for endometriosis in UEETF and suggest that medical suppression of suspected disease with GnRH antagonist prior to the next transfer could improve success rates and address underlying inflammatory and epigenetic changes associated with UEETF.
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Affiliation(s)
- Bruce A. Lessey
- Department of OBGYN, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA; (A.D.); (J.L.D.)
| | - Allan Dong
- Department of OBGYN, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA; (A.D.); (J.L.D.)
| | - Jeffrey L. Deaton
- Department of OBGYN, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA; (A.D.); (J.L.D.)
| | | | - Ricardo F. Savaris
- Department of OBGYN, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, RS, Brazil;
| | - Stephen J. Walker
- Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC 27101, USA;
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26
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Takada L, Kawano T, Yano K, Iwamoto Y, Ogata M, Kedoin C, Murakami M, Sugita K, Onishi S, Muto M, Kirishima M, Tanimoto A, Ieiri S. Ovarian endometrioma: a report of a pediatric case diagnosed prior to menstruation. Surg Case Rep 2024; 10:152. [PMID: 38898208 PMCID: PMC11187045 DOI: 10.1186/s40792-024-01951-5] [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: 04/12/2024] [Accepted: 06/12/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Ovarian endometriomas (OEs) are rarely found in the pediatric population, especially before menstruation. We report a 6-year-old girl who was postoperatively diagnosed with OE before menstruation. CASE PRESENTATION A 6-year-old girl presented to a local pediatrician with abdominal pain and vomiting. Abdominal ultrasonography revealed a multilocular cystic lesion to the left of the bladder. Magnetic resonance imaging (MRI) revealed similar findings, with the contents of the cyst showing a low signal on T1-weighted imaging and a high signal on T2-weighted imaging. The patient was referred to our institution for further examination. Enhanced computed tomography (CT) showed a multilocular cystic lesion sized 56 × 44 × 30 mm with partial calcification. The left ovarian vein was dilated, suggesting the origin of the tumor to be the left ovary. Extirpation of the lesion was performed under laparoscopic assistance. Pathological findings indicated an ovarian endometrioma. To our knowledge, this is the youngest report of an OE diagnosed in a patient prior to menstruation. CONCLUSIONS OEs in children before menstruation are extremely rare; thus, the long-term prognosis is yet to be determined.
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Affiliation(s)
- Lynne Takada
- Department of Paediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan
| | - Takafumi Kawano
- Department of Paediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan.
| | - Keisuke Yano
- Department of Paediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan
| | - Yumiko Iwamoto
- Department of Paediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan
| | - Masato Ogata
- Department of Paediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan
| | - Chihiro Kedoin
- Department of Paediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan
| | - Masakazu Murakami
- Department of Paediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan
| | - Koshiro Sugita
- Department of Paediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan
| | - Shun Onishi
- Department of Paediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan
| | - Mitsuru Muto
- Department of Paediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan
| | - Mari Kirishima
- Department of Pathology, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Akihide Tanimoto
- Department of Pathology, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Satoshi Ieiri
- Department of Paediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan
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27
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Liu M, Peng R, Tian C, Shi J, Ma J, Shi R, Qi X, Zhao R, Guan H. Effects of the gut microbiota and its metabolite short-chain fatty acids on endometriosis. Front Cell Infect Microbiol 2024; 14:1373004. [PMID: 38938880 PMCID: PMC11208329 DOI: 10.3389/fcimb.2024.1373004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/31/2024] [Indexed: 06/29/2024] Open
Abstract
In recent years, a growing body of research has confirmed that the gut microbiota plays a major role in the maintenance of human health and disease. A gut microbiota imbalance can lead to the development of many diseases, such as pregnancy complications, adverse pregnancy outcomes, polycystic ovary syndrome, endometriosis, and cancer. Short-chain fatty acids are metabolites of specific intestinal bacteria and are crucial for maintaining intestinal homeostasis and regulating metabolism and immunity. Endometriosis is the result of cell proliferation, escape from immune surveillance, and invasive metastasis. There is a strong correlation between the anti-proliferative and anti-inflammatory effects of short-chain fatty acids produced by gut microbes and the development of endometriosis. Given that the mechanism of action of gut microbiota and Short-chain fatty acids in endometriosis remain unclear, this paper aims to provide a comprehensive review of the complex interactions between intestinal flora, short-chain fatty acids and endometriosis. In addition, we explored potential microbial-based treatment strategies for endometriosis, providing new insights into the future development of diagnostic tests and prevention and treatment methods for endometriosis.
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Affiliation(s)
- Menghe Liu
- College of Pharmacy, Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Ru Peng
- Department of Obstetrics and Gynecology, Hohhot Maternal and Child Health Care Hospital, Hohhot, Inner Mongolia Autonomous Region, China
| | - Chunfang Tian
- Department of Oncology, Inner Mongolia Traditional Chinese Medicine Hospital, Hohhot, Inner Mongolia Autonomous Region, China
| | - Jianping Shi
- College of Traditional Chinese Medicine, Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Jiannan Ma
- College of Pharmacy, Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Ruiwen Shi
- College of Pharmacy, Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Xiao Qi
- College of Pharmacy, Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Rongwei Zhao
- Department of Obstetrics and Gynecology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Haibin Guan
- College of Pharmacy, Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
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28
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Slayden O, Luo F, Park Y, Moses AS, Demessie AA, Singh P, Korzun T, Taratula O, Taratula O. Targeted nanoparticles for imaging and therapy of endometriosis†. Biol Reprod 2024; 110:1191-1200. [PMID: 38738758 PMCID: PMC11180615 DOI: 10.1093/biolre/ioae073] [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: 02/29/2024] [Revised: 05/01/2024] [Accepted: 05/10/2024] [Indexed: 05/14/2024] Open
Abstract
In this brief review, we discuss our efforts to validate nanoplatforms for imaging and treatment of endometriosis. We specifically highlight our use of nonhuman primates and primate tissues in this effort. Endometriosis is a painful disorder of women and nonhuman primates where endometrium-like tissue exists outside of the uterus. There are no reliable, specific, and noninvasive diagnostic tests for endometriosis. Laparoscopic imaging remains the gold standard for identifying small endometriotic lesions in both women and monkeys. Visualizing and surgically removing microscopic lesions remains a clinical challenge. To address this challenge, we have created nanoparticle reagents that, when administered intravenously, enter endometriotic lesions both passively and by targeting endometriotic cells. The particles can carry payloads, including near-infrared fluorescent dyes and magnetic nanoparticles. These agents can be used for imaging and thermal ablation of diseased tissues. We evaluated this approach on macaque endometriotic cells, human and macaque endometrium engrafted into immunodeficient mice, in endometrium subcutaneously autografted in macaques, and in rhesus monkeys with spontaneous endometriosis. Employing these models, we report that nanoplatform-based reagents can improve imaging and provide thermal ablation of endometriotic tissues.
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Affiliation(s)
- Ov Slayden
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - Fangzhou Luo
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - Youngrong Park
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, USA
| | - Abraham S Moses
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, USA
| | - Ananiya A Demessie
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, USA
| | - Prem Singh
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, USA
| | - Tetiana Korzun
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, USA
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Olena Taratula
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, USA
| | - Oleh Taratula
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, USA
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Taylor HS, Dong L, Haikonen J, Oppelt P, Tamussino K, Wenzl R, Faustmann T, Groettrup-Wolfers E, Ren X, Seitz C. Vilaprisan for the treatment of symptomatic endometriosis: results from a terminated phase 2b randomized controlled trial. F S Rep 2024; 5:189-196. [PMID: 38983729 PMCID: PMC11228778 DOI: 10.1016/j.xfre.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 07/11/2024] Open
Abstract
Objective To evaluate the efficacy and safety of 2 doses of vilaprisan vs. placebo in participants with symptomatic endometriosis. Design Multicenter, randomized, double-blind, placebo-controlled, parallel-group phase 2b trial (NCT03573336). The initially planned sample size was 315 patients. Recruitment was paused to assess long-term toxicity findings in rodents; although the findings were assessed as likely to be of limited clinical relevance in humans, the study was closed by the sponsor. During the pause, enrolled patients completed 3 or 6 months of treatment per their assigned regimen. Setting University hospitals, a regional hospital, and a private clinic. Patients Premenopausal adults with confirmed endometriosis and moderate-to-severe pelvic pain (≥4/10 on a numerical rating scale) were enrolled. Inclusion required protocol adherence, including ≥24 diary entries, and an average pain score of ≥3.5. Intervention Participants were randomly assigned 1:1:1 to receive vilaprisan (2 mg), vilaprisan (4 mg), or placebo. Main Outcome Measures The primary outcome was a change in the 7-day mean "worst pain" (per the endometriosis symptom diary item 1) from baseline to month 3. All analyses were descriptive only. Results Eight participants were randomly assigned to treatment before the study pause: 6 received vilaprisan (4 mg, n = 4 and 2 mg, n = 2), and 2 received placebo. The 6 vilaprisan recipients experienced an improvement in endometriosis-associated pelvic pain, whereas the 2 placebo recipients experienced no change or increased pain; all 8 participants had decreased use of pain medication. Bleeding intensity decreased from baseline in the vilaprisan group. Conclusion The study findings suggest that vilaprisan may improve outcomes in patients with endometriosis. Further studies in larger populations would be needed to accurately assess treatment effects. Clinical Trial Registration Number NCT03573336.
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Affiliation(s)
- Hugh S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | | | - Johanna Haikonen
- Department of Obstetrics and Gynecology, University of Turku, Turku, Finland
- Department of Obstetrics and Gynecology, Central Hospital Satasairaala, Pori, Finland
| | - Peter Oppelt
- Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Linz, Austria
| | - Karl Tamussino
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Rene Wenzl
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | | | | | - Xiaowei Ren
- Bayer Healthcare Co. Ltd., Beijing, People's Republic of China
| | - Christian Seitz
- Bayer AG, Berlin, Germany
- Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Bendifallah S, Dabi Y, Suisse S, Ilic J, Delbos L, Poilblanc M, Descamps P, Golfier F, Jornea L, Bouteiller D, Touboul C, Puchar A, Daraï E. Saliva-based microRNA diagnostic signature for the superficial peritoneal endometriosis phenotype. Eur J Obstet Gynecol Reprod Biol 2024; 297:187-196. [PMID: 38677096 DOI: 10.1016/j.ejogrb.2024.04.020] [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: 01/31/2024] [Revised: 04/06/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE Patients with superficial peritoneal endometriosis (SPE) present with symptoms suggestive of endometriosis but clinical and imaging exams are inconclusive. Consequently, laparoscopy is usually necessary to confirm diagnosis. The present study aimed to evaluate the accuracy of microRNAs (miRNAs) to diagnose patients with SPE from the ENDOmiARN cohort STUDY DESIGN: This prospective study (NCT04728152) included 200 saliva samples obtained between January and June 2021 from women with pelvic pain suggestive of endometriosis. All patients underwent either laparoscopy and/or MRI to confirm the presence of endometriosis. Among the patients with endometriosis, two groups were defined: an SPE phenotype group of patients with peritoneal lesions only, and a non-SPE control group of patients with other endometriosis phenotypes (endometrioma and/or deep endometriosis). Data analysis consisted of two parts: (i) identification of a set of miRNA biomarkers using next-generation sequencing (NGS), and (ii) development of a saliva-based miRNA signature for the SPE phenotype in patients with endometriosis based on a Random Forest (RF) model. RESULTS Among the 153 patients with confirmed endometriosis, 10.5 % (n = 16) had an SPE phenotype. Of the 2633 known miRNAs, the feature selection method generated a signature of 89 miRNAs of the SPE phenotype. After validation, the best model, representing the most accurate signature had a 100 % sensitivity, specificity, and AUC. CONCLUSION This signature could constitute a new diagnostic strategy to detect the SPE phenotype based on a simple biological test and render diagnostic laparoscopy obsolete. PRéCIS: We generated a saliva-based signature to identify patients with superficial peritoneal endometriosis which is the most challenging form of endometriosis to diagnose and which is often either misdiagnosed or requires invasive laparoscopy.
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Affiliation(s)
- Sofiane Bendifallah
- Sorbonne University - Department of Obstetrics and Reproductive Medicine, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France; Clinical Research Group (GRC) Paris 6: Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), France.
| | - Yohann Dabi
- Sorbonne University - Department of Obstetrics and Reproductive Medicine, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France; Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, INSERM UMR_S_938 75020 Paris, France
| | | | - Johanna Ilic
- Sorbonne University - Department of Obstetrics and Reproductive Medicine, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France
| | - Léa Delbos
- Department of Obstetrics and Reproductive Medicine - CHU d'Angers, Endometriosis Expert Center - Pays de la Loire, France.
| | - Mathieu Poilblanc
- Department of Obstetrics and Gynecology, Lyon Sud University Hospital, Hospices Civils de Lyon, Lyon1 University, Lyon, France; Endometriosis Expert Center, President of the EndAURA Network
| | - Philippe Descamps
- Department of Obstetrics and Reproductive Medicine - CHU d'Angers, Endometriosis Expert Center - Pays de la Loire, France
| | - Francois Golfier
- Department of Obstetrics and Gynecology, Lyon Sud University Hospital, Hospices Civils de Lyon, Lyon1 University, Lyon, France; Endometriosis Expert Center, President of the EndAURA Network
| | - Ludmila Jornea
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Delphine Bouteiller
- Genotyping and Sequencing Core Facility, iGenSeq, Institut du Cerveau et de la Moelle Epinière, ICM, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Cyril Touboul
- Sorbonne University - Department of Obstetrics and Reproductive Medicine, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France; Clinical Research Group (GRC) Paris 6: Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), France
| | - Anne Puchar
- Sorbonne University - Department of Obstetrics and Reproductive Medicine, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France
| | - Emile Daraï
- Sorbonne University - Department of Obstetrics and Reproductive Medicine, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France; Clinical Research Group (GRC) Paris 6: Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), France
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Psilopatis I, Burghaus S, Au K, Hofbeck L, Windischbauer L, Lotz L, Beckmann MW. The Hallmarks of Endometriosis. Geburtshilfe Frauenheilkd 2024; 84:555-563. [PMID: 38884026 PMCID: PMC11175833 DOI: 10.1055/a-2306-8759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/14/2024] [Indexed: 06/18/2024] Open
Abstract
A heuristic tool called "the hallmarks of cancer" helps to reduce the enormous complexity of cancer phenotypes and genotypes to a preliminary set of guiding principles. Other aspects of cancer have surfaced as possible improvements in our understanding of the disease's mechanisms. Endometriosis is a gynecological disease condition negatively impacting the quality of life of many women. To date, there is no curative treatment for endometriosis. Therapy is aimed at treating the symptoms using hormone therapy, pain therapy and complementary therapy. Chronic pain and overlapping pain syndromes and illnesses can also be treated with multimodal pain therapy and psychosomatic therapy. Endometriosis is, however, a chronic and complex entity which, in this regard, resembles cancer. The present work investigates the hallmarks of endometriosis with a view to summarizing the current research status and paving new ways for future research projects.
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Affiliation(s)
- Iason Psilopatis
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Stefanie Burghaus
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Katharina Au
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Louisa Hofbeck
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Lisa Windischbauer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Laura Lotz
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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Condous G, Gerges B, Thomassin-Naggara I, Becker C, Tomassetti C, Krentel H, van Herendael BJ, Malzoni M, Abrao MS, Saridogan E, Keckstein J, Hudelist G. Non-invasive imaging techniques for diagnosis of pelvic deep endometriosis and endometriosis classification systems: an International Consensus Statement†,‡. Facts Views Vis Obgyn 2024; 16:127-144. [PMID: 38807551 PMCID: PMC11366111 DOI: 10.52054/fvvo.16.2.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Abstract
The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and International Deep Endometriosis Analysis (IDEA) group, the European Endometriosis League (EEL), the European Society for Gynaecological Endoscopy (ESGE), the European Society of Human Reproduction and Embryology (ESHRE), the International Society for Gynecologic Endoscopy (ISGE), the American Association of Gynecologic Laparoscopists (AAGL) and the European Society of Urogenital Radiology (ESUR) elected an international, multidisciplinary panel of gynecological surgeons, sonographers and radiologists, including a steering committee, which searched the literature for relevant articles in order to review the literature and provide evidence-based and clinically relevant statements on the use of imaging techniques for non-invasive diagnosis and classification of pelvic deep endometriosis. Preliminary statements were drafted based on a review of the relevant literature. Following two rounds of revisions and voting orchestrated by chairs of the participating societies, consensus statements were finalized. A final version of the document was then resubmitted to the society chairs for approval. Twenty statements were drafted, of which 14 reached strong and three moderate agreement after the first voting round. The remaining three statements were discussed by all members of the steering committee and society chairs and rephrased, followed by an additional round of voting. At the conclusion of the process, 14 statements had strong and five statements moderate agreement, with one statement left in equipoise. This consensus work aims to guide clinicians involved in treating women with suspected endometriosis during patient assessment, counselling and planning of surgical treatment strategies.
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Condous G, Gerges B, Thomassin-Naggara I, Becker C, Tomassetti C, Krentel H, van Herendael BJ, Malzoni M, Abrao MS, Saridogan E, Keckstein J, Hudelist G. Non-invasive imaging techniques for diagnosis of pelvic deep endometriosis and endometriosis classification systems: an International Consensus Statement . Hum Reprod Open 2024; 2024:hoae029. [PMID: 38812884 PMCID: PMC11134890 DOI: 10.1093/hropen/hoae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Indexed: 05/31/2024] Open
Abstract
The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and International Deep Endometriosis Analysis (IDEA) group, the European Endometriosis League (EEL), the European Society for Gynaecological Endoscopy (ESGE), ESHRE, the International Society for Gynecologic Endoscopy (ISGE), the American Association of Gynecologic Laparoscopists (AAGL) and the European Society of Urogenital Radiology (ESUR) elected an international, multidisciplinary panel of gynecological surgeons, sonographers, and radiologists, including a steering committee, which searched the literature for relevant articles in order to review the literature and provide evidence-based and clinically relevant statements on the use of imaging techniques for non-invasive diagnosis and classification of pelvic deep endometriosis. Preliminary statements were drafted based on review of the relevant literature. Following two rounds of revisions and voting orchestrated by chairs of the participating societies, consensus statements were finalized. A final version of the document was then resubmitted to the society chairs for approval. Twenty statements were drafted, of which 14 reached strong and three moderate agreement after the first voting round. The remaining three statements were discussed by all members of the steering committee and society chairs and rephrased, followed by an additional round of voting. At the conclusion of the process, 14 statements had strong and five statements moderate agreement, with one statement left in equipoise. This consensus work aims to guide clinicians involved in treating women with suspected endometriosis during patient assessment, counselling, and planning of surgical treatment strategies.
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Affiliation(s)
- G Condous
- Acute Gynaecology, Early Pregnancy & Advanced Endosurgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, NSW, Australia
| | - B Gerges
- Acute Gynaecology, Early Pregnancy & Advanced Endosurgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, NSW, Australia
- Sydney West Advanced Pelvic Surgery (SWAPS), Blacktown Hospital, Blacktown, NSW, Australia
| | - I Thomassin-Naggara
- APHP Hopital Tenon, Department of Radiology, Sorbonne Université, Paris, France
| | - C Becker
- Nuffield Department of Women’s and Reproductive Health, Endometriosis CaRe Centre Oxford, University of Oxford, Oxford, UK
| | - C Tomassetti
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - H Krentel
- Department of Gynecology, Obstetrics and Gynecological Oncology, Bethesda Hospital, Duisburg, Germany
| | - B J van Herendael
- Department of Minimally Invasive Gynecologic Surgery, Ziekenhuis Netwerk Antwerpen Campus Stuivenberg, Antwerp, Belgium
- Università degli Studi dell‘Insubria, Varese, Italy
| | - M Malzoni
- Endoscopica Malzoni, Centre for Advanced Pelvic Surgery, Avellino, Italy
| | - M S Abrao
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - E Saridogan
- Department of Obstetrics and Gynaecology, University College London Hospital, London, UK
| | - J Keckstein
- Stiftung Endometrioseforschung (SEF), Westerstede, Germany
| | - G Hudelist
- Department of Gynecology, Center for Endometriosis, Hospital St John of God Vienna, Vienna,Austria
- Rudolfinerhaus Private Clinic & Campus, Vienna, Austria
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Schofield E, Sussex R, Crotti T, Evans S. Using language to identify a bladder pain component in women with Dysmenorrhoea-Related Pelvic Pain: A cross-sectional study. Aust N Z J Obstet Gynaecol 2024. [PMID: 38803121 DOI: 10.1111/ajo.13833] [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: 05/14/2023] [Accepted: 04/25/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Dysmenorrhoea-Related Pelvic Pain (DRPP) is a common condition, which may or may not include bladder-related symptoms. Primary health care practitioners (PHCP) rely heavily on language for diagnosis of DRPP-related conditions. However, there are no established pain descriptors to assist PHCP to determine whether an individual's DRPP may include a bladder component. AIMS To identify differences in the use of pain descriptors in women with DRPP with and without a co-existing bladder pain component, through an exploratory study of the language of pelvic pain in women. MATERIALS AND METHODS A cross-sectional online survey of Australian and New Zealand women (n = 750, ages 18-49) who have self-identified pelvic pain. Free text and predetermined pain descriptors used by women with a self-perceived bladder pain component (DRPPB+, n = 468) were compared to those without bladder pain (DRPPB-, n = 282). Statistical analysis included Pearson χ2, logistic regression and analysis of variance tests using StataCorp Stata Statistical Software combined with qualitative data from AntConc concordance software. RESULTS Within free-form text, bloating (P = 0.014) and pressure (P = 0.031) were used more commonly to describe dysmenorrhoea in women with DRPPB+, while the word excruciating (P < 0.001) was more commonly used by women with DRPPB-. From a pre-determined list of descriptors, pounding (P < 0.001), tingling (P < 0.001), stabbing (P = 0.010), burning (P = 0.002) and cramping (P = 0.021) were more commonly used by women with DRPPB+, than women with DRPPB-. CONCLUSIONS Systematic patterns of word use should encourage practitioners to further enquire about bladder symptoms that may co-exist with dysmenorrhoea. Knowledge of these words may be useful in targeting diagnostic and therapeutic interventions.
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Affiliation(s)
- Eleanor Schofield
- School of Biomedicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Roland Sussex
- Institute for Teaching and Learning Innovation, School of Languages and Cultures, The University of Queensland, Brisbane, Queensland, Australia
| | - Tania Crotti
- School of Biomedicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Susan Evans
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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Sinai D, Avni C, Toren P. Beyond physical pain: A large-scale cohort study on endometriosis trends and mental health correlates. J Psychosom Res 2024; 182:111809. [PMID: 38795400 DOI: 10.1016/j.jpsychores.2024.111809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND This study investigates the increased prevalence of endometriosis in Israel and its association with psychiatric comorbidities, focusing on the timing of psychiatric diagnoses in relation to endometriosis diagnosis. METHODS Employing a retrospective cohort analysis, we reviewed data from 1,291,963 patients in a large scale medical database, identifying 24,259 cases (1.88%) of endometriosis. The analysis included demographic details, ICD-10 diagnoses of endometriosis and mental health conditions, and medication use patterns. RESULTS A marked rise in endometriosis diagnosis was observed, particularly among women born between 1973 and 1978. Those with endometriosis were more likely to have psychiatric disorders-such as mood disorders, anxiety, PTSD, and eating disorders-than the control group, with the majority of psychiatric diagnoses occurring prior to endometriosis detection, except for PTSD. The study also highlighted significant sociocultural and socioeconomic disparities in endometriosis diagnosis, suggesting barriers to healthcare access and the influence of cultural factors. Limitations include potential biases from the retrospective design and the specific context of Israel's healthcare system, which may limit generalizability. CONCLUSIONS The significant rise in endometriosis and its strong association with psychiatric comorbidities, predominantly preceding the diagnosis of endometriosis, underscores the necessity for integrated care approaches. The disparities in diagnosis rates call for culturally sensitive healthcare practices and early psychiatric interventions.
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Affiliation(s)
- Dana Sinai
- Ramat-Chen Brüll Mental Health Center, Clalit Health Services Community Division, Tel-Aviv District, Tel-Aviv, Israel; Geha Mental Health Data Research Center, Petah Tikva, Israel; Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel.
| | - Chen Avni
- Ramat-Chen Brüll Mental Health Center, Clalit Health Services Community Division, Tel-Aviv District, Tel-Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Paz Toren
- Ramat-Chen Brüll Mental Health Center, Clalit Health Services Community Division, Tel-Aviv District, Tel-Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Wang H, Cao Y, Gou Y, Wang H, Liang Z, Wu Q, Tan J, Liu J, Li Z, Cui J, Zhang H, Zhang Z. IGF2BP3 promotes glutamine metabolism of endometriosis by interacting with UCA1 to enhances the mRNA stability of GLS1. Mol Med 2024; 30:64. [PMID: 38760723 PMCID: PMC11102260 DOI: 10.1186/s10020-024-00834-7] [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: 03/06/2024] [Accepted: 05/08/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Insulin like growth factor II mRNA binding protein 3 (IGF2BP3) has been implicated in numerous inflammatory and cancerous conditions. However, its precise molecular mechanisms in endometriosis (EMs) remains unclear. The aim of this study is to examine the influence of IGF2BP3 on the occurrence and progression of EMs and to elucidate its underlying molecular mechanism. METHODS Efects of IGF2BP3 on endometriosis were confrmed in vitro and in vivo. Based on bioinformatics analysis, RNA immunoprecipitation (RIP), RNA pull-down assays and Fluorescent in situ hybridization (FISH) were used to show the association between IGF2BP3 and UCA1. Single-cell spatial transcriptomics analysis shows the expression distribution of glutaminase 1 (GLS1) mRNA in EMs. Study the effect on glutamine metabolism after ectopic endometriotic stromal cells (eESCs) were transfected with Sh-IGF2BP3 and Sh-UCA1 lentivirus. RESULTS Immunohistochemical staining have revealed that IGF2BP3 was upregulated in ectopic endometriotic lesions (EC) compared to normal endometrial tissues (EN). The proliferation and migration ability of eESCs were greatly reduced by downregulating IGF2BP3. Additionally, IGF2BP3 has been observed to interact with urothelial carcinoma associated 1 (UCA1), leading to increased stability of GLS1 mRNA and subsequently enhancing glutamine metabolism. Results also demonstrated that IGF2BP3 directly interacts with the 3' UTR region of GLS1 mRNA, influencing its expression and stability. Furthermore, UCA1 was able to bind with c-MYC protein, stabilizing c-MYC mRNA and consequently enhancing GLS1 expression through transcriptional promotion. CONCLUSION These discoveries underscored the critical involvement of IGF2BP3 in the elevation and stability of GLS1 mRNA in the context of glutamine metabolism by interacting with UCA1 in EMs. The implications of our study extended to the identification of possible therapeutic targets for individuals with EMs.
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Affiliation(s)
- Honglin Wang
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Harbin Medical University, 148 Baojian Road, Harbin, 150086, China
| | - Yingying Cao
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Harbin Medical University, 148 Baojian Road, Harbin, 150086, China
| | - Yanling Gou
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Harbin Medical University, 148 Baojian Road, Harbin, 150086, China
| | - Hao Wang
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, 200080, China
| | - Zongwen Liang
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Harbin Medical University, 148 Baojian Road, Harbin, 150086, China
| | - Qiong Wu
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Harbin Medical University, 148 Baojian Road, Harbin, 150086, China
| | - Jiahuan Tan
- Department of Obstetrics and Gynecology, Zhongda Hospital Southeast University (Jiangbei), NanJing, China
| | - Jinming Liu
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Harbin Medical University, 148 Baojian Road, Harbin, 150086, China
| | - Zhi Li
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Harbin Medical University, 148 Baojian Road, Harbin, 150086, China
| | - Jing Cui
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Harbin Medical University, 148 Baojian Road, Harbin, 150086, China
| | - Huiyan Zhang
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Harbin Medical University, 148 Baojian Road, Harbin, 150086, China
| | - Zongfeng Zhang
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Harbin Medical University, 148 Baojian Road, Harbin, 150086, China.
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Noar M, Mathias J, Kolatkar A. Gastrointestinal Myoelectrical Activity (GIMA) Biomarker for Noninvasive Diagnosis of Endometriosis. J Clin Med 2024; 13:2866. [PMID: 38792407 PMCID: PMC11122642 DOI: 10.3390/jcm13102866] [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: 04/07/2024] [Revised: 05/04/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Endometriosis represents substantial direct and indirect healthcare costs impacted by an absence of uniformly accurate, non-invasive diagnostic tools. We endeavored to demonstrate gastrointestinal myoelectrical activity (GIMA) biomarkers, unique to endometriosis, will allow non-invasive, uniformly accurate diagnosis or exclusion of endometriosis. Methods: Prospective open-label comparative study of 154 patients, age ≥ 18, with or without diagnosed endometriosis. Population included 62 non-endometriosis controls (Cohort 1), 43 subjects with surgically/histologically confirmed endometriosis (Cohort 2), and 49 subjects with abdominal pain and negative imaging (Cohort 3). Non-invasive electroviscerography (EVG) recorded GIMA biomarkers from three abdominal electrodes before and 30 min post water load protocol. Cohort 2 had postoperative EVG and Cohort 3 had preoperative EVG. Calculated specificity, sensitivity, negative predictive value (NPV), positive predictive value (PPV), and predictive probability or C-statistic used univariate, multivariate, linear, and logistical regression analyses of the area under the curve (AUC) at all frequency and time points, including age and pain covariants. Results: The non-endometriosis cohort differed significantly from the endometriosis cohorts (p < 0.001) for median (IQR) and AUC percent frequency distribution of power at baseline, 10 min, 20 min, and 30 min post water load at all frequency ranges: 15-20 cpm, 30-40 cpm, and 40-50 cpm. The endometriosis cohorts were statistically similar (p > 0.05). GIMA biomarker threshold scoring demonstrated 95%/91% sensitivity and PPV, 96%/95% specificity and NPV, and a C-statistic of >99%/98%, respectively, for age subsets. GIMA biomarkers in Cohort 3 predicted 47/49 subjects positive and 2/49 negative for endometriosis, confirmed surgically. Hormonal therapy, surgical stage, nor pain score affected diagnostic accuracy. Conclusions: EVG with GIMA biomarker detection distinguished participants with and without endometriosis based upon endometriosis-specific GIMA biomarkers threshold scoring.
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Affiliation(s)
- Mark Noar
- Endometriosis and Neuroenterology Research Institute, 53 Loveton Circle, Sparks Glencoe, MD 21152, USA
| | - John Mathias
- Woman’s Hospital of Texas, 7600 Fannin Street, Houston, TX 77054, USA;
- Gastrointestinal Consultants of Houston, 7501 Fannin St., Suite 705, Houston, TX 77054, USA
| | - Ajit Kolatkar
- Specialty Business Center, Integrative Ayurveda Gastroenterology and Nutrition Initiative, 202, Balewadi, Pune 411045, Maharashtra, India;
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Ellis K, Wood R. Research priorities of endometriosis patients and supporters in Aotearoa New Zealand. Aust N Z J Obstet Gynaecol 2024. [PMID: 38706178 DOI: 10.1111/ajo.13831] [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: 12/19/2023] [Accepted: 04/16/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND In New Zealand, an estimated 10% of women and people presumed female at birth have endometriosis, a disease characterised by the presence of tissue similar to the lining of the uterus, outside of the uterus. AIMS The purpose of this study was to characterise the research priorities of New Zealand endometriosis patients and their support networks in alignment with an Australian study. This will allow researchers to be able to ensure their research aligns with closing research gaps prioritised by those who directly experience the impacts of the disease. METHODS AND MATERIALS There were 1262 responses to an online Qualtrics survey advertised through Endometriosis New Zealand's social media accounts and mailing list to reach endometriosis patients and their support networks. RESULTS Overall, the highest research priorities for surgically or radiologically confirmed endometriosis patients, clinically suspected endometriosis patients, chronic pelvic pain patients, and their parents, partners, family members and friends were the management and treatment of endometriosis, followed by understanding endometriosis' cause, and improved capacity to diagnose endometriosis earlier. The key differences between the priorities of symptomatic participants and supporters were that symptomatic participants placed a significantly higher priority on understanding the cause of endometriosis, and supporters placed a significantly higher priority on improving the diagnosis of endometriosis. CONCLUSIONS There is alignment between the ranking of general research priority areas for endometriosis in Australasia, allowing for clear priorities for future research teams to structure their work around patient-centredness.
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Affiliation(s)
- Katherine Ellis
- Department of Chemical and Process Engineering, University of Canterbury, Christchurch, New Zealand
- Endometriosis New Zealand, Christchurch, New Zealand
| | - Rachael Wood
- Department of Chemical and Process Engineering, University of Canterbury, Christchurch, New Zealand
- Biomolecular Interaction Centre, University of Canterbury, Christchurch, New Zealand
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Singh SS, Allaire C, Al-Nourhji O, Bougie O, Bridge-Cook P, Duigenan S, Kroft J, Lemyre M, Leonardi M, Leyland N, Maheux-Lacroix S, Wessels J, Wahl K, Yong PJ. Guideline No. 449: Diagnosis and Impact of Endometriosis - A Canadian Guideline. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102450. [PMID: 38555044 DOI: 10.1016/j.jogc.2024.102450] [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] [Indexed: 04/02/2024]
Abstract
OBJECTIVE To provide a contemporary approach to the understanding of the impact and methods for the diagnosis of endometriosis in Canada. TARGET POPULATION Individuals, families, communities, health care providers, and health care administrators who are affected by, care for patients with, or manage delivery of services for endometriosis. OPTIONS The diagnosis of endometriosis is facilitated by a detailed history, examination, and imaging tests with providers who are experienced in endometriosis care. Surgical evaluation with pathology confirms a diagnosis of endometriosis; however, it is not required for those whose diagnosis was confirmed with imaging. OUTCOMES There is a need to address earlier recognition of endometriosis to facilitate timely access to care and support. Education directed at the public, affected individuals and families, health care providers, and health care administrators are essential to reduce delays in diagnosis and treatment. BENEFITS, HARMS, AND COSTS Increased awareness and education about the impact and approach to diagnosis may support timely access to care for patients and families affected by endometriosis. Earlier and appropriate care may support a reduced health care system burden; however, improved clinical evaluation may require initial investments. EVIDENCE Each section was reviewed with a unique search strategy representative of the evidence available in the literature related to the area of focus. The literature searches for each section of this guideline are listed in Appendix A and include information from published systematic reviews described in the text. VALIDATION METHODS The recommendations were developed following two rounds of review by a national expert panel through an iterative 2-year consensus process. Further details on the process are shared in Appendix B. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix C (Table C1 for definitions and Table C2 for interpretations of strong and conditional recommendations). INTENDED AUDIENCE This guideline is intended to support health care providers and policymakers involved in the care of those impacted by endometriosis and the systems required to support them. TWEETABLE ABSTRACT Endometriosis impact and diagnosis updated guidelines for Canadian health care providers and policymakers. SUMMARY STATEMENTS RECOMMENDATIONS.
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Lukac S, Hancke K, Janni W, Pfister K, Schäffler H, Schmid M, Ebner F, Kloss T, Dayan D. Three-dimensional model for improvement of endometriosis care (3D-E). Int J Gynaecol Obstet 2024; 165:416-423. [PMID: 37795648 DOI: 10.1002/ijgo.15165] [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: 07/10/2023] [Revised: 09/10/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Endometriosis affects approximately 10% of women of reproductive age and leads to significant morbidity and financial burden. Consequently, countries such as France and Germany are formulating strategies to combat endometriosis. In this study, we propose the implementation of our three-dimensional model (3D-E) to raise awareness about endometriosis and enhance timely diagnosis, treatment, and long-term care for affected patients. METHODS Based on the adapted Six Sigma Principle and the modified recommendation of Sales et al. for implementing evidence-based findings into a clinical routine, we first conducted a comprehensive investigation to identify risk factors leading to diagnostic delay of endometriosis. After identifying improvable factors, the applicable options were selected due to defined criteria such as integrability in the clinical routine, cost-effectiveness, and evidence-based-principle. Finally, solutions feasible for health care providers were integrated and the 3D-E model was established. RESULTS Some of the main risk factors contributing to diagnostic delays are symptoms acceptance and misinterpreted symptoms, especially if presenting to nongynecologists in cases of extragenital endometriosis with atypical presentation. Therefore, we tried to sensitize colleagues (first dimension) with a review paper in Germany's largest medical journal and started an elective for medical students (second dimension) at our university. In order to involve additional health care professionals in endometriosis care (third dimension), we are preparing the concept of the EndoNurse. CONCLUSION The 3D-E model is a relatively low-cost, comprehensive, and worldwide adaptable approach for facilitating knowledge transfer, sensitizing health care providers, and improving endometriosis diagnostics and therapy for patients with endometriosis who are in the center of the model.
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Affiliation(s)
- Stefan Lukac
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Katharina Hancke
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Wolfgang Janni
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Kerstin Pfister
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Henning Schäffler
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Marinus Schmid
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Florian Ebner
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
- Gynäkologische Gemeinschaftspraxis Freising & Moosburg, Munich, Germany
| | - Tabea Kloss
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Davut Dayan
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
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Cromeens MG, Knafl K, Robinson WR, Carey ET, Haji-Noor Z, Thoyre S. Endometriosis and Disability: Analysis of Federal Court Appeals of Social Security Disability Insurance and Supplemental Security Income Claims by Individuals Suffering From Endometriosis. Womens Health Issues 2024; 34:221-231. [PMID: 38418360 PMCID: PMC11129848 DOI: 10.1016/j.whi.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND Endometriosis, a chronic noncancerous gynecologic condition commonly characterized by disruptive physical and psychosocial symptoms, can be disabling. Individuals in the United States with endometriosis who are unable to work before retirement age can apply for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI). Given the multi-step process of disability review, it is important to better understand how disability decisions are made. This study aimed to examine approaches and rationales of U.S. federal appeals courts reviewing SSDI and/or SSI claims involving endometriosis-related issues of appeal. METHODS We searched Westlaw and Nexis Uni records, available as of January 2021, for federal appeals of SSDI and SSI claims including endometriosis as an impairment. Two independent reviewers screened full-text cases and extracted data. Framework Analysis was applied to courts' rationales regarding endometriosis-related issues of appeal. RESULTS Eighty-seven appeals addressed an endometriosis-related issue. Three themes-evidence, treatment, and time-were identified across the decisions. The courts' discussions across themes exposed rationales and evidentiary requirements that posed challenges for claimants with endometriosis. The courts found subjective reports of symptoms insufficient evidence of impairment and positive responses to treatments to indicate cures or prevent claimants from demonstrating the necessary continuous 12 months of impairment. Some courts expected claimants to use treatments such as contraception or hysterectomy without addressing the risks of such treatments or the fact that they might have been counter to claimants' needs and preferences. CONCLUSIONS Individuals with endometriosis face evidentiary obstacles and common misconceptions about disease, diagnosis, and treatment in disability claims. SSDI and SSI endometriosis claims are systematically disadvantaged, particularly among those without access to care. The health care, policy, and legal systems can leverage the findings in this study to create a more equitable disability application and review system for those with chronic pain conditions such as endometriosis.
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Affiliation(s)
- Martha Grace Cromeens
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina; Indiana University School of Nursing, Indianapolis, Indiana; School of Nursing, University of Washington, Seattle, Washington.
| | - Kathleen Knafl
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina
| | - Whitney R Robinson
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; Division of Women's Community and Population Health, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina
| | - Erin T Carey
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Zakiya Haji-Noor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Suzanne Thoyre
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina
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Singh SS, Allaire C, Al-Nourhji O, Bougie O, Bridge-Cook P, Duigenan S, Kroft J, Lemyre M, Leonardi M, Leyland N, Maheux-Lacroix S, Wessels J, Wahl K, Yong PJ. Directive clinique n o 449 : Directive canadienne sur le diagnostic et les impacts de l'endométriose. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102451. [PMID: 38555045 DOI: 10.1016/j.jogc.2024.102451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
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Werdel R, Mabie A, Evans TL, Coté RD, Schlundt A, Doehrman P, Dilsaver D, Coté JJ. Serum Levels of Interleukins in Endometriosis Patients: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2024; 31:387-396.e11. [PMID: 38428575 DOI: 10.1016/j.jmig.2024.02.011] [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: 11/15/2023] [Revised: 02/01/2024] [Accepted: 02/23/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE The aims of this systematic review and meta-analysis were to produce a comprehensive survey of the serum levels of interleukins (ILs) in untreated people with endometriosis compared with people without endometriosis. DATA SOURCES A systematic literature search of English language studies within Cinahl, Medline Complete, PubMed, and Scopus from inception to May 2023 was performed. METHODS OF STUDY SELECTION We included studies that compared IL serum levels in people with endometriosis to those without endometriosis. Meta-analysis was performed on IL-1RA, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-17A, IL-18, IL-23, and IL-37. TABULATION, INTEGRATION, AND RESULTS The systematic search retrieved 651 studies, of which 77 underwent a full-text review. A total of 30 studies met inclusion criteria for the meta-analysis. IL-1Ra, IL-6, and IL-37 serum levels were 2.56 (95% CI 2.20-2.92, p <.001), 1.38 (95% CI 0.58-2.17, p <.001), and 1.77 (95% CI 1.33-2.20, p <.001) standard deviations higher in the patients with endometriosis compared with patients without endometriosis while IL-23 serum levels 0.40 (95% CI -0.73 to -0.07, p = .02) standard deviations lower, respectively. CONCLUSION There is mounting evidence that ILs, especially IL-6, may be good candidates for unique noninvasive diagnostic tools and/or treatment pathways for endometriosis.
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Affiliation(s)
- Ryan Werdel
- Kansas City University College of Osteopathic Medicine (Werdel), Kansas City, MO; Creighton University School of Medicine, Department of Biomedical Sciences (Werdel), Omaha, NE
| | - April Mabie
- Creighton University School of Medicine, (Mabie and Evans), Omaha, NE
| | - Taylor L Evans
- Creighton University School of Medicine, (Mabie and Evans), Omaha, NE
| | - Remington D Coté
- Creighton University, Department of Biology (R. Coté), Omaha, NE
| | - Andrew Schlundt
- Creighton University, Department of Exercise Science (Schlundt), Omaha, NE
| | - Pooja Doehrman
- Creighton University School of Medicine, Department of Obstetrics & Gynecology (Dr. Doehrman), Phoenix, AZ; CommonSpirit Health, Department of Obstetrics & Gynecology (Drs. Doehrman and J. Coté), Chicago, IL; Arizona College of Medicine, Department of Obstetrics & Gynecology (Dr. Doehrman), Phoenix, AZ
| | - Danielle Dilsaver
- Creighton University School of Medicine, Department of Clinical Research and Public Health (Dilsaver), Omaha, NE
| | - John J Coté
- Creighton University School of Medicine, Department of Obstetrics & Gynecology (Dr. J.Coté), Omaha, NE; CommonSpirit Health, Department of Obstetrics & Gynecology (Drs. Doehrman and J. Coté), Chicago, IL.
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Mostafavi SRS, Kor E, Sakhaei SM, Kor A. The correlation between ultrasonographic findings and clinical symptoms of pelvic endometriosis. BMC Res Notes 2024; 17:108. [PMID: 38637887 PMCID: PMC11027415 DOI: 10.1186/s13104-024-06761-4] [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: 04/07/2023] [Accepted: 04/02/2024] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVE Considering the importance of endometriosis and its relatively high prevalence among women, this study sought to investigate clinical and Transrectal and transvaginal ultrasounds (TVS) findings of disease. METHODS This descriptive-analytical study was performed based on medical records of 155 women with endometriosis admitted to Rasool-e Akram Hospital in Tehran for a TVS. All the sonography data and patients' information were collected into checklists and analyzed in SPSS-25 software (IBM). RESULTS The mean age of participants was 32.4 ± 6.1 years, ranging from 18 to 50 years. Endometrioma was prevalent in 129 patients (84.8%). Size of endometrioma (diameter) was more than 3 cm in 79.9% of patients, and 3 cm or fewer in 20.1% of cases. Bladder, intestinal, vaginal, and rectosigmoid involvements with endometriosis implants were observed in 4 (2.6%), 54 (35.5), 3 (0.2%), and 51 (33.5) of patients, respectively. A total of 64.5% of patients were diagnosed with incomplete stenosis of the Douglas pouch and 35.5% had complete stenosis. Deep infiltrating endometriosis (DIE) was less than 1 cm in 20.7%, 1 to 3 cm in 42.3%, and over 3 cm in 37% of patients. The most common manifestations of endometriosis Obliteration of the Douglas pouch, endometrioma, and DIE. In addition, imaging modalities have shown promising results, indicating the necessity to use transvaginal ultrasound as the first line of diagnosis in patients with clinically suspected endometriosis.
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Affiliation(s)
| | - Elham Kor
- Department of Radiology, Rasoul-E-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Anis Kor
- Department of Radiology, Rasoul-E-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Qing X, He L, Ma Y, Zhang Y, Zheng W. Systematic review and meta-analysis on the effect of adjuvant gonadotropin-releasing hormone agonist (GnRH-a) on pregnancy outcomes in women with endometriosis following conservative surgery. BMC Pregnancy Childbirth 2024; 24:237. [PMID: 38575880 PMCID: PMC10993455 DOI: 10.1186/s12884-024-06430-1] [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: 09/13/2023] [Accepted: 03/15/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Endometriosis frequently results in pain and infertility. While conservative surgery offers some relief, it often falls short of ensuring satisfactory pregnancy outcomes. Adjuvant GnRH-a is administered post-surgery to mitigate recurrence; however, its impact on pregnancy outcomes remains debated. This study endeavors to assess the efficacy of adjuvant GnRH-a in enhancing pregnancy outcomes post-conservative surgery in endometriosis patients. METHODS Databases including PubMed, Embase, the Cochrane Library, Medline (Ovid), Web of Science, and Scopus were rigorously searched up to 02 August 2023, without linguistic constraints. Identified articles were screened using strict inclusion and exclusion criteria. Evaluated outcomes encompassed pregnancy rate, live birth rate, miscarriage rate, ectopic pregnancy rate, multiple pregnancy rate, mean postoperative pregnancy interval, recurrence rate, and adverse reaction rate. The Cochrane risk of bias tool and the Jadad score evaluated the included studies' quality. Subgroup and sensitivity analysis were implemented to analyze the pooled results. A meta-analysis model expressed results as standardized mean difference (SMD) and Risk ratio (RR). RESULTS A total of 17 studies about 2485 patients were assimilated. Meta-analysis revealed that post-surgery, the GnRH-a cohort experienced a marginally elevated pregnancy rate (RR = 1.20, 95% CI = 1.02-1.41; P = 0.03) and a reduced mean time to conceive (RR = -1.17, 95% CI = -1.70- -0.64; P < 0.0001). Contrarily, other evaluated outcomes did not exhibit notable statistical differences. CONCLUSIONS Incorporating adjuvant GnRH-a following conservative surgery may be deemed beneficial for women with endometriosis, especially before Assisted Reproductive Technology (ART). Nonetheless, owing to pronounced heterogeneity, subsequent research is warranted to substantiate these potential advantages conclusively. REGISTRATION NUMBER CRD42023448280.
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Affiliation(s)
- Xuemei Qing
- Department of Obstetrics and Gynecology, Southwest Medical University, Luzhou, Sichuan, 646000, China
- Department of Obstetrics and Gynecology, Qingbaijiang District People's Hospital, Chengdu, Sichuan, 610300, China
| | - Lele He
- Department of Obstetrics and Gynecology, Southwest Medical University, Luzhou, Sichuan, 646000, China
- Department of Obstetrics and Gynecology, Chongzhou Maternal and Child Health Care Hospital, Chengdu, Sichuan, 611200, China
| | - Ying Ma
- Department of Obstetrics and Gynecology, Mianyang Central Hospital, Mianyang, Sichuan, 621000, China.
- Department of Obstetrics and Gynecology, Chengdu Medical College, Chengdu, Sichuan, 610500, China.
| | - Yong Zhang
- Department of Obstetrics and Gynecology, Southwest Medical University, Luzhou, Sichuan, 646000, China.
- Department of Obstetrics and Gynecology, Mianyang Central Hospital, Mianyang, Sichuan, 621000, China.
| | - Wenxin Zheng
- Department of Obstetrics and Gynecology, Department of Pathology, Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
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Swift B, Taneri B, Becker CM, Basarir H, Naci H, Missmer SA, Zondervan KT, Rahmioglu N. Prevalence, diagnostic delay and economic burden of endometriosis and its impact on quality of life: results from an Eastern Mediterranean population. Eur J Public Health 2024; 34:244-252. [PMID: 38070492 PMCID: PMC10990517 DOI: 10.1093/eurpub/ckad216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND There are limited data on endometriosis from the Eastern Mediterranean region. This study for the first time estimates the prevalence and impact of endometriosis on women in Northern Cyprus, an under-represented region in Europe. METHODS Cyprus Women's Health Research Initiative, a cross-sectional study recruited 7646 women aged 18-55 in Northern Cyprus between January 2018 and February 2020. Cases were identified using self-reported and ultrasound data and two control groups were defined, with (n = 2922) and without (n = 4314) pain. Standardized tools, including the 11-point Numerical Rating Scale and the Short Form 36 Health Survey version 2, were used to assess pain and quality of life, respectively. RESULTS Prevalence and median diagnostic delay of endometriosis were 5.4% [95% confidence interval (CI): 4.9-5.9%, n = 410] and 7 (interquartile range 15.5) years. Endometriosis cases experienced a higher prevalence of bladder pain compared with asymptomatic pain controls (6.3% vs. 1.0%, P < 0.001) and irritable bowel syndrome relating to pelvic pain compared with symptomatic (4.6% vs. 2.6%, P = 0.027) and asymptomatic (0.3%, P < 0.001) controls. The odds of endometriosis cases reporting an anxiety diagnosis was 1.56 (95% CI: 1.03-2.38) higher than the symptomatic and 1.95 (95% CI: 1.30-2.92) times higher than the asymptomatic controls. The physical component score of the health-related quality-of-life instrument suggested a significant difference between the endometriosis cases and the symptomatic controls (46.8 vs. 48.5, P = 0.034). Average annual economic cost of endometriosis cases was Int$9864 (95% CI: $8811-$10 917) including healthcare, costs relating to absence and loss of productivity at work. CONCLUSION Prevalence was lower than the global 10% estimate, and substantial proportion of women without endometriosis reported moderate/severe pelvic pain hinting at many undiagnosed cases within this population. Coupled with lower quality of life, significant economic burden and underutilized pain management options, the study highlights multiple opportunities to improve care for endometriosis patients and women with pelvic pain.
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Affiliation(s)
- Bethan Swift
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Bahar Taneri
- Faculty of Arts and Sciences, Department of Biological Sciences, Eastern Mediterranean University, Famagusta, Northern Cyprus
- Cyprus Women’s Health Research Society (CoHERS), Nicosia, Northern Cyprus
| | - Christian M Becker
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
| | | | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Stacey A Missmer
- Department of Obstetrics and Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Krina T Zondervan
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Nilufer Rahmioglu
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Cyprus Women’s Health Research Society (CoHERS), Nicosia, Northern Cyprus
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Stragapede E, Huber JD, Corsini-Munt S. My Catastrophizing and Your Catastrophizing: Dyadic Associations of Pain Catastrophizing and the Physical, Psychological, and Relational Well-being of Persons With Endometriosis and Their Partners. Clin J Pain 2024; 40:221-229. [PMID: 38229502 DOI: 10.1097/ajp.0000000000001193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024]
Abstract
OBJECTIVES Endometriosis, a painful chronic gynecologic condition, contributes to disruptions in multiple areas of life for both those affected and their partner. Pain catastrophizing has been associated with worse pain outcomes and quality of life for women with endometriosis and with more cognitive load for partners. Examining both partners' pain catastrophizing dyadically with our variables of interest will enhance understanding of its associations with the distressing nature of experiencing and responding to pain during sex for couples with endometriosis. METHODS Persons with endometriosis experiencing pain during sex and their partners (n=52 couples; 104 individuals) completed online self-report measures of pain catastrophizing, depressive symptoms, sexual satisfaction, and partner responses to pain. Persons with endometriosis reported on pain during sexual activity. Analyses were guided by the Actor-Partner Interdependence Model. RESULTS Persons with endometriosis' pain catastrophizing was associated with their higher pain intensity and unpleasantness during sex. When persons with endometriosis reported more pain catastrophizing, they were less sexually satisfied and reported their partners responded more negatively to their pain. When partners reported higher catastrophizing, they were more depressed and responded more negatively to the pain. DISCUSSION Consistent with the Communal Coping Model of pain catastrophizing, although meant to elicit support from the environment, the often-deleterious cognitive process of magnifying, ruminating, and feeling helpless about one's pain (or one's partner's pain) is associated with poorer outcomes for the individual with pain and their romantic partner. Implications for pain management include the relevance of involving the partner and attending to the pain cognitions of both members of the couple.
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Affiliation(s)
| | - Jonathan D Huber
- Huber Medicine Professional Corporation, Private Practice Ottawa, ON, Canada
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Moro F, Ianieri MM, De Cicco Nardone A, Carfagna P, Mascilini F, Vizzielli G, Biasioli A, Pontrelli G, Virgilio BA, Ladisa I, Carlea A, Lo Turco A, Beneduce G, Arcieri M, Scaglione G, Fanfani F, Scambia G, Testa AC. Comparison of clinical and ultrasound examinations in assessing the parametria in patients with deep infiltrating endometriosis: a multicentre prospective study. Reprod Biomed Online 2024; 48:103733. [PMID: 38401251 DOI: 10.1016/j.rbmo.2023.103733] [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: 06/24/2023] [Revised: 10/11/2023] [Accepted: 11/17/2023] [Indexed: 02/26/2024]
Abstract
RESEARCH QUESTION How do clinical rectovaginal examination and transvaginal ultrasound examination perform in the diagnosis of parametrial infiltration in patients with endometriosis? DESIGN This was a multicentre prospective observational study. Patients with suspected deep endometriosis at clinical examination and/or at ultrasound evaluation and scheduled for surgery were included. Following multicentre multidisciplinary meetings, consensus was obtained on terms and methodology to define the parametrium at pelvic anatomy, ultrasound and surgery. Sensitivity, specificity, accuracy, and positive and negative likelihood ratios were calculated for clinical and ultrasound examinations with respect to surgery. RESULTS In total, 195 women were selected for the present study and 164 were included in the analysis. Ultrasound examination had good to high specificity (>80%) for all parameters, except the left lateral parametrium (78.8%). The sensitivity of ultrasound examination was good to high for fixity of the right and left ovaries, uterosacral ligaments, retrocervix and rectovaginal space; and low for the anterior and lateral parametria, vagina, bladder and bowel. Clinical examination had good to high specificity for fixity of the left ovary, anterior parametrium, right uterosacral ligament, retrocervix and vagina; and low specificity for fixity of the right ovary, lateral parametrium, left uterosacral ligament and rectovaginal space. The sensitivity of clinical examination was good for the uterosacral ligaments and rectovaginal space, and low for the remaining parameters. CONCLUSION Ultrasound examination provided good specificity for all the parameters, but sensitivity was low for the anterior and lateral parametria. Clinical examination provided good specificity for the anterior and posterior parametria, but sensitivity was low for the anterior and lateral parametria. Further prospective studies are needed to validate this methodology and confirm the results.
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Affiliation(s)
- Francesca Moro
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy.
| | - Manuel Maria Ianieri
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Alessandra De Cicco Nardone
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Pietro Carfagna
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Floriana Mascilini
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Giuseppe Vizzielli
- Department of Maternal and Child Health, Obstetrics and Gynaecology Clinic, University Hospital of Udine, Udine, Italy; Department of Medical Area, University of Udine, Udine, Italy
| | - Anna Biasioli
- Department of Medical Area, University of Udine, Udine, Italy
| | - Giovanni Pontrelli
- Department of Obstetrics and Gynaecology, Policlinico of Abano Terme, Abano Terme, Italy
| | - Bruna Anna Virgilio
- Department of Obstetrics and Gynaecology, Policlinico of Abano Terme, Abano Terme, Italy
| | - Irene Ladisa
- Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Rome, Italy
| | - Annunziata Carlea
- Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Rome, Italy
| | - Alice Lo Turco
- Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Rome, Italy
| | - Giuliana Beneduce
- Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Rome, Italy
| | - Martina Arcieri
- Clinic of Obstetrics and Gynaecology, 'Santa Maria della Misericordia' University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Department of Biomedical, Dental, Morphological and Functional Imaging Science, University of Messina, Messina, Italy
| | - Giulia Scaglione
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Francesco Fanfani
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Rome, Italy
| | - Antonia Carla Testa
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Rome, Italy
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Coelingh Bennink HJT, van Gennip FAM, Gerrits MGF, Egberts JFM, Gemzell-Danielsson K, Kopp-Kallner H. Health benefits of combined oral contraceptives - a narrative review. EUR J CONTRACEP REPR 2024; 29:40-52. [PMID: 38426312 DOI: 10.1080/13625187.2024.2317295] [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: 08/18/2023] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE This review presents an update of the non-contraceptive health benefits of the combined oral contraceptive pill. METHODS We conducted a literature search for (review) articles that discussed the health benefits of combined oral contraceptives (COCs), in the period from 1980 to 2023. RESULTS We identified 21 subjective and/or objective health benefits of COCs related to (i) the reproductive tract, (ii) non-gynaecological benign disorders and (iii) malignancies. Reproductive tract benefits are related to menstrual bleeding(including anaemia and toxic shock syndrome), dysmenorrhoea, migraine, premenstrual syndrome (PMS), ovarian cysts, Polycystic Ovary Syndrome (PCOS), androgen related symptoms, ectopic pregnancy, hypoestrogenism, endometriosis and adenomyosis, uterine fibroids and pelvic inflammatory disease (PID). Non-gynaecological benefits are related to benign breast disease, osteoporosis, rheumatoid arthritis, multiple sclerosis, asthma and porphyria. Health benefits of COCs related to cancer are lower risks of endometrial cancer, ovarian cancer and colorectal cancer. CONCLUSIONS The use of combined oral contraceptives is accompanied with a range of health benefits, to be balanced against its side-effects and risks. Several health benefits of COCs are a reason for non-contraceptive COC prescription.
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Affiliation(s)
| | | | | | | | | | - Helena Kopp-Kallner
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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50
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Chen-Yost HI, Huang T, O'Brien K, Weir W, Reddy RM, Lieberman R, Pang J. Endometriosis first presenting in pleural fluid cytology. Diagn Cytopathol 2024; 52:E95-E99. [PMID: 38291867 DOI: 10.1002/dc.25278] [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: 12/06/2023] [Accepted: 01/16/2024] [Indexed: 02/01/2024]
Abstract
Most patients with thoracic endometriosis present with catamenial pneumothorax, a rare condition in which recurrent episodes occur within 72 h before or after the start of menstruation. We report a case of thoracic endometriosis presenting with recurrent bloody pleural effusions without pneumothorax diagnosed on pleural fluid cytology. We describe the cytomorphology and immunoprofile of thoracic endometriosis and discuss the differential diagnoses, including neoplastic processes. We also highlight the importance of communication with clinicians for timeliness of diagnosis and treatment, especially when thoracic endometriosis is not suspected.
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Affiliation(s)
| | - Tao Huang
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Kathleen O'Brien
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - William Weir
- Section of Thoracic Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Rishindra M Reddy
- Section of Thoracic Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Richard Lieberman
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan, USA
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Judy Pang
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan, USA
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