1
|
Rezende GP, Venturini MC, Kawagoe LN, Yela Gomes DA, Benetti-Pinto CL. Surgery vs. hormone-based treatment for pain control in deep infiltrating endometriosis: a retrospective cohort study. Curr Med Res Opin 2022; 38:641-647. [PMID: 35060442 DOI: 10.1080/03007995.2022.2031940] [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] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the outcome of surgical or hormone-based pharmacological treatment for deep infiltrating endometriosis (DIE) in patients with pain symptoms. STUDY DESIGN A retrospective cohort study of 122 women with DIE of the bowel was conducted: 61 women underwent surgical treatment due to poor pain control and 61 received hormone-based treatment alone for at least six months. Chronic pelvic pain, dysmenorrhea, deep dyspareunia, dyschezia and dysuria were evaluated by a visual analog scale (VAS) to measure pain on a scale from 0 to 10. Dyspareunia was further evaluated using the Deep Dyspareunia Scale (scores of 0-3). RESULTS Surgery (n = 61 women) was performed at a mean of 3.3 ± 1.6 years previously, while hormone-based treatment alone (n = 61 women) was used for a mean of 3.0 ± 1.41 years. After surgery, women without a desire to procreate received hormone-based treatment. Before treatment, the most intense endometriosis-related pain in the surgical treatment group and hormone-based treatment group alone were chronic pelvic pain (VAS = 9.48 ± 1.49; 8.57 ± 2.22), dysmenorrhea (VAS = 9.61 ± 1.45; 9.02 ± 1.35) and deep dyspareunia (VAS = 8.04 ± 2.82; 7.47 ± 3.21, respectively), all with mean pain scores of around 8 (0-10) in both groups. Both treatments were effective at reducing all symptoms (p < .001). The surgical treatment proved to be more effective and more enduring at improving chronic pelvic pain (p < .001), dyschezia (p = .003) and deep dyspareunia (p < .001). Regarding deep dyspareunia, using the deep dyspareunia scale, ∼70% of surgically treated women scored 0 or 1 (absent or mild deep dyspareunia) after treatment, compared to scores 2 or 3 (intense dyspareunia) in about 70% of the group using hormone-based treatment (p < .001). CONCLUSION Both types of treatment, surgical and pharmacological, effectively improved pain symptoms associated with DIE. However, improvement in chronic pelvic pain, dyschezia and deep dyspareunia was greater and longer-lasting after surgery.
Collapse
Affiliation(s)
- Gabriela Pravatta Rezende
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Marina Capovilla Venturini
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Lucas Nobushy Kawagoe
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Daniela Angerame Yela Gomes
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | |
Collapse
|
2
|
Zhang ZY, Wang J, Fan YL, Wang BY, Zhang WT. Effectiveness of neuromuscular electrical stimulation for endometriosis-related pain: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20483. [PMID: 32569169 PMCID: PMC7310956 DOI: 10.1097/md.0000000000020483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study will assess the effectiveness and safety of neuromuscular electrical stimulation (NMES) for endometriosis-related pain (ERP). METHODS Seven electronic databases of Cochrane Library, PUBMED, EMBASE, WANGFANG, VIP, CBM, and CNKI will be searched. We will search all electronic databases related the randomized controlled trials (RCTs) on the effectiveness and safety of NMES for ERP up to the March 31, 2020 without restrictions of language. RevMan 5.3 software will be used for risk of bias assessment, related data analysis and meta-analysis. RESULTS This systematic review and meta-analysis will summarize current high-quality RCTs on the effectiveness and safety of NMES for ERP. Results of this study will provide the basis for both clinician and further research. CONCLUSION This study will investigate whether NMES is effective and safety for the treatment of ERP. SYSTEMATIC REVIEW REGISTRATION INPLASY202040191.
Collapse
Affiliation(s)
| | | | | | | | - Wei-Ting Zhang
- Department of Internal Medicine, Affiliated Hongqi Hospital of Mudanjiang Medical University, Mudanjiang, China
| |
Collapse
|
3
|
Brubel R, Bokor A, Pohl A, Schilli GK, Szereday L, Bacher-Szamuel R, Rigo J, Polgar B. Serum galectin-9 as a noninvasive biomarker for the detection of endometriosis and pelvic pain or infertility-related gynecologic disorders. Fertil Steril 2017; 108:1016-1025.e2. [PMID: 29202955 DOI: 10.1016/j.fertnstert.2017.09.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the usefulness of soluble galectin-9 (Gal-9) in the noninvasive laboratory diagnosis of endometriosis and various gynecologic disorders. DESIGN Prospective case-control study. SETTING University medical centers. PATIENT(S) A total of 135 women of reproductive age were involved in the study, 77 endometriosis patients, 28 gynecologic controls, and 30 healthy women. INTERVENTION(S) Diagnostic laparoscopy and collection of tissue biopsies, peritoneal cells, and native peripheral blood from different case groups of gynecology patients and healthy women. MAIN OUTCOME MEASURE(S) The expression of mRNA and serum concentration of Gal-9. RESULT(S) Semiquantitative reverse transcription-polymerase chain reaction analysis and serum soluble Gal-9 ELISA were performed on three different cohorts of patients: those with endometriosis, those with benign gynecologic disorders, and healthy controls. Differences in the Gal-9 concentrations between the investigated groups and the stability of Gal-9 in the serum and diagnostic characteristics of Gal-9 ELISA were determined by statistical evaluation and receiver operating characteristic (ROC) curve analysis. Significantly elevated Gal-9 levels were found in both minimal-mild (I-II) and moderate-severe (III-IV) stages of endometriosis in comparison with healthy controls. At a cutoff of 132 pg/mL, ROC analysis revealed an excellent diagnostic value of Gal-9 ELISA in endometriosis (area under the curve = 0.973) with a sensitivity of 94% and specificity of 93.75%, indicating better diagnostic potential than that of other endometriosis biomarkers. Furthermore, various pelvic pain or infertility-associated benign gynecologic conditions were also associated with increased serum Gal-9 levels. CONCLUSION(S) Our results suggest that Gal-9 could be a promising noninvasive biomarker of endometriosis and a predictor of various infertility or pelvic pain-related gynecologic disorders.
Collapse
Affiliation(s)
- Reka Brubel
- First Department of Obstetrics and Gynaecology, Semmelweis University, Budapest, Hungary
| | - Attila Bokor
- First Department of Obstetrics and Gynaecology, Semmelweis University, Budapest, Hungary
| | - Akos Pohl
- First Department of Obstetrics and Gynaecology, Semmelweis University, Budapest, Hungary
| | - Gabriella Krisztina Schilli
- Department of Medical Microbiology and Immunology, University of Pecs, Pecs, Hungary; Janos Szentagothai Research Centre, Pecs, Hungary
| | - Laszlo Szereday
- Department of Medical Microbiology and Immunology, University of Pecs, Pecs, Hungary; Janos Szentagothai Research Centre, Pecs, Hungary
| | - Reka Bacher-Szamuel
- Department of Medical Microbiology and Immunology, University of Pecs, Pecs, Hungary; Janos Szentagothai Research Centre, Pecs, Hungary
| | - Janos Rigo
- First Department of Obstetrics and Gynaecology, Semmelweis University, Budapest, Hungary
| | - Beata Polgar
- Department of Medical Microbiology and Immunology, University of Pecs, Pecs, Hungary; Janos Szentagothai Research Centre, Pecs, Hungary.
| |
Collapse
|
4
|
Xu Y, Zhao W, Li T, Zhao Y, Bu H, Song S. Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis. PLoS One 2017; 12:e0186616. [PMID: 29077705 PMCID: PMC5659600 DOI: 10.1371/journal.pone.0186616] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 10/04/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Endometriosis is a multifactorial, oestrogen-dependent, inflammatory, gynaecological condition that can result in long-lasting visceral pelvic pain and infertility. Acupuncture could be an effective treatment for endometriosis and may relieve pain. Our aim in the present study was to determine the effectiveness of acupuncture as a treatment for endometriosis-related pain. METHODS In December 2016, six databases were searched for randomised controlled trials that determined the effectiveness of acupuncture in the treatment of endometriosis-related pain. Ultimately, 10 studies involving 589 patients were included. The main outcomes assessed were variation in pain level, variation in peripheral blood CA-125 level, and clinical effective rate. All analyses were performed using comprehensive meta-analysis statistical software. RESULTS Of the 10 studies included, only one pilot study used a placebo control and assessed blinding; the rest used various controls (medications and herbs), which were impossible to blind. The sample sizes were small in all studies, ranging from 8 to 36 patients per arm. The mean difference (MD) in pain reduction (pre- minus post-interventional pain level-measured on a 0-10-point scale) between the acupuncture and control groups was 1.36 (95% confidence intervals [CI] = 1.01-1.72, P<0.0001). Acupuncture had a positive effect on peripheral blood CA-125 levels, as compared with the control groups (MD = 5.9, 95% CI = 1.56-10.25, P = 0.008). Similarly, the effect of acupuncture on clinical effective rate was positive, as compared with the control groups (odds ratio = 2.07; 95% CI = 1.24-3.44, P = 0.005). CONCLUSIONS Few randomised, blinded clinical trials have addressed the efficacy of acupuncture in treating endometriosis-related pain. Nonetheless, the current literature suggests that acupuncture reduces pain and serum CA-125 levels, regardless of the control intervention used. To confirm these findings, additional, blinded studies with proper controls and adequate sample sizes are needed.
Collapse
Affiliation(s)
- Yang Xu
- Department of Gynecology and Obstetrics, Nankai Hospital, Tianjin Academy of Integrative Medicine, Tianjin, China
| | - Wenli Zhao
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Department of Neurology, Nankai Hospital, Tianjin Academy of Integrative Medicine, Tianjin, China
| | - Te Li
- Department of Chinese Medicine, Tianjin Hearing Impairment Specialist Hospital, Tianjin, China
| | - Ye Zhao
- Department of Chemical Engineering, University of Florida, Gainesville, Florida, United States of America
| | - Huaien Bu
- Department of Public Health, School of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- * E-mail: (HB); (SS)
| | - Shilin Song
- Laboratory of Anatomy, School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- * E-mail: (HB); (SS)
| |
Collapse
|
5
|
Mira TAA, Giraldo PC, Yela DA, Benetti-Pinto CL. Effectiveness of complementary pain treatment for women with deep endometriosis through Transcutaneous Electrical Nerve Stimulation (TENS): randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2015; 194:1-6. [PMID: 26319650 DOI: 10.1016/j.ejogrb.2015.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/03/2015] [Accepted: 07/23/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Evaluate TENS effectiveness as a complementary treatment of chronic pelvic pain and deep dyspareunia in women with deep endometriosis. STUDY DESIGN This randomized controlled trial was performed in a tertiary health care center, including twenty-two women with deep endometriosis undergoing hormone therapy with persistent pelvic pain and/or deep dyspareunia. This study was registered in the Brazilian Record of Clinical Trials (ReBEC), under n RBR-3rndh6. TENS application for 8 weeks followed a randomized allocation into two groups: Group 1 - acupuncture-like TENS (Frequency: 8Hz, pulse duration: 250μs) - VIF (n=11) and Group 2 - self-applied TENS (Frequency: 85Hz, pulse duration: 75μs) (n=11). The intensity applied was "strong, but comfortable". We evaluated patients before and after treatment by the use of the Visual Analogue Scale, Deep Dyspareunia Scale and Endometriosis Quality of Life Questionnaire. We used the Wilcoxon and Mann-Whitney tests to compare before and after treatment conditions. RESULTS Despite the use of hormone therapy for 1.65±2.08 years, the 22 women with deep endometriosis sustained pelvic pain complaints (VAS=5.95±2.13 and 2.45±2.42, p<.001) and/or deep dyspareunia (DDS=2.29±0.46 and 1.20±1.01, p=.001). We observed significant improvement for chronic pelvic pain, deep dyspareunia and quality of life by the use of TENS. Both application types of TENS were effective for improving the evaluated types of pain. CONCLUSIONS Both resources (acupuncture-like TENS and self-applied TENS) demonstrated effectiveness as a complementary treatment of pelvic pain and deep dyspareunia, improving quality of life in women with deep endometriosis regardless of the device used for treatment.
Collapse
Affiliation(s)
- Ticiana A A Mira
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Paulo C Giraldo
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Daniela A Yela
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | | |
Collapse
|
6
|
CHEN YU, CAI SHENGYUN, WANG JINGWEN, XU MINGJUAN. Valproic acid-induced histone acetylation suppresses CYP19 gene expression and inhibits the growth and survival of endometrial stromal cells. Int J Mol Med 2015; 36:725-32. [DOI: 10.3892/ijmm.2015.2263] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 06/12/2015] [Indexed: 11/06/2022] Open
|
7
|
Riazi H, Tehranian N, Ziaei S, Mohammadi E, Hajizadeh E, Montazeri A. Clinical diagnosis of pelvic endometriosis: a scoping review. BMC Womens Health 2015; 15:39. [PMID: 25952159 PMCID: PMC4450847 DOI: 10.1186/s12905-015-0196-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 04/24/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Accurate and timely diagnosis of endometriosis is associated with confusion. Clinical manifestations, imaging techniques, biomarkers and surgical techniques are used as diagnostic approaches. This paper reviews current evidence on clinical manifestation in order to help practitioners and perhaps improve women's health. METHODS A review of the literature on clinical diagnosis of pelvic endometriosis that appeared in the English language biomedical journals was performed using PubMed, Science Direct and Google Scholar. The search strategy included the combination of key words 'endometriosis' and 'diagnosis' or 'clinical diagnosis' in the titles or abstracts of articles. The search included all papers published during the year 2000 to 2014. Then, the findings were classified in order to summarize the evidence. RESULTS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, in all 51 papers were found relevant and included in this review. In general we found three categories of diagnostic approaches for clinical manifestation including: i) diagnosis via symptoms obtained from history taking, ii) diagnosis via signs obtained from physical examination and iii) diagnosis via risk factors obtained from history taking. CONCLUSION Diagnosis of endometriosis is a matter of concern. Since the disease is associated with diverse clinical symptoms and signs, deeper and more comprehensive consideration according to patient's history and clinical findings is recommended for early and more accurate detection in order to prioritize women for further investigation and contribute to its early management.
Collapse
Affiliation(s)
- Hedyeh Riazi
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Jalal-e Al Ahmad Highway, P.O Box 14115-331, Tehran, Iran.
| | - Najmeh Tehranian
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Jalal-e Al Ahmad Highway, P.O Box 14115-331, Tehran, Iran.
| | - Saeideh Ziaei
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Jalal-e Al Ahmad Highway, P.O Box 14115-331, Tehran, Iran.
| | - Easa Mohammadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Jalal-e Al Ahmad Highway, P.O Box 14115-331, Tehran, Iran.
| | - Ebrahim Hajizadeh
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Jalal-e Al Ahmad Highway, P.O Box 14115-331, Tehran, Iran.
| | - Ali Montazeri
- Mental Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, P.O Box 13185-1488, Tehran, Iran.
- Faculty of Humanity Sciences, University of Science & Culture, ACECR, Tehran, Iran.
| |
Collapse
|
8
|
Riazi H, Tehranian N, Ziaei S, Mohammadi E, Hajizadeh E, Montazeri A. Patients' and physicians' descriptions of occurrence and diagnosis of endometriosis: a qualitative study from Iran. BMC WOMENS HEALTH 2014; 14:103. [PMID: 25174639 PMCID: PMC4158003 DOI: 10.1186/1472-6874-14-103] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 08/18/2014] [Indexed: 11/20/2022]
Abstract
Background The prevalence of endometriosis is considerable but its diagnosis is a dilemma. The aim of this study was to explore the perception and experiences of endometriosis patients and physicians about occurrence and diagnosis of endometriosis. Methods A qualitative research using content analysis was used to obtain data from purposely selected endometriosis patients (12 participants) and gynecologists (6 participants) from January to September 2013 in Tehran. Data were coded and analyzed using a thematic approach. Results Seven themes emerged: 1) pain localization, 2) Severity of pain and struggle for pain relief, 3) Feeling inability to play the role of femininity, 4) Reducing physical health, 5) Disruption of social life, 6) Looking for a reliable diagnostic indicator, 7) Uncertainty of physical examination. The results highlighted that patients with the disease can experience different feelings that interfere with their wellbeing and their lives, and sometimes could be disabling. Conclusion Patients and physicians are looking for a certain, noninvasive and inexpensive diagnostic method. This study helps to promote clinical diagnostic view and knowledge development about description of endometriosis diagnosis to decrease diagnostic delay and mismanagement.
Collapse
Affiliation(s)
| | - Najmeh Tehranian
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | | | | | | | | |
Collapse
|
9
|
Eutopic and ectopic stromal cells from patients with endometriosis exhibit differential invasive, adhesive, and proliferative behavior. Fertil Steril 2013; 100:761-9. [DOI: 10.1016/j.fertnstert.2013.04.041] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 04/16/2013] [Accepted: 04/25/2013] [Indexed: 01/21/2023]
|
10
|
Miller D, Jones C, Aplin J, Nardo L. Altered glycosylation in peri-implantation phase endometrium in women with stages III and IV endometriosis. Hum Reprod 2009; 25:406-11. [DOI: 10.1093/humrep/dep401] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
11
|
|