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Viviano M, Benagiano G, Guo SW, Pluchino N. Why do oestrogens matter: systematic review and meta-analysis assessing GnRH antagonists, considering add-back therapy, for endometriosis-associated pain. Reprod Biomed Online 2024; 49:104321. [PMID: 39098266 DOI: 10.1016/j.rbmo.2024.104321] [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: 01/23/2024] [Revised: 05/28/2024] [Accepted: 06/05/2024] [Indexed: 08/06/2024]
Abstract
Gonadotrophin-releasing hormone (GnRH) antagonists have been demonstrated to reduce endometriosis-associated pain. Because of the hypo-oestrogenic state they induce, however, higher dosages of GnRH antagonists are not recommended for used long term. This unwanted effect may be eliminated by so-called add-back therapy (ABT). This review was conducted to assess the safety and efficacy of GnRH antagonists, with or without add-back hormonal replacement therapy. Out of the 345 studies selected through the initial search, seven randomized controlled trials were included, comparing different oral GnRH antagonists at varying dosages, from a minimum of 50 mg to a maximum of 200 mg once or twice daily. Women treated with the lowest dose of GnRH antagonists had significantly greater mean pain score reductions from baseline throughout treatment compared with those treated with placebo (odds ratio [OR] -13.12, 95% CI -17.35 to -8.89 and OR -3.08, 95% CI -4.39 to -1.76 for dysmenorrhoea and non-menstrual pelvic pain, respectively). Compatible with the dose-response effect, a positive correlation was found between response rates and adverse event rates. While GnRH antagonists offer an advantage in terms of pain reduction for endometriosis, the more recent literature suggests using GnRH antagonists with ABT, which, while mitigating the hypo-oestrogenic effects of GnRH antagonists, maintain their efficacy, while allowing their long-term use.
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Affiliation(s)
- Manuela Viviano
- Division of Gynecology, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland..
| | - Giuseppe Benagiano
- Faculty of Medicine and Dentistry, Sapienza, University of Rome, Rome, Italy
| | - Sun-Wei Guo
- Research Institute, Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Nicola Pluchino
- Fertility Medicine and Gynecological Endocrinology Unit, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
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2
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Uimari O, Nazri H, Tapmeier T. Endometriosis and Uterine Fibroids (Leiomyomata): Comorbidity, Risks and Implications. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:750018. [PMID: 36304022 PMCID: PMC9580755 DOI: 10.3389/frph.2021.750018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022] Open
Abstract
Uterine Fibroids (leiomyomata) and endometriosis affect millions of women world-wide. Although aetiology and natural history of the conditions are markedly different, symptoms can overlap and make differential diagnoses necessary, often using invasive methods such as laparoscopy. Considerable comorbidity exists between the two conditions and needs to be taken into account when treating fibroids and/or endometriosis. The genetic foundations of both uterine fibroids and endometriosis remain to be fully understood but recent evidence suggest common underpinnings. Here, we discuss the comorbidity of uterine fibroids and endometriosis and the implications for diagnosis, treatment and risks.
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Affiliation(s)
- Outi Uimari
- Department of Obstetrics and Gynecology, Oulu University, Oulu, Finland
- PEDEGO Research Unit (Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology) and Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
- Endometriosis CaRe Centre, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Hannah Nazri
- Endometriosis CaRe Centre, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Thomas Tapmeier
- Endometriosis CaRe Centre, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- *Correspondence: Thomas Tapmeier
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Chen X, Man GCW, Hung SW, Zhang T, Fung LWY, Cheung CW, Chung JPW, Li TC, Wang CC. Therapeutic effects of green tea on endometriosis. Crit Rev Food Sci Nutr 2021:1-14. [PMID: 34620005 DOI: 10.1080/10408398.2021.1986465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Endometriosis is a chronic disorder characterized by the presence of endometrial glands and stroma outside the uterine cavity. It affects 8%-10% of women in their reproductive years, and represents a major clinical problem with deleterious social, sexual and reproductive consequences. Current treatment options include pain relief, hormonal intervention and surgical removal. However, these treatments are deemed unsatisfactory owing to varying success, significant side effects and high recurrence rates. Green tea and its major bioactive component, (-)-epigallocatechin gallate (EGCG), possess diverse biological properties, particularly anti-angiogenic, anti-proliferation, anti-metastasis, and apoptosis induction. In recent years, preclinical studies have proposed the use of green tea to inhibit the growth of endometriosis. Herein, the aim of this review is to summarize the potential therapeutic effects of green tea on molecular and cellular mechanism through inflammation, oxidative stress, invasion and adhesion, apoptosis and angiogenesis in endometriosis.
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Affiliation(s)
- Xiaoyan Chen
- Department of Obstetrics and Gynaecology, Shenzhen Baoan Women's and Children's Hospital, Shenzhen University, Shenzhen, China.,Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Gene Chi Wai Man
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.,Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Sze Wan Hung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Tao Zhang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Linda Wen Ying Fung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Chun Wai Cheung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Jacqueline Pui Wah Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Tin Chiu Li
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.,Li Ka Shing Institute of Health Sciences; School of Biomedical Sciences; Chinese University of Hong Kong-Sichuan University Joint Laboratory in Reproductive Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chi Chiu Wang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.,Li Ka Shing Institute of Health Sciences; School of Biomedical Sciences; Chinese University of Hong Kong-Sichuan University Joint Laboratory in Reproductive Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Dorning A, Dhami P, Panir K, Hogg C, Park E, Ferguson GD, Hargrove D, Karras J, Horne AW, Greaves E. Bioluminescent imaging in induced mouse models of endometriosis reveals differences in four model variations. Dis Model Mech 2021; 14:271817. [PMID: 34382636 PMCID: PMC8419713 DOI: 10.1242/dmm.049070] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/21/2021] [Indexed: 12/18/2022] Open
Abstract
Our understanding of the aetiology and pathophysiology of endometriosis remains limited. Disease modelling in the field is problematic as many versions of induced mouse models of endometriosis exist. We integrated bioluminescent imaging of ‘lesions’ generated using luciferase-expressing donor mice. We compared longitudinal bioluminescence and histology of lesions, sensory behaviour of mice with induced endometriosis and the impact of the gonadotropin-releasing hormone antagonist Cetrorelix on lesion regression and sensory behaviour. Four models of endometriosis were tested. We found that the nature of the donor uterine material was a key determinant of how chronic the lesions were, as well as their cellular composition. The severity of pain-like behaviour also varied across models. Although Cetrorelix significantly reduced lesion bioluminescence in all models, it had varying impacts on pain-like behaviour. Collectively, our results demonstrate key differences in the progression of the ‘disease’ across different mouse models of endometriosis. We propose that validation and testing in multiple models, each of which may be representative of the different subtypes/heterogeneity observed in women, should become a standard approach to discovery science in the field of endometriosis. Summary: Different versions of syngeneic mouse models of induced endometriosis exhibit disparities in chronicity and cellular composition of lesions, as well as endometriosis-associated hyperalgesia.
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Affiliation(s)
- Ashley Dorning
- Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Priya Dhami
- Centre for Early Life, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Kavita Panir
- Centre for Early Life, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Chloe Hogg
- Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Emma Park
- Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Gregory D Ferguson
- Ferring Research Institute, 4245 Sorrento Valley Blvd, San Diego, CA 92121, USA
| | - Diane Hargrove
- Ferring Research Institute, 4245 Sorrento Valley Blvd, San Diego, CA 92121, USA
| | - James Karras
- Ferring Research Institute, 4245 Sorrento Valley Blvd, San Diego, CA 92121, USA
| | - Andrew W Horne
- Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Erin Greaves
- Centre for Early Life, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
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Abrao MS, Surrey E, Gordon K, Snabes MC, Wang H, Ijacu H, Taylor HS. Reductions in endometriosis-associated pain among women treated with elagolix are consistent across a range of baseline characteristics reflective of real-world patients. BMC WOMENS HEALTH 2021; 21:246. [PMID: 34134684 PMCID: PMC8210385 DOI: 10.1186/s12905-021-01385-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/03/2021] [Indexed: 01/03/2023]
Abstract
Background Elagolix is an oral, gonadotropin-releasing hormone (GnRH) receptor antagonist, that significantly reduces dysmenorrhea and non-menstrual pelvic pain (NMPP) in women with moderate to severe endometriosis-associated pain. Methods Data were pooled from two 6-month, placebo-controlled, phase 3 studies (Elaris Endometriosis [EM]-I and II) in which 2 doses of elagolix were evaluated (150 mg once daily and 200 mg twice daily). Pooled data from > 1600 women, aged 18–49, were used to evaluate the efficacy of elagolix and health-related quality of life (HRQoL) in prespecified subgroups of women with various baseline characteristics. Results Of the 1686 women treated, 1285 (76.2%) completed the studies. The percentages of women with clinically meaningful reductions in dysmenorrhea and NMPP were generally consistent by subgroup. Significant treatment by subgroup interaction was demonstrated for dysmenorrhea response in baseline analgesic use (p < 0.01) and previous history of pregnancy (p < 0.05) subgroups, and for NMPP response in the baseline NMPP score (p < 0.05) and history of pregnancy (p < 0.05) subgroups. Patient-reported reduction in pain at month 3 was significant across all subgroups taking elagolix 200 mg BID, and significant across most subgroups with elagolix 150 mg QD. Women across subgroups experienced improvement within each domain of the Endometriosis Health Profile-30 (EHP-30), although significant treatment by subgroup interactions were observed in several categories. Conclusions Elagolix was effective in reducing dysmenorrhea and NMPP, and improving HRQoL, compared with placebo across numerous subgroups of women with various baseline characteristics, covering a broad segment of the endometriosis disease and patient types. Clinical trial registration: ClinicalTrials.gov: https://www.clinicaltrials.gov/ct2/show/NCT01620528; https://www.clinicaltrials.gov/ct2/show/NCT01931670. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01385-3.
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Affiliation(s)
- Mauricio S Abrao
- Endometriosis Section, Gynecologic Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Sao Sebastiao 550, São Paulo, SP, 04708-000, Brazil. .,Gynecologic Division, Hospital BP-A Beneficencia Portuguesa de Sao Paulo, São Paulo, SP, Brazil.
| | - Eric Surrey
- Colorado Center for Reproductive Medicine, Lone Tree, CO, USA
| | - Keith Gordon
- Departments of Clinical Development, Medical Affairs, and Statistics, AbbVie Inc., North Chicago, IL, USA
| | - Michael C Snabes
- Departments of Clinical Development, Medical Affairs, and Statistics, AbbVie Inc., North Chicago, IL, USA
| | - Hui Wang
- Departments of Clinical Development, Medical Affairs, and Statistics, AbbVie Inc., North Chicago, IL, USA
| | - Horia Ijacu
- Departments of Clinical Development, Medical Affairs, and Statistics, AbbVie Inc., North Chicago, IL, USA
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
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Abstract
BACKGROUND Endometriosis is associated with pain and infertility. Surgical interventions aim to remove visible areas of endometriosis and restore the anatomy. OBJECTIVES To assess the effectiveness and safety of laparoscopic surgery in the treatment of pain and infertility associated with endometriosis. SEARCH METHODS This review has drawn on the search strategy developed by the Cochrane Gynaecology and Fertility Group including searching the Cochrane Gynaecology and Fertility Group's specialised register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, reference lists for relevant trials, and trial registries from inception to April 2020. SELECTION CRITERIA We selected randomised controlled trials (RCTs) that compared the effectiveness and safety of laparoscopic surgery with any other laparoscopic or robotic intervention, holistic or medical treatment, or diagnostic laparoscopy only. DATA COLLECTION AND ANALYSIS Two review authors independently performed selection of studies, assessment of trial quality and extraction of relevant data with disagreements resolved by a third review author. We collected data for the core outcome set for endometriosis. Primary outcomes included overall pain and live birth. We evaluated the quality of evidence using GRADE methods. MAIN RESULTS We included 14 RCTs. The studies randomised 1563 women with endometriosis. Four RCTs compared laparoscopic ablation or excision with diagnostic laparoscopy only. Two RCTs compared laparoscopic excision with diagnostic laparoscopy only. One RCT compared laparoscopic ablation or excision with laparoscopic ablation or excision and uterine suspension. Two RCTs compared laparoscopic ablation and uterine nerve transection with diagnostic laparoscopy only. One RCT compared laparoscopic ablation with diagnostic laparoscopy and gonadotropin-releasing hormone (GnRH) analogues. Two RCTs compared laparoscopic ablation with laparoscopic excision. One RCT compared laparoscopic ablation or excision with helium thermal coagulator with laparoscopic ablation or excision with electrodiathermy. One RCT compared conservative laparoscopic surgery with laparoscopic colorectal resection of deep endometriosis infiltrating the rectum. Common limitations in the primary studies included lack of clearly described blinding, failure to fully describe methods of randomisation and allocation concealment, and poor reporting of outcome data. Laparoscopic treatment versus diagnostic laparoscopy We are uncertain of the effect of laparoscopic treatment on overall pain scores compared to diagnostic laparoscopy only at six months (mean difference (MD) 0.90, 95% confidence interval (CI) 0.31 to 1.49; 1 RCT, 16 participants; very low quality evidence) and at 12 months (MD 1.65, 95% CI 1.11 to 2.19; 1 RCT, 16 participants; very low quality evidence), where a positive value means pain relief (the higher the score, the more pain relief) and a negative value reflects pain increase (the lower the score, the worse the increase in pain). No studies looked at live birth. We are uncertain of the effect of laparoscopic treatment on quality of life compared to diagnostic laparoscopy only: EuroQol-5D index summary at six months (MD 0.03, 95% CI -0.12 to 0.18; 1 RCT, 39 participants; low quality evidence), 12-item Short Form (SF-12) mental health component (MD 2.30, 95% CI -4.50 to 9.10; 1 RCT, 39 participants; low quality evidence) and SF-12 physical health component (MD 2.70, 95% CI -2.90 to 8.30; 1 RCT, 39 participants; low quality evidence). Laparoscopic treatment probably improves viable intrauterine pregnancy rate compared to diagnostic laparoscopy only (odds ratio (OR) 1.89, 95% CI 1.25 to 2.86; 3 RCTs, 528 participants; I2 = 0%; moderate quality evidence). We are uncertain of the effect of laparoscopic treatment compared to diagnostic laparoscopy only on ectopic pregnancy (MD 1.18, 95% CI 0.10 to 13.48; 1 RCT, 100 participants; low quality evidence) and miscarriage (MD 0.94, 95% CI 0.35 to 2.54; 2 RCTs, 112 participants; low quality evidence). There was limited reporting of adverse events. No conversions to laparotomy were reported in both groups (1 RCT, 341 participants). Laparoscopic ablation and uterine nerve transection versus diagnostic laparoscopy We are uncertain of the effect of laparoscopic ablation and uterine nerve transection on adverse events (more specifically vascular injury) compared to diagnostic laparoscopy only (OR 0.33, 95% CI 0.01 to 8.32; 1 RCT, 141 participants; low quality evidence). No studies looked at overall pain scores (at six and 12 months), live birth, quality of life, viable intrauterine pregnancy confirmed by ultrasound, ectopic pregnancy and miscarriage. Laparoscopic ablation versus laparoscopic excision There was insufficient evidence to determine whether there was a difference in overall pain, measured at 12 months, for laparoscopic ablation compared with laparoscopic excision (MD 0.00, 95% CI -1.22 to 1.22; 1 RCT, 103 participants; very low quality evidence). No studies looked at overall pain scores at six months, live birth, quality of life, viable intrauterine pregnancy confirmed by ultrasound, ectopic pregnancy, miscarriage and adverse events. Helium thermal coagulator versus electrodiathermy We are uncertain whether helium thermal coagulator compared to electrodiathermy improves quality of life using the 30-item Endometriosis Health Profile (EHP-30) at nine months, when considering the components: pain (MD 6.68, 95% CI -3.07 to 16.43; 1 RCT, 119 participants; very low quality evidence), control and powerlessness (MD 4.79, 95% CI -6.92 to 16.50; 1 RCT, 119 participants; very low quality evidence), emotional well-being (MD 6.17, 95% CI -3.95 to 16.29; 1 RCT, 119 participants; very low quality evidence) and social support (MD 5.62, 95% CI -6.21 to 17.45; 1 RCT, 119 participants; very low quality evidence). Adverse events were not estimable. No studies looked at overall pain scores (at six and 12 months), live birth, viable intrauterine pregnancy confirmed by ultrasound, ectopic pregnancy and miscarriage. AUTHORS' CONCLUSIONS Compared to diagnostic laparoscopy only, it is uncertain whether laparoscopic surgery reduces overall pain associated with minimal to severe endometriosis. No data were reported on live birth. There is moderate quality evidence that laparoscopic surgery increases viable intrauterine pregnancy rates confirmed by ultrasound compared to diagnostic laparoscopy only. No studies were found that looked at live birth for any of the comparisons. Further research is needed considering the management of different subtypes of endometriosis and comparing laparoscopic interventions with lifestyle and medical interventions. There was insufficient evidence on adverse events to allow any conclusions to be drawn regarding safety.
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Affiliation(s)
- Celine Bafort
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Yusuf Beebeejaun
- King's Fertility, King's College Hospital NHS Foundation Trust, London, UK
| | - Carla Tomassetti
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Jan Bosteels
- Academic Centre for General Practice, Cochrane Belgium, Leuven, Belgium
| | - James Mn Duffy
- Institute for Women's Health, University College London, London, UK
- King's Fertility, Fetal Medicine Research Institute, London, UK
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Harris A, McCaughey T, Tsaltas J, Davies-Tuck M, Ratner R, Najjar H, Barel O. Endometriosis-related pelvic pain following laparoscopic surgical treatment. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2020. [DOI: 10.1177/2284026520926038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Endometriosis is a common, often-debilitating disease, affecting women of reproductive age. Pain is a common symptom of the disease and is commonly treated by surgery, medical therapy, or a combination of the two. This study aimed to evaluate the rates of ongoing pain post laparoscopic excision and the risk factors for ongoing pain symptoms. Methods: This retrospective cohort study analyzed the medical records of all patients who underwent laparoscopic surgery for endometriosis in a large tertiary healthcare service in Australia between January 2009 and September 2016. Results were analyzed using SPSS statistics version 11. Results: A total of 972 patients met the inclusion criteria; of these, 398 had follow-up at our hospital network and were included in the final analysis. The median age was 34.5 years, 69.6% were of Caucasian ethnicity, and the median body mass index was 25.9; 70.6% of our patients reported decreased pain after surgery. Patients who suffered from chronic pain were twice as likely to experience ongoing pain, while patients with stage 3–4 endometriosis were found to have 65% reduced odds of pain at follow-up (95% confidence interval = 0.22–0.61, p < 0.001). In univariate analysis of non-Caucasian patients, those who had a specialist endometriosis surgeon perform the surgery had significantly higher incidence of symptom improvement (58% reduced odds of recurrent pain and 40% reduced odds, p < 0.05, accordingly). Conclusion: The prevalence and severity of pain associated with endometriosis mandates a thorough understanding of the effectiveness of current management. Our article highlights the utility of laparoscopic surgery in treating endometriosis-associated pain.
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Affiliation(s)
- Amani Harris
- Gynaecological Endoscopy and Endometriosis Surgery Unit, Monash Health and Monash University, Melbourne, VIC, Australia
| | - Tristan McCaughey
- Gynaecological Endoscopy and Endometriosis Surgery Unit, Monash Health and Monash University, Melbourne, VIC, Australia
- The Royal Women’s Hospital, Melbourne, VIC, Australia
| | - Jim Tsaltas
- Gynaecological Endoscopy and Endometriosis Surgery Unit, Monash Health and Monash University, Melbourne, VIC, Australia
- Melbourne IVF, Melbourne, VIC, Australia
| | - Miranda Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Roni Ratner
- Gynaecological Endoscopy and Endometriosis Surgery Unit, Monash Health and Monash University, Melbourne, VIC, Australia
| | - Haider Najjar
- Gynaecological Endoscopy and Endometriosis Surgery Unit, Monash Health and Monash University, Melbourne, VIC, Australia
- Melbourne IVF, Melbourne, VIC, Australia
| | - Oshri Barel
- Obstetrics and Gynecology, Assuta Medical Center, Ben-Gurion University of the Negev, Ashdod, Israel
- Assuta Ashdod University Hospital, Ashdod, Israel
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Understanding pre-operative staging and surgical practice in advanced endometriosis: A survey of Canadian gynaecologists. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2020. [DOI: 10.1177/2284026520924500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Study objective: To determine the pre-operative evaluation, surgical management and referral practices in patients with advanced stage endometriosis by Canadian gynaecologists. Design: A survey of obstetricians and gynaecologists. Setting: The survey was initiated and piloted at an academic centre by general gynaecologists and endometriosis specialists. Intervention: Electronically distributed to 733 individuals by the Society of Obstetricians and Gynaecologists of Canada. This included all members, irrespective of subspecialty and practice patterns. Measurement: Responses were collected using a web-based survey tool and analysed using Excel. Results: The response rate was 15.7% (115 respondents). Pre-operatively, 62.2% of respondents perform a transvaginal ultrasound on all of their patients, while magnetic resonance imaging is reserved for patients with physical exam findings suspicious for advanced endometriosis (26.7%) or in whom the surgeons suspect deep infiltrating endometriosis, bowel, bladder or uterosacral disease (54.4%). Most surgeons (81.4%) report encountering advanced disease that they did not suspect pre-operatively <10% of the time. Although 40% of respondents would refer their patients in whom they suspected deep infiltrating endometriosis, endometriomas, bowel, bladder or uterosacral ligament involvement to an endometriosis specialist prior to any attempted surgery, 54.4% would never refer without previously confirming the diagnosis at laparoscopy. In contrast, only 15% felt comfortable treating advanced endometriosis completely at time of laparoscopy (including deep infiltrating endometriosis, bladder and bowel disease). Post-operatively, 67.8% of respondents refer patients to an endometriosis specialist only if their disease was not appropriately treated surgically, while 23.3% do not refer any of their patients. Conclusion: Our study identified significant variability in the management of advanced endometriosis in Canada. Understanding these patterns will help us formulate a more universal investigation and management plan, which may improve the identification of patients pre-operatively with advanced stage endometriosis that could benefit from treatment by an endometriosis specialist.
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Budden A, Ravendran K, Abbott JA. Identifying the Problems of Randomized Controlled Trials for the Surgical Management of Endometriosis-associated Pelvic Pain. J Minim Invasive Gynecol 2020; 27:419-432. [DOI: 10.1016/j.jmig.2019.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/24/2019] [Accepted: 11/01/2019] [Indexed: 12/20/2022]
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10
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Leonardi M, Gibbons T, Armour M, Wang R, Glanville E, Hodgson R, Cave AE, Ong J, Tong YYF, Jacobson TZ, Mol BW, Johnson NP, Condous G. When to Do Surgery and When Not to Do Surgery for Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 27:390-407.e3. [DOI: 10.1016/j.jmig.2019.10.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 12/24/2022]
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Greaves E, Rosser M, Saunders PTK. Endometriosis-Associated Pain - Do Preclinical Rodent Models Provide a Good Platform for Translation? ADVANCES IN ANATOMY, EMBRYOLOGY, AND CELL BIOLOGY 2020; 232:25-55. [PMID: 33278006 DOI: 10.1007/978-3-030-51856-1_3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Pelvic pain is a common symptom of endometriosis. Our understanding of its etiology remains incomplete and medical management is limited by poor translation from preclinical models to clinical trials. In this review, we briefly consider the evidence, or lack thereof, that different subtypes of lesion, extra-uterine bleeding, and neuropathic pathways add to the complex and heterogeneous pain experience of women with the condition. We summarize the studies in rodent models of endometriosis that have used behavioral endpoints (evoked and non-evoked) to explore mechanisms of endometriosis-associated pain. Lesion innervation, activation of nerves by pronociceptive molecules released by immune cells, and a role for estrogen in modulating hyperalgesia are key endometriosis-associated pain mechanisms replicated in preclinical rodent models. The presence of ectopic (full thickness uterus or endometrial) tissue may be associated with changes in the spinal cord and brain, which appear to model changes reported in patients. While preclinical models using rats and mice have yielded insights that appear relevant to mechanisms responsible for the development of endometriosis-associated pain, they are limited in scope. Specifically, most studies are based on models that only resulted in the formation of superficial lesions and use induced (evoked) behavioral 'pain' tests. We suggest that translation for patient benefit will be improved by new approaches including models of ovarian and deep infiltrating disease and measurement of spontaneous pain behaviors. Future studies must also capitalize on new advances in the wider field of pain medicine to identify more effective treatments for endometriosis-associated pain.
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Affiliation(s)
- Erin Greaves
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
| | - Matthew Rosser
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Philippa T K Saunders
- Centre for Inflammation Research, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
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Laparoscopic Vessel Endometriosis Resection Surgery: A Case Report and Review of Literature. Case Rep Obstet Gynecol 2019; 2019:1375208. [PMID: 31915556 PMCID: PMC6930385 DOI: 10.1155/2019/1375208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/13/2019] [Accepted: 08/27/2019] [Indexed: 11/17/2022] Open
Abstract
Background Endometriosis usually occurs in the pelvis and often involves the ovaries, the uterosacral and broad ligaments, and the pelvic peritoneum. In rare instances, it can occur in the vasculature of the pelvis. Patients with endometriosis present with abnormal pain, menstrual cycle disruption and infertility. Management of endometriosis is usually surgical with excision of the tissue via laparoscopic means. Case A 42-year-old Gravida 5, Para 2-0-3-2 patient with a 22 year history of endometriosis, who had had multiple laparoscopic endometriosis resections, total abdominal hysterectomy, and an exploratory laparotomy with bilateral salpingo-oophorectomy, presented with left pelvic pain when standing, dyspareunia, and a 3.7 cm cyst on ultrasound. The patient underwent laparoscopic vessel endometriosis resection and excision of endometriotic nodules from external iliac vessels. Final pathology report showed evidence of old endometriosis in all locations. On interval follow-up, the patient reported sustained relief from pain. Conclusion Complete resection of endometriosis from large vessels can be successfully achieved laparoscopically by a well-experienced surgeon with delicate, proper techniques.
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Singh SS, Gude K, Perdeaux E, Gattrell WT, Becker CM. Surgical Outcomes in Patients With Endometriosis: A Systematic Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 42:881-888.e11. [PMID: 31718952 DOI: 10.1016/j.jogc.2019.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Among women treated surgically for endometriosis-associated pain, comprehensive data are lacking on the proportions of patients who experience little or no symptom relief, develop recurrent symptoms, or require further surgical treatment for endometriosis. The aim of this study was to assess the efficacy of surgical procedures used to treat endometriosis-associated pain. METHODS Medline and Embase were searched on October 13, 2016. Articles referring to women undergoing surgery for the treatment of endometriosis-associated pain were screened by two independent investigators. For each included treatment arm, data were extracted for the proportion of patients reporting partial or no improvement after surgery for endometriosis-associated pain, pain recurrence, or requirement for further surgery. RESULTS A total of 38 studies were included. Most studies did not report relevant outcomes to evaluate pain (71.1%) and recurrent surgery (68.4%). Of the women who underwent lesion excision, 11.8% reported no improvement in pain, and 22.6% underwent further surgery. Postoperative pain, recurrent pain, and adverse events were reported by 34.3%, 28.7%, and 14.8%, respectively, of patients who underwent excision or ablation of endometriosis combined with pelvic denervation and in 25.0%, 15.8%, and 8.1% of women who underwent lesion excision alone. Of the patients who were treated surgically for deep endometriosis affecting the bowel and/or bladder, 7.0% experienced recurrent symptoms, and 4.1% underwent further surgery. CONCLUSION This review supports the findings of previous studies and highlights the need for standardized reporting and more detailed follow-up after surgery for endometriosis-associated pain.
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Affiliation(s)
- Sukhbir S Singh
- Department of Obstetrics and Gynecology, The Ottawa Hospital & University of Ottawa, Ottawa, ON.
| | - Kerstin Gude
- Global Pharmacovigilance, Bayer AG, Berlin, Germany
| | | | - William T Gattrell
- Research Evaluation Unit, Oxford PharmaGenesis, Oxford, United Kingdom; Department of Mechanical Engineering and Mathematical Sciences, Oxford Brookes University, Oxford, United Kingdom
| | - Christian M Becker
- Endometriosis Care and Research (CaRe) Centre, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
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Jonas WB, Crawford C, Colloca L, Kriston L, Linde K, Moseley B, Meissner K. Are Invasive Procedures Effective for Chronic Pain? A Systematic Review. PAIN MEDICINE (MALDEN, MASS.) 2019; 20:1281-1293. [PMID: 30204920 PMCID: PMC6611529 DOI: 10.1093/pm/pny154] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To assess the evidence for the safety and efficacy of invasive procedures for reducing chronic pain and improving function and health-related quality of life compared with sham (placebo) procedures. DESIGN Systematic review with meta-analysis. METHODS Studies were identified by searching multiple electronic databases, examining reference lists, and communicating with experts. Randomized controlled trials comparing invasive procedures with identical but otherwise sham procedures for chronic pain conditions were selected. Three authors independently extracted and described study characteristics and assessed Cochrane risk of bias. Two subsets of data on back and knee pain, respectively, were pooled using random-effects meta-analysis. Overall quality of the literature was assessed through Grading of Recommendations, Assessment, Development, and Evaluation. RESULTS Twenty-five trials (2,000 participants) were included in the review assessing the effect of invasive procedures over sham. Conditions included low back (N = 7 trials), arthritis (4), angina (4), abdominal pain (3), endometriosis (3), biliary colic (2), and migraine (2). Thirteen trials (52%) reported an adequate concealment of allocation. Fourteen studies (56%) reported on adverse events. Of these, the risk of any adverse event was significantly higher for invasive procedures (12%) than sham procedures (4%; risk difference = 0.05, 95% confidence interval [CI] = 0.01 to 0.09, P = 0.01, I2 = 65%). In the two meta-analysis subsets, the standardized mean difference for reduction of low back pain in seven studies (N = 445) was 0.18 (95% CI = -0.14 to 0.51, P = 0.26, I2 = 62%), and for knee pain in three studies (N = 496) it was 0.04 (95% CI = -0.11 to 0.19, P = 0.63, I2 = 36%). The relative contribution of within-group improvement in sham treatments accounted for 87% of the effect compared with active treatment across all conditions. CONCLUSIONS There is little evidence for the specific efficacy beyond sham for invasive procedures in chronic pain. A moderate amount of evidence does not support the use of invasive procedures as compared with sham procedures for patients with chronic back or knee pain. Given their high cost and safety concerns, more rigorous studies are required before invasive procedures are routinely used for patients with chronic pain.
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Affiliation(s)
- Wayne B Jonas
- Integrative Health Programs, H&S Ventures, Alexandria, Virginia
| | | | - Luana Colloca
- University of Maryland School of Nursing and Medicine, Baltimore, Maryland, USA
| | - Levente Kriston
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus Linde
- Institute of General Practice, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Bruce Moseley
- Joseph Barnhart Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Karin Meissner
- Division Health Promotion, University of Applied Sciences Coburg, Coburg, Germany
- Institute of Medical Psychology, LMU Munich, Munich, Germany
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Kong H, Hu L, Nie L, Yu X, Dai W, Li J, Chen C, Bu Z, Shi H, Wu Q, Guan Y, Sun Y. A multi-center, randomized controlled clinical trial of the application of a shortened protocol of long-acting Triptorelin down-regulated prior to IVF/ICSI among patients with endometriosis: A protocol. Reprod Health 2018; 15:213. [PMID: 30572916 PMCID: PMC6302481 DOI: 10.1186/s12978-018-0639-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 11/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Endometriosis is the major cause of progressive pelvic pain and subfertility. Up to 50% of reproductive-age women suffer from pelvic pain. Endometriosis is a classic indication for IVF. Compared with women whose inability to procreate is caused by simple tubal infertility, women with endometriosis often have lower pregnancy rates following in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). The administration of gonadotrophin-releasing hormone (GnRH) agonists prior to IVF/ICSI can improve the successful pregnancy rate. Whether a briefer treatment interval would be efficacious has not been studied. METHODS/DESIGN Eligible and consenting women will be randomly assigned to one of two treatments (one cycle of a GnRH agonist or two cycles of a GnRH agonist) prior to IVF/ICSI using a table of random numbers. The primary outcome of this trial is clinical pregnancy rate. Other outcomes include gonadotrophin (Gn) duration, the total dose of follicle-stimulating hormone (FSH) used, number of oocytes retrieved, number of embryos available for transfer, implantation rate, the abortion rate, live birth rate, and incidence of moderate-to-severe ovarian hyperstimulation. The sample size of this trial is estimated to be 421 participants for each of the two arms. Appropriate interim analyses will be conducted by a data monitoring and ethics committee (DMEC), and the final test will be an intention-to-treat analysis. TRIAL REGISTRATION This trial has been assigned the following registry number: NCT03006406 .
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Affiliation(s)
- Huijuan Kong
- Center for Reproductive Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Reproduction and Genetics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Linli Hu
- Center for Reproductive Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Reproduction and Genetics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ling Nie
- Jiangxi Maternal and Child Health hospital, Nanchang, China
| | - Xiaona Yu
- Center for Reproductive Medicine, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei Dai
- Center for Reproductive Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Reproduction and Genetics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Li
- Center for Reproductive Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Reproduction and Genetics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Caihong Chen
- Center for Reproductive Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Reproduction and Genetics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhiqin Bu
- Center for Reproductive Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Reproduction and Genetics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hao Shi
- Center for Reproductive Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Reproduction and Genetics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiongfang Wu
- Jiangxi Maternal and Child Health hospital, Nanchang, China
| | - Yichun Guan
- Center for Reproductive Medicine, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingpu Sun
- Center for Reproductive Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China. .,Henan Key Laboratory of Reproduction and Genetics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Lefebvre G, Allaire C, Jeffrey J, Vilos G. Archivée: No 109 - Hystérectomie. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:e581-e595. [DOI: 10.1016/j.jogc.2018.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lefebvre G, Allaire C, Jeffrey J, Vilos G. No. 109-Hysterectomy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:e567-e579. [PMID: 29921436 DOI: 10.1016/j.jogc.2018.04.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify the indications for hysterectomy, preoperative assessment, and available alternatives required prior to hysterectomy. Patient self-reported outcomes of hysterectomy have revealed high levels of patient satisfaction. These may be maximized by careful preoperative assessment and discussion of other treatment choices. In most cases hysterectomy is performed to relieve symptoms and improve quality of life. The patient's preference regarding treatment alternatives must be considered carefully. OPTIONS The areas of clinical practice considered in formulating this guideline are preoperative assessment including alternative treatments, choice of method for hysterectomy, and evaluation of risks and benefits. The risk-to-benefit ratio must be examined individually by the woman and her health practitioners. OUTCOMES Optimizing the decision-making process of women and their caregivers in proceeding with a hysterectomy having considered the disease process, and available alternative treatments and options, and having reviewed the risks and anticipated benefits. EVIDENCE Using Medline, PubMed, and the Cochrane Database, English language articles were reviewed from 1996 to 2001 as well as the review published in the 1996 SOGC guidelines. The level of evidence has been determined using the criteria described by the Canadian Task Force on the Periodic Health Examination. BENEFITS, HARMS, AND COSTS Hysterectomy is the treatment of choice for certain gynaecologic conditions. The predicted advantages must be carefully weighed against the possible risks of the surgery and other treatment alternatives. In the properly selected patient, the result from the surgery should be an improvement in the quality of life. The cost of the surgery to the health care system and to the patient must be interpreted in the context of the cost of untreated conditions. The approach selected for the hysterectomy will impact on the cost of the surgery. RECOMMENDATIONS Benign Disease Preinvasive Disease Invasive Disease Acute Conditions Other Indications Surgical Approach VALIDATION: Medline searches were performed in preparing this guideline with input from experts in their field across Canada. The guideline was reviewed and accepted by SOGC Council and Executive. SPONSOR The Society of Obstetricians and Gynaecologists of Canada.
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Lee JH, Song JY, Yi KW, Lee SR, Lee DY, Shin JH, Cho S, Seo SK, Kim SH. Effectiveness of Dienogest for Treatment of Recurrent Endometriosis: Multicenter Data. Reprod Sci 2018; 25:1515-1522. [DOI: 10.1177/1933719118779733] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Jae Hoon Lee
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Yen Song
- Department of Obstetrics and Gynecology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kyong Wook Yi
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, South Korea
| | - Sa Ra Lee
- Department of Obstetrics and Gynecology, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Dong-Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung-Ho Shin
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, South Korea
| | - SiHyun Cho
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Kyo Seo
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Hoon Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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de Sanctis V, Matalliotakis M, Soliman AT, Elsefdy H, Di Maio S, Fiscina B. A focus on the distinctions and current evidence of endometriosis in adolescents. Best Pract Res Clin Obstet Gynaecol 2018; 51:138-150. [PMID: 29548642 DOI: 10.1016/j.bpobgyn.2018.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/23/2018] [Indexed: 12/22/2022]
Abstract
Endometriosis (EM) occurring in adolescents presents distinct clinical and histologic characteristics compared to the disease in women. Because the symptoms of EM are nonspecific, often overlapping with those experienced in a range of gynecological and gastrointestinal conditions, the process of reaching a diagnosis of EM is often delayed. The diagnosis of EM is suspected depending on the history and the symptoms and signs, is corroborated by physical examination and imaging techniques, and is finally proved by histological examination of specimens collected during laparoscopy. Currently, there is insufficient evidence to make strong recommendations for management in adolescents who may have EM. This short report reviews some peculiarities of EM in adolescents and provides an update of recent knowledge of the diagnosis and treatment of EM. We hope that the present contribution may help to bring more attention to the clinical diagnosis of EM and consequently aid in decreasing diagnostic delay.
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Affiliation(s)
| | - Michail Matalliotakis
- Department of Obstetrics and Gynecology, Venizeleio and Pananio General Hospital of Heraklion, Crete, Greece; Section of Molecular Pathology and Human Genetics, Department of Internal Medicine, School of Medicine University of Crete, Heraklion, Greece
| | - Ashraf T Soliman
- Department of Pediatrics, Division of Endocrinology, Alexandria University Children's Hospital, Alexandria, Egypt
| | - Heba Elsefdy
- Department of Pediatrics, Ain Shams University, Egypt
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Candiani M, Ronzoni S, Gentilini D, Tandoi I, Somigliana E, Viganò P. Peculiar Aspects of Endometriosis in Adolescents. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/228402651000200104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although documented rates of endometriosis in adolescent patients undergoing laparoscopy for chronic pelvic pain range from about 25% to 45%, adolescent endometriosis has received limited attention in terms of research activity and follow-up studies. In this manuscript, distinctive characteristics of adolescent and young endometriosis have been considered in order to define pathogenetic and scientific concepts that might be useful in clarifying some aspects of the adult disease as well. Some highlights relative to the cellular origin of the disease can be derived from reported cases before menarche, from the appearance of endometriotic lesions in teenagers (mostly stage I-II endometriosis), and from the relative infrequency of ovarian endometriotic cysts in this population. Adolescents and young patients might be also particularly useful for studying the natural course of the disease. To this end, clinical manifestations and recurrence patterns of the disease in adolescent patients need to be elucidated. Differences in clinical aspects of the disease between the adult and young populations are presented. Risk of recurrence and potential risk factors involved in the reappearance of the disease in teenagers are completely unknown. (Journal of Endometriosis 2010; 2: 19–25)
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Affiliation(s)
- Massimo Candiani
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan - Italy
| | - Stefania Ronzoni
- Department of Obstetrics and Gynecology, DMSD San Paolo Hospital, Milan - Italy
| | | | - Iacopo Tandoi
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan - Italy
| | | | - Paola Viganò
- CROG: Center for Research in Obstetrics and Gynecology, Milan - Italy
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Tanmahasamut P, Saejong R, Rattanachaiyanont M, Angsuwathana S, Techatraisak K, Sanga-Areekul N. Postoperative desogestrel for pelvic endometriosis-related pain: a randomized controlled trial. Gynecol Endocrinol 2017; 33:534-539. [PMID: 28266234 DOI: 10.1080/09513590.2017.1296124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To determine the effectiveness of desogestrel for relieving endometriosis-related pain. METHODS A double-blinded randomized placebo-controlled trial was conducted in 40 patients who had endometriosis with moderate-to-severe dysmenorrhea or chronic pelvic pain undergoing laparoscopic conservative surgery. After surgery, patients were randomized to desogestrel or placebo group. Outcomes included changes in visual analog scale (VAS) of dysmenorrhea, pelvic pain and dyspareunia, patient satisfaction, and adverse effects. RESULTS Forty patients were randomized to desogestrel group (n = 20) and placebo group (n = 20). At month 6, the desogestrel group had significantly lower median VAS of overall pelvic pain, dysmenorrhea and noncyclic pelvic pain. Comparing with the placebo group, the desogestrel group had greater reduction in VAS of overall pain, dysmenorrhea and pelvic pain, but comparable reduction in VAS of dyspareunia. No patient in the desogestrel group but 4 patients in the placebo group still had moderate-to-severe pelvic pain at 6 months postoperatively. The proportion of patients who rated the treatment as very satisfied was higher in the desogestrel group than in the placebo group. There was no serious adverse event during the study period. CONCLUSIONS Desogestrel is effective and acceptable for postoperative therapy for patients with moderate-to-severe pain related to endometriosis.
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Affiliation(s)
- Prasong Tanmahasamut
- a Department of Obstetrics and Gynecology , Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand
| | - Ratikorn Saejong
- a Department of Obstetrics and Gynecology , Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand
| | - Manee Rattanachaiyanont
- a Department of Obstetrics and Gynecology , Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand
| | - Surasak Angsuwathana
- a Department of Obstetrics and Gynecology , Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand
| | - Kitirat Techatraisak
- a Department of Obstetrics and Gynecology , Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand
| | - Nutchaya Sanga-Areekul
- a Department of Obstetrics and Gynecology , Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand
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Hirsch M, Duffy JM, Kusznir JO, Davis CJ, Plana MN, Khan KS, Duffy JM, Farquhar C, Hirsch M, Johnson N, Khan K. Variation in outcome reporting in endometriosis trials: a systematic review. Am J Obstet Gynecol 2016; 214:452-464. [PMID: 26778385 DOI: 10.1016/j.ajog.2015.12.039] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 12/17/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We reviewed the outcomes and outcome measures reported in randomized controlled trials and their relationship with methodological quality, year of publication, commercial funding, and journal impact factor. DATA SOURCES We searched the following sources: (1) Cochrane Central Register of Controlled Trials, (2) Embase, and (3) MEDLINE from inception to November 2014. STUDY ELIGIBILITY We included all randomized controlled trials evaluating a surgical intervention with or without a medical adjuvant therapy for the treatment of endometriosis symptoms. STUDY DESIGN Two authors independently selected trials, assessed methodological quality (Jadad score; range, 1-5), outcome reporting quality (Management of Otitis Media with Effusion in Cleft Palate criteria; range, 1-6), year of publication, impact factor in the year of publication, and commercial funding (yes or no). Univariate and bivariate analyses were performed using Spearman Rh and Mann-Whitney U tests. We used a multivariate linear regression model to assess relationship associations between outcome reporting quality and other variables. RESULTS There were 54 randomized controlled trials (5427 participants), which reported 164 outcomes and 113 outcome measures. The 3 most commonly reported primary outcomes were dysmenorrhea (10 outcome measures; 23 trials), dyspareunia (11 outcome measures; 21 trials), and pregnancy (3 outcome measures; 26 trials). The median quality of outcome reporting was 3 (interquartile range 4-2) and methodological quality 3 (interquartile range 5-2). Multivariate linear regression demonstrated a relationship between outcome reporting quality with methodological quality (β = 0.325; P = .038) and year of publication (β = 0.067; P = .040). No relationship was demonstrated between outcome reporting quality with journal impact factor (Rho = 0.190; P = .212) or commercial funding (P = .370). CONCLUSION Variation in outcome reporting within published endometriosis trials prohibits comparison, combination, and synthesis of data. This limits the usefulness of research to inform clinical practice, enhance patient care, and improve patient outcomes. In the absence of a core outcome set for endometriosis we recommend the use of the 3 most common pain (dysmenorrhea, dyspareunia, and pelvic pain) and subfertility (pregnancy, miscarriage, and live birth) outcomes. International consensus among stakeholders is needed to establish a core outcome set for endometriosis trials.
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Mellado BH, Falcone ACM, Poli-Neto OB, Rosa E Silva JC, Nogueira AA, Candido-Dos-Reis FJ. Social isolation in women with endometriosis and chronic pelvic pain. Int J Gynaecol Obstet 2016; 133:199-201. [PMID: 26873129 DOI: 10.1016/j.ijgo.2015.08.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/19/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the perceptions of women with endometriosis and chronic pelvic pain regarding their social ties. METHODS A qualitative study was undertaken of women with chronic pelvic pain and endometriosis. Focus groups discussions among four to six participants were performed until saturation at the Clinics Hospital of Ribeirão Preto Medical School, Ribeirão Preto, southwest Brazil, between February 2013 and January 2014. Transcripts were analyzed according to the grounded theory approach and the emerging categories were coded using the WebQDA platform. RESULTS Six focus group discussions took place, with a total of 29 patients. Social isolation was the main emerging theme. Social isolation was associated with a lack of understanding about endometriosis symptoms and with resignation in face of recurrent pain episodes. Avoiding partner intimacy and isolation from family and friends were components of social isolation. CONCLUSION Women with endometriosis develop progressive social isolation after the onset of chronic pelvic pain. This finding is important for the multidisciplinary management of the disease.
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Affiliation(s)
- Bruna H Mellado
- Department of Gynecology and Obstetrics of Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Ananda C M Falcone
- Department of Gynecology and Obstetrics of Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Omero B Poli-Neto
- Department of Gynecology and Obstetrics of Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Julio C Rosa E Silva
- Department of Gynecology and Obstetrics of Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Antonio A Nogueira
- Department of Gynecology and Obstetrics of Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Francisco J Candido-Dos-Reis
- Department of Gynecology and Obstetrics of Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil.
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Jonas WB, Crawford C, Colloca L, Kaptchuk TJ, Moseley B, Miller FG, Kriston L, Linde K, Meissner K. To what extent are surgery and invasive procedures effective beyond a placebo response? A systematic review with meta-analysis of randomised, sham controlled trials. BMJ Open 2015; 5:e009655. [PMID: 26656986 PMCID: PMC4679929 DOI: 10.1136/bmjopen-2015-009655] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To assess the quantity and quality of randomised, sham-controlled studies of surgery and invasive procedures and estimate the treatment-specific and non-specific effects of those procedures. DESIGN Systematic review and meta-analysis. DATA SOURCES We searched PubMed, EMBASE, CINAHL, CENTRAL (Cochrane Library), PILOTS, PsycInfo, DoD Biomedical Research, clinicaltrials.gov, NLM catalog and NIH Grantee Publications Database from their inception through January 2015. STUDY SELECTION We included randomised controlled trials of surgery and invasive procedures that penetrated the skin or an orifice and had a parallel sham procedure for comparison. DATA EXTRACTION AND ANALYSIS Three authors independently extracted data and assessed risk of bias. Studies reporting continuous outcomes were pooled and the standardised mean difference (SMD) with 95% CIs was calculated using a random effects model for difference between true and sham groups. RESULTS 55 studies (3574 patients) were identified meeting inclusion criteria; 39 provided sufficient data for inclusion in the main analysis (2902 patients). The overall SMD of the continuous primary outcome between treatment/sham-control groups was 0.34 (95% CI 0.20 to 0.49; p<0.00001; I(2)=67%). The SMD for surgery versus sham surgery was non-significant for pain-related conditions (n=15, SMD=0.13, p=0.08), marginally significant for studies on weight loss (n=10, SMD=0.52, p=0.05) and significant for gastroesophageal reflux disorder (GERD) studies (n=5, SMD=0.65, p<0.001) and for other conditions (n=8, SMD=0.44, p=0.004). Mean improvement in sham groups relative to active treatment was larger in pain-related conditions (78%) and obesity (71%) than in GERD (57%) and other conditions (57%), and was smaller in classical-surgery trials (21%) than in endoscopic trials (73%) and those using percutaneous procedures (64%). CONCLUSIONS The non-specific effects of surgery and other invasive procedures are generally large. Particularly in the field of pain-related conditions, more evidence from randomised placebo-controlled trials is needed to avoid continuation of ineffective treatments.
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Affiliation(s)
| | | | - Luana Colloca
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, Maryland, USA
- Department of Anesthesiology, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Ted J Kaptchuk
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, Massachusetts, USA
| | | | - Franklin G Miller
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus Linde
- Institute of General Practice, Technische Universitat Munchen, Munich, Germany
| | - Karin Meissner
- Institute of Medical Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
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Change in Pain and Quality of Life Among Women Enrolled in a Trial Examining the Use of Narrow Band Imaging During Laparoscopic Surgery for Suspected Endometriosis. J Minim Invasive Gynecol 2015; 22:1208-14. [DOI: 10.1016/j.jmig.2015.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 11/19/2022]
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Abstract
BACKGROUND Chronic pelvic pain in women represents a difficult diagnostic and therapeutic problem in the gynecological practice which is always a challenge when dealing with affected women. GYNECOLOGICAL CAUSES Possible gynecological causes are endometriosis, adhesions and/or pelvic inflammatory disease (PID), pelvic varicosis and ovarian retention syndrome/ovarian remnant syndrome. Other somatic causes are irritable bowel syndrome, bladder pain syndrome, interstitial cystitis and fibromyalgia. PSYCHOSOCIAL FACTORS Psychosocial causes contributing to chronic pelvic pain are a high comorbidity with psychological factors, such as anxiety disorders and substance abuse or depression but the influence of social factors is less certain. The association with physical and sexual abuse also remains unclear. DIAGNOSTICS AND THERAPY Important diagnostic steps are recording the patient history, a gynecological examination and laparoscopy. Multidisciplinary therapeutic approaches are considered to be very promising. Basic psychosomatic care and psychotherapy should be integrated into the therapeutic concept at an early stage.
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Affiliation(s)
- F Siedentopf
- Klinik für Gynäkologie und Geburtshilfe, Martin-Luther-Krankenhaus, Caspar-Theyß-Str. 27-31, 14193, Berlin, Deutschland,
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Gurian MBF, Mitidieri AMDS, Rosa E Silva JC, Poli Neto OB, Nogueira AA, Candido dos Reis FJ. Measures used to assess chronic pelvic pain in randomized controlled clinical trials: a systematic review. J Eval Clin Pract 2015; 21:749-56. [PMID: 25809923 DOI: 10.1111/jep.12340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2015] [Indexed: 01/16/2023]
Abstract
RATIONALE Many types of pain assessment are available to researchers carrying out clinical trials in chronic pelvic pain (CPP), ranging from a single-item scale to multidimensional inventories. AIM Our objective was to investigate which assessments of pain are more commonly used in clinical trials on CPP. METHOD We have reviewed articles published between 1991 and 2014. A total of 74 studies out of 1299 original research articles reviewed met the selection criteria by containing at least one method of pain assessment. The selected studies were classified according to the dimensions of pain evaluated, the type of scale and the descriptors used. RESULTS The instruments most frequently used were single-item VAS and Biberoglu and Behrman pain score, while multidimensional inventories were used in few studies. The results of clinical studies in CPP are more frequently based on one-dimensional measurements. Valuable results from clinical studies in CPP might have been omitted because of incomplete outcome measurements. CONCLUSION We believe the authors of clinical studies should report their results in a comprehensive way including in the outcomes of the measurement of one-dimensional and multidimensional pain characteristics.
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Affiliation(s)
| | - Andréia M D S Mitidieri
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Júlio C Rosa E Silva
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Omero B Poli Neto
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Antônio A Nogueira
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
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Nesbitt-Hawes EM, Campbell N, Maley PE, Won H, Hooshmand D, Henry A, Ledger W, Abbott JA. The Surgical Treatment of Severe Endometriosis Positively Affects the Chance of Natural or Assisted Pregnancy Postoperatively. BIOMED RESEARCH INTERNATIONAL 2015; 2015:438790. [PMID: 26247022 PMCID: PMC4515280 DOI: 10.1155/2015/438790] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 01/12/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To report reproductive outcomes following laparoscopic surgical excision of histologically confirmed r-ASRM stage III-IV endometriosis. STUDY DESIGN A retrospective cohort study was performed at the Royal Hospital for Women, a university teaching hospital, Sydney, Australia. Women who had fertility-preserving laparoscopic excision of stage III-IV endometriosis from 1997 to 2009 were contacted regarding reproductive outcomes. RESULTS In the study period, 355 women underwent surgery for stage III-IV endometriosis. Follow-up data are available for 253/355 (71%) women. Postoperatively, 142/253 (56%) women attempted to conceive with a conception rate of 104/142 (73%). Confidence intervals for pregnancy for women who were attempting conception (including the nonresponders) range from 104/262 (40%) to 224/262 (85%). Median time to conception was 12 months. No positive prognostic factors for pregnancy were identified on regression analyses. CONCLUSIONS These data provide information to women with suspected severe disease preoperatively concerning their likely postoperative fertility outcomes. Ours is a population with severe endometriosis, rather than an infertile population with endometriosis, so caution needs to be applied when applying these data to women with fertility issues alone.
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Affiliation(s)
- Erin M. Nesbitt-Hawes
- University of New South Wales, Sydney, Australia
- Royal Hospital for Women, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Neil Campbell
- University of New South Wales, Sydney, Australia
- Royal Hospital for Women, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | | | - Haryun Won
- University of New South Wales, Sydney, Australia
- Royal Hospital for Women, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Dona Hooshmand
- Royal Hospital for Women, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Amanda Henry
- University of New South Wales, Sydney, Australia
- Royal Hospital for Women, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - William Ledger
- University of New South Wales, Sydney, Australia
- Royal Hospital for Women, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
| | - Jason A. Abbott
- University of New South Wales, Sydney, Australia
- Royal Hospital for Women, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
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Api M, Boza AT, Kayatas S, Eroglu M. Effect of Surgical Removal of Endometriomas on Cyclic and Non-cyclic Pelvic Pain. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2015; 9:183-8. [PMID: 26246876 PMCID: PMC4518486 DOI: 10.22074/ijfs.2015.4252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 03/08/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Endometriosis is a complex disease with a spectrum of pain symptoms from mild dysmenorrhea to debilitating pelvic pain. There is no concrete evidence in the literature whether endometriotic cyst per se, causes pain spectrum related to the disease. The aim of the present study was to evaluate the effect of surgical removal of endome- triomas on pain symptoms. MATERIALS AND METHODS In this prospective, observational, before-after study, which was conducted between March 2012 and January 2013 in Training and Research Hospital,Adana, Turkey, a total of 23 patients including 16 sexually active and 7 vir- gin symptomatic women were questioned for non-cyclic pelvic pain (NCPP), intensity of the NCPP, presence of cyclic dysmenorrhea, and dyspareunia before and after the endometrioma operation. Participants who were sonographically diagnosed and later pathologically confirmed as having endometrioma without sign and symptoms of deep infiltrative endometriosis (DIE) were also questioned for pain symptoms before and after the laparoscopic removal of cyst wall. Patients with intraabdominal adhesions, history of pelvic inflammatory disease, and pathological diagnosis other than endometrioma were excluded. No ancillary procedures were applied for pain management, but if pain was present, pelvic peritoneal endometriotic lesions were ablated beside the removal of ovar- ian endometriotic cysts. RESULTS Out of 23 cases with endometrioma, 91 and 78% reported to have NCPP and dysmenorrhea, respectively, before the operation, while 60 and 48%, respec- tively, after the operation (McNemar's test, P=0.016 for both figures). Among the sexually active cases, 31% (5/16) had dyspareunia before the operation and only 1 case reported the pain relief after the operation (McNemar's test, P=1). Intensity of NCPP were reported to be none (8.7%), moderate (21.7%), severe (56.5%) and un- bearable (13%) before the operation and decreased to none (43.5%), mild (43.5%), moderate (4.3%) and severe (8.7%) after the operation (Wilcoxon signed-rank test, P<0.001). CONCLUSION In symptomatic cases with ovarian endometrioma, without sign and symptoms of DIE, laparoscopic removal of the cysts with/without ablation of the peritoneal endometriotic lesions yields relief of NCPP and cyclic dysmenorrhea, but not dyspareunia.
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Affiliation(s)
- Murat Api
- Zeynep Kamil Women and Children Diseases Training and Research Hospital, Department of Obstetrics
and Gynecology, Istanbul, Turkey
| | - Aysen Telce Boza
- Zeynep Kamil Women and Children Diseases Training and Research Hospital, Department of Obstetrics
and Gynecology, Istanbul, Turkey
| | - Semra Kayatas
- Zeynep Kamil Women and Children Diseases Training and Research Hospital, Department of Obstetrics
and Gynecology, Istanbul, Turkey
| | - Mustafa Eroglu
- Zeynep Kamil Women and Children Diseases Training and Research Hospital, Department of Obstetrics
and Gynecology, Istanbul, Turkey
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Lazzeri L, Vannuccini S, Orlandini C, Luisi S, Zupi E, Nappi RE, Petraglia F. Surgical treatment affects perceived stress differently in women with endometriosis: correlation with severity of pain. Fertil Steril 2014; 103:433-8. [PMID: 25487748 DOI: 10.1016/j.fertnstert.2014.10.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 10/21/2014] [Accepted: 10/22/2014] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To investigate the amount of perceived stress in a group of women with different forms of endometriosis-related pain before and after surgical treatment. DESIGN Prospective clinical trial. SETTING University hospital. PATIENT(S) A group of women (n = 98) referred to our center for chronic pain and suspected of having endometriosis. INTERVENTION(S) All women suspected of having endometriosis with ultrasonography underwent to a clinical evaluation including assessment of perception of stress. Endometriosis was confirmed histologically by laparoscopy. Painful symptoms and perception of stress were recorded 1 month after surgery. MAIN OUTCOME MEASURE(S) Perceived stress scale (PSS) and visual analog scale for painful symptoms before and 1 month after surgery for endometriosis. RESULT(S) The PSS score before surgery was perceived as "very high" in patients with deep endometriosis (n = 20) or deep endometriosis associated with endometrioma (n = 21); "high" or "medium" PSS was perceived in patients with endometrioma (n = 34) or endometrioma associated with peritoneal endometriosis (n = 23). After the surgical treatment a significant decrease of the "very high" PSS score was shown, as well as when the entire group of patients was considered. When evaluated before and after surgery, according to the severity of pain (dysmenorrhea, dyspareunia, and pelvic pain), a direct correlation was found with the level of PSS. CONCLUSION(S) Patients with deep endometriosis-related pain (dysmenorrhea, pelvic pain, dyspareunia) showed the highest level of perceived stress, which significantly decreased after surgical treatment.
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Affiliation(s)
- Lucia Lazzeri
- Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Silvia Vannuccini
- Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Cinzia Orlandini
- Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Stefano Luisi
- Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Errico Zupi
- Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Rossella Elena Nappi
- Research Center for Reproductive Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Felice Petraglia
- Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
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Endometriosis and the Enigmatic Question of Progression. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2014. [DOI: 10.5301/je.5000191] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Aims The aim of this study was to identify whether endometriosis is a progressive disease with age, and to review the literature on this topic. Material and methods The incidence of endometriosis in a cohort of 500 women who underwent laparoscopy between 2003 and 2013 in the Greenville Health System, in South Carolina, United States, was reviewed. The search of the world literature on progression of endometriosis was limited to 1980 and beyond. Results The correlation between stage of endometriosis and age was found to be small (r = −0.04; 95% CI, −0.13 to 0.04; p = 0.3; n = 471). The literature search identified 16 studies on adults. Progression of endometriosis findings at laparoscopy occurred in 31% of the cases with follow-up (n = 162). Conclusions Endometriosis of minimal or mild American Society for Reproductive Medicine (rASRM) classification stage is equally likely to be present in women of all ages; similarly, endometriosis in its severe form is not age-dependent.
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Jarrell J, Ross S, Robert M, Wood S, Tang S, Stephanson K, Giamberardino MA. Prediction of postoperative pain after gynecologic laparoscopy for nonacute pelvic pain. Am J Obstet Gynecol 2014; 211:360.e1-8. [PMID: 24732001 DOI: 10.1016/j.ajog.2014.04.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/18/2014] [Accepted: 04/09/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The primary objectives of this study were to explore the pain experience after gynecologic laparoscopy that is performed for nonacute pain conditions and to determine whether preoperative psychologic tests and quantitative tests of sensitization can predict postoperative pain. STUDY DESIGN Participants included 61 women who underwent laparoscopy for nonacute pain (n = 61). A second group of 16 women who had undergone tubal ligation was included to explore whether laparoscopy induced a painful postoperative response in women without preoperative pain. Subjective tests included numeric pain scale, pain catastrophizing scale, depression scale, global assessment of change, and the McGill Pain Questionnaire Short Form. Quantitative sensory testing included abdominal cutaneous allodynia, trigger points, and reduced pain thresholds. The nonacute pain sample had 80% power to detect a difference of 0.5 standard deviation in average pain levels. Analysis included parametric and nonparametric comparisons of groups and univariate and linear regression analysis of clinically relevant variables. RESULTS In women who underwent tubal ligation, pain levels were low before and after the procedure. In women who underwent surgery for nonacute pain, pain levels at 6 months and all psychologic test scores were reduced significantly compared with baseline (P < .001 and P = .001, respectively). Among those women with positive results on the quantitative pain tests of sensitization at baseline, average postoperative pain was also significantly reduced (P < .001). Univariate analysis demonstrated only tests of sensitization that were correlated with change in average pain level (P = .01). Regression analysis suggested that baseline pain, catastrophizing, and the presence of cutaneous allodynia significantly predicted pain levels 6 months after surgery (P < .001). CONCLUSION Pain after laparoscopic surgery for nonacute painful conditions can be predicted by baseline pain, catastrophizing, and the presence of allodynia, which is a simple swab test that indicates sensitization.
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Bourdel N, Alves J, Pickering G, Ramilo I, Roman H, Canis M. Systematic review of endometriosis pain assessment: how to choose a scale? Hum Reprod Update 2014; 21:136-52. [PMID: 25180023 DOI: 10.1093/humupd/dmu046] [Citation(s) in RCA: 211] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Numerous studies concerning endometriosis and pain have been reported. However, there is no consensus on the best method to evaluate pain in endometriosis and many scales have been used. Moreover, there are only a few descriptions of minimal clinically important differences after treatment (MCID) to evaluate variations in pain. In our study, we aim to identify pain scales used in endometriosis pain treatment, to address their strong and weak points and to define which would be the ideal scale to help clinicians and researchers to evaluate endometriosis-related pain. METHODS A search of the MEDLINE and EMBASE databases was carried out for publications in English, French or Portuguese from 1980 to December 2012, for the words: endometriosis, treatment, pain. Studies were selected if they studied an endometriosis treatment and a pain scale was specified. A quantitative and a qualitative analysis of each scale was performed to define strong and weak points of each scale (systematic registration number: CRD42013005336). RESULTS A total of 736 publications were identified. After excluding duplications and applying inclusion criteria 258 studies remained. We found that the visual analog scale (VAS) is the most frequently used scale. Both VAS and the numerical rating scale (NRS) show a good balance between strong and weak points in comparison with others such as the Biberoglu and Behrman scale. Concerning MCID, only VAS, NRS and Brief Pain Inventory scales have reported MCID and, among these, only VAS MCID has been studied in endometriosis patients (VAS MCID = 10 mm). Adding the Clinical Global Impression score (CGI) to the pain scale allows calculation of the MCID. CONCLUSIONS When using pain scales their strengths and weaknesses must be known and included in the analysis. VAS is the most frequently used pain scale and, together with NRS, seems the best adapted for endometriosis pain measurement. The use of VAS or NRS for each type of typical pain related to endometriosis (dysmenorrhea, deep dyspareunia and non-menstrual chronic pelvic pain), combined with the CGI and a quality-of-life scale will provide both clinicians and researchers with tools to evaluate treatment response.
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Affiliation(s)
- Nicolas Bourdel
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France Faculté de medicine, ISIT - Université d'Auvergne, Place Henri Dunant, 63000 Clermont-Ferrand, France
| | - João Alves
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France
| | - Gisele Pickering
- Centre de Pharmacologie Clinique, CHU Clermont Ferrand, Inserm CIC 501, Inserm, U1107 Neuro-Dol, F-63003 Clermont-Ferrand, France
| | - Irina Ramilo
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France
| | - Horace Roman
- Department of Gynecology and Obstetrics, Rouen University Hospital-Charles Nicolle, 1 rue de Germont, 76031 Rouen, France
| | - Michel Canis
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France Faculté de medicine, ISIT - Université d'Auvergne, Place Henri Dunant, 63000 Clermont-Ferrand, France
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Jacobson TZ, Duffy JMN, Barlow DH, Koninckx PR, Garry R. WITHDRAWN: Laparoscopic surgery for pelvic pain associated with endometriosis. Cochrane Database Syst Rev 2014; 2014:CD001300. [PMID: 25130257 PMCID: PMC10734376 DOI: 10.1002/14651858.cd001300.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This review has been replaced by a review entitled 'Laparoscopic surgery for endometriosis', published in issue 4 of The Cochrane Library, 2014. The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Tal Z Jacobson
- Mater Mother's HospitalDepartment of Obstetrics and GynaecologySouth BrisbaneBrisbaneQueenslandAustralia4101
| | - James MN Duffy
- Balliol College, University of OxfordNuffield Department of Primary Care Health SciencesNew Radcliffe House58 Turner StreetOxfordOxfordshireUKOX2 6NW
| | | | - Philippe R Koninckx
- Univ. Hospital Leuven, Campus GasthuisbergDepartment of Obstetrics & GynecologyHerestraat 49BLeuvenBelgiumB‐3000
| | - Ray Garry
- University of Teeside and South Cleveland Hospital, MiddlesbroughGynaecological Surgery94 WestgateGuisboroughYorkshireUKTS14 6AP
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Walch K, Kernstock T, Poschalko-Hammerle G, Gleiß A, Staudigl C, Wenzl R. Prevalence and severity of cyclic leg pain in women with endometriosis and in controls - effect of laparoscopic surgery. Eur J Obstet Gynecol Reprod Biol 2014; 179:51-7. [PMID: 24965980 DOI: 10.1016/j.ejogrb.2014.05.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 03/05/2014] [Accepted: 05/23/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE In addition to dysmenorrhea, dyspareunia, and subfertility, pain in the lower extremities has been described to be a further complaint in women affected by endometriosis, and lysis of nerve entrapment was thought to be associated with amelioration of leg pain. Therefore, we aimed to compare the prevalence of cyclic leg pain and pain intensity between women with endometriosis and without endometriosis, and to evaluate the effect of laparoscopic surgery. STUDY DESIGN Forty-four women with endometriosis and 58 controls were included in a prospective, controlled clinical trial at a University hospital/tertiary referral center. Participants were asked to complete questionnaires the day before and six to nine weeks after laparoscopy. The prevalence and intensity of leg pain and improvement after laparoscopic surgery, quantified according to a visual analog scale (VAS) score, were evaluated. We also recorded involvement of dermatomes, the presence and intensity of dysmenorrhea, and correlations between age, stage of endometriosis (rAFS-score), and preoperative VAS scores. RESULTS Before surgery, more women were affected by leg pain in the endometriosis group, compared to the control group (45.5% and 25.9%, respectively). Preoperative VAS scores for leg pain, however, were not significantly different between the two groups. A moderate correlation in the preoperative VAS scores between leg pain and dysmenorrhea was observed. After laparoscopy, we found a significant improvement in leg pain intensity in both groups. The mean difference in the VAS score for pain reduction between the study group and the control group was 0.74 (95% CI: -0.61-2.08), which was not statistically significant. CONCLUSIONS The prevalence of leg pain is increased in endometriosis, while leg pain intensity is not, compared to women without endometriosis. Laparoscopic surgery-even without preparation and decompression of nerve tissue-is associated with an improvement in pain intensity in women with endometriosis, as well as in the group without endometriosis.
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Affiliation(s)
- Katharina Walch
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
| | - Tamara Kernstock
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Gunda Poschalko-Hammerle
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Andreas Gleiß
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Austria
| | - Christine Staudigl
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - René Wenzl
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Duffy JMN, Arambage K, Correa FJS, Olive D, Farquhar C, Garry R, Barlow DH, Jacobson TZ. Laparoscopic surgery for endometriosis. Cochrane Database Syst Rev 2014:CD011031. [PMID: 24696265 DOI: 10.1002/14651858.cd011031.pub2] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Endometriosis is the presence of endometrial glands or stroma in sites other than the uterine cavity and is associated with pain and subfertility. Surgical interventions aim to remove visible areas of endometriosis and restore the anatomy. OBJECTIVES To assess the effectiveness and safety of laparoscopic surgery in the treatment of painful symptoms and subfertility associated with endometriosis. SEARCH METHODS This review has drawn on the search strategy developed by the Cochrane Menstrual Disorders and Subfertility Group including searching CENTRAL, MEDLINE, EMBASE, PsycINFO, and trial registries from inception to July 2013. SELECTION CRITERIA Randomised controlled trials (RCTs) were selected in which the effectiveness and safety of laparoscopic surgery used to treat pain or subfertility associated with endometriosis was compared with any other laparoscopic or robotic intervention, holistic or medical treatment or diagnostic laparoscopy only. DATA COLLECTION AND ANALYSIS Selection of studies, assessment of trial quality and extraction of relevant data were performed independently by two review authors with disagreements resolved by a third review author. The quality of evidence was evaluated using GRADE methods. MAIN RESULTS Ten RCTs were included in the review. The studies randomised 973 participants experiencing pain or subfertility associated with endometriosis. Five RCTs compared laparoscopic ablation or excision versus diagnostic laparoscopy only. Two RCTs compared laparoscopic excision versus diagnostic laparoscopy only. Two RCTs compared laparoscopic excision versus ablation. One RCT compared laparoscopic ablation versus diagnostic laparoscopy and injectable gonadotropin-releasing hormone analogue (GnRHa) (goserelin) with add-back therapy. Common limitations in the primary studies included lack of clearly-described blinding, failure to fully describe methods of randomisation and allocation concealment, and risk of attrition bias.Laparoscopic surgery was associated with decreased overall pain (measured as 'pain better or improved') compared with diagnostic laparoscopy, both at six months (odds ratio (OR) 6.58, 95% CI 3.31 to 13.10, 3 RCTs, 171 participants, I(2) = 0%, moderate quality evidence) and at 12 months (OR 10.00, 95% CI 3.21 to 31.17, 1 RCT, 69 participants, low quality evidence). Compared with diagnostic laparoscopy, laparoscopic surgery was also associated with an increased live birth or ongoing pregnancy rate (OR 1.94, 95% CI 1.20 to 3.16, P = 0.007, 2 RCTs, 382 participants, I(2) = 0%, moderate quality evidence) and increased clinical pregnancy rate (OR 1.89, 95% CI 1.25 to 2.86, P = 0.003, 3 RCTs, 528 participants, I(2) = 0%, moderate quality evidence). Two studies collected data on adverse events (including infection, vascular and visceral injury and conversion to laparotomy) and reported no events in either arm. Other studies did not report this outcome. The similar effect of laparoscopic surgery and diagnostic laparotomy on the rate of miscarriage per pregnancy was imprecise (OR 0.94, 95% CI 0.35 to 2.54, 2 studies, 112 women, moderate quality evidence).When laparoscopic ablation was compared with diagnostic laparoscopy plus medical therapy (GnRHa plus add-back therapy), more women in the ablation group reported that they were pain free at 12 months (OR 5.63, 95% CI 1.18 to 26.85, 1 RCT, 35 participants, low quality evidence).The difference between laparoscopic ablation and laparoscopic excision in the proportion of women reporting overall pain relief at 12 months on a VAS 0 to 10 pain scale was 0 (95% CI -1.22 to 1.22, P = 1.00, 1 RCT, 103 participants, low quality evidence). AUTHORS' CONCLUSIONS There is moderate quality evidence that laparoscopic surgery to treat mild and moderate endometriosis reduces overall pain and increases live birth or ongoing pregnancy rates. There is low quality evidence that laparoscopic excision and ablation were similarly effective in relieving pain, although there was only one relevant study. More research is needed considering severe endometriosis, different types of pain associated with endometriosis (for example dysmenorrhoea (pain with menstruation)) and comparing laparoscopic interventions with holistic and medical interventions. There was insufficient evidence on adverse events to allow any conclusions to be drawn regarding safety.
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Affiliation(s)
- James M N Duffy
- Women's Health Research Unit, Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, 58 Turner Street, London, Greater London, UK, E1 2AB
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Treatment of pelvic pain associated with endometriosis: a committee opinion. Fertil Steril 2014; 101:927-35. [PMID: 24630080 DOI: 10.1016/j.fertnstert.2014.02.012] [Citation(s) in RCA: 226] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 02/07/2014] [Indexed: 11/22/2022]
Abstract
Pain associated with endometriosis may involve many mechanisms and requires careful evaluation to confirm the diagnosis and exclude other potential causes. Both medical and surgical treatments for pain related to endometriosis are effective, and choice of treatment must be individualized. This document replaces the document by the same name last published in 2008 (Fertil Steril 2008;90:S260-9).
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Yeung P, Tu F, Bajzak K, Lamvu G, Guzovsky O, Agnelli R, Peavey M, Winer W, Albee R, Sinervo K. A pilot feasibility multicenter study of patients after excision of endometriosis. JSLS 2013; 17:88-94. [PMID: 23743377 PMCID: PMC3662751 DOI: 10.4293/108680812x13517013317833] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A multicenter prospective study evaluating the management of endometriosis comparing excision versus ablation is needed using primary outcomes other than chronic pelvic pain. Objective: To serve as a pilot feasibility study for a randomized study of excision versus ablation in the treatment of endometriosis by (1) estimating the magnitude of change in symptoms after excision only at multiple referral centers and (2) determining the proportion of women willing to participate in a randomized trial. Methods: We performed a multicenter prospective study of women undergoing excision for endometriosis (Canadian Task Force class II-3) at Duke University Center for Endometriosis Research & Treatment (currently the Saint Louis University Center for Endometriosis), Center for Endometriosis Care, Northshore University Health System, Memorial University (Canada), and Florida Hospital. The study comprised 100 female patients, aged 18 to 55 years, with endometriosis-suspected pelvic pain. The intervention was laparoscopic excision only of the abnormal peritoneum suspicious for endometriosis. The main outcome measures were quality of life, pelvic pain, dysmenorrhea, dyspareunia, and bowel and bladder symptoms. Results: The mean follow-up period was 8.5 months. Excision of endometriosis showed a significant reduction in all pain scores except bowel symptoms, as well as significant improvement in quality of life. Of the patients, 84% were willing to participate in a randomized study. Conclusions: Quality of life is a needed primary outcome for any randomized study comparing excision versus ablation. A multicenter comparative trial is feasible, although quality assurance would have to be addressed. Patients were willing to be randomized even at surgical referral centers.
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Affiliation(s)
- Patrick Yeung
- Department of Obstetrics, Gynecology & Women's Health, Saint Louis University, St. Louis, MO, USA.
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41
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Kim SH, Chae HD, Kim CH, Kang BM. Update on the treatment of endometriosis. Clin Exp Reprod Med 2013; 40:55-9. [PMID: 23875160 PMCID: PMC3714429 DOI: 10.5653/cerm.2013.40.2.55] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 09/12/2012] [Accepted: 09/30/2012] [Indexed: 12/21/2022] Open
Abstract
Endometriosis is defined as the presence of functional endometrial tissue outside the uterus, causing diverse progressive symptoms such as infertility, pelvic pain, and dysmenorrhea. Although endometriosis has been described since the 1800s, the mechanisms responsible for its pathogenesis and progression remain poorly understood. It is well established that endometriosis grows and regresses in an estrogen-dependent fashion and the disease can be effectively cured by definitive surgery. However, prolonged medical therapy may be needed in most of the cases since conservative surgery is usually performed especially in young women. This treatment modality is often associated with only partial relief and/or recurrence of the disease. In the present review, up-to-date findings on the treatment of endometriosis will be briefly summarized. The outcomes of surgery in patients with endometriosis will be reviewed in terms of pelvic pain relief as well as infertility treatment largely based on recent Cochrane reviews and clinical reports. The efficacy of newer drugs including aromatase inhibitor, anti-tumor necrosis factor-alpha, and dienogest will be also reviewed based on recent clinical studies.
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Affiliation(s)
- Sung Hoon Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Bernardi LA, Pavone ME. Endometriosis: An Update on Management. WOMENS HEALTH 2013; 9:233-50. [DOI: 10.2217/whe.13.24] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Lia A Bernardi
- Department of Obstetrics & Gynecology, University of Illinois at Chicago, IL, USA
| | - Mary Ellen Pavone
- Department of Obstetrics & Gynecology, Division of Reproductive Endocrinology & Infertility & Division of Reproductive Biology, Feinberg School of Medicine at Northwestern University, 303 Superior Street, Suite 4-123, Chicago, IL 60611, USA
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Kyama CM, Mihalyi A, Chai D, Simsa P, Mwenda JM, D'Hooghe TM. Baboon model for the study of endometriosis. ACTA ACUST UNITED AC 2012; 3:637-46. [PMID: 19804041 DOI: 10.2217/17455057.3.5.637] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Endometriosis is a benign, estrogen-dependent disease and is now recognized as an enigmatic disease owing to its various clinical manifestations and locations. The lack of a reliable and specific method for the early detection of endometriosis often results in delayed diagnosis. So far, research has born inadequate findings regarding understanding the basic etiology or pathophysiology of endometriosis. Animal models that accurately represent the cellular and molecular changes associated with the initiation and progression of human endometriosis have significant potential to facilitate the development of better methods for the early detection and treatment of endometriosis. A number of animal model systems have been developed for the study of this disease. These models replicate many of the known salient features of human endometriosis. This review provides an insight into the use of the baboon model for studies focused on understanding human endometriosis.
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Affiliation(s)
- Cleophas M Kyama
- Leuven University Fertility Centre, Department of Obstetrics & Gynaecology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
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Agresta F, Ansaloni L, Baiocchi GL, Bergamini C, Campanile FC, Carlucci M, Cocorullo G, Corradi A, Franzato B, Lupo M, Mandalà V, Mirabella A, Pernazza G, Piccoli M, Staudacher C, Vettoretto N, Zago M, Lettieri E, Levati A, Pietrini D, Scaglione M, De Masi S, De Placido G, Francucci M, Rasi M, Fingerhut A, Uranüs S, Garattini S. Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d'Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell'Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES). Surg Endosc 2012; 26:2134-64. [PMID: 22736283 DOI: 10.1007/s00464-012-2331-3] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 04/16/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND In January 2010, the SICE (Italian Society of Endoscopic Surgery), under the auspices of the EAES, decided to revisit the clinical recommendations for the role of laparoscopy in abdominal emergencies in adults, with the primary intent being to update the 2006 EAES indications and supplement the existing guidelines on specific diseases. METHODS Other Italian surgical societies were invited into the Consensus to form a panel of 12 expert surgeons. In order to get a multidisciplinary panel, other stakeholders involved in abdominal emergencies were invited along with a patient's association. In November 2010, the panel met in Rome to discuss each chapter according to the Delphi method, producing key statements with a grade of recommendations followed by commentary to explain the rationale and the level of evidence behind the statements. Thereafter, the statements were presented to the Annual Congress of the EAES in June 2011. RESULTS A thorough literature review was necessary to assess whether the recommendations issued in 2006 are still current. In many cases new studies allowed us to better clarify some issues (such as for diverticulitis, small bowel obstruction, pancreatitis, hernias, trauma), to confirm the key role of laparoscopy (such as for cholecystitis, gynecological disorders, nonspecific abdominal pain, appendicitis), but occasionally previous strong recommendations have to be challenged after review of recent research (such as for perforated peptic ulcer). CONCLUSIONS Every surgeon has to develop his or her own approach, taking into account the clinical situation, her/his proficiency (and the experience of the team) with the various techniques, and the specific organizational setting in which she/he is working. This guideline has been developed bearing in mind that every surgeon could use the data reported to support her/his judgment.
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Affiliation(s)
- Ferdinando Agresta
- Department of General Surgery, Presidio Ospedaliero di Adria, Piazza degli Etruschi, 9, 45011 Adria, RO, Italy.
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Jarrell J. Endometriosis and abdominal myofascial pain in adults and adolescents. Curr Pain Headache Rep 2012; 15:368-76. [PMID: 21755274 DOI: 10.1007/s11916-011-0218-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Endometriosis and myofascial pain are common disorders with significant impact on quality of life. Increasingly, these conditions are being recognized as highly interconnected through processes that have been described for more than a century. This review is directed to this interconnection through a description of the relationships of endometriosis to proposed mechanisms of pain and chronic pain physiology; the clinical assessment of myofascial representations of this pain; and an approach to the management of these interconnected disorders.
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Affiliation(s)
- John Jarrell
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada.
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Harirchian P, Gashaw I, Lipskind ST, Braundmeier AG, Hastings JM, Olson MR, Fazleabas AT. Lesion kinetics in a non-human primate model of endometriosis. Hum Reprod 2012; 27:2341-51. [PMID: 22674203 DOI: 10.1093/humrep/des196] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Endometriosis is a common cause of pelvic pain and infertility in women of reproductive age. It is characterized by the presence of endometrial tissue outside the normal location, predominantly in the pelvic peritoneum causing severe abdominal pain. However, the severity of the symptoms of endometriosis does not always correlate with the anatomic severity of the disease. This lack of correlation may be due to morphological lesion variation during disease progression. This study examined lesion kinetics in a non-human primate model of endometriosis to better understand lesion dynamics. METHODS Endometriosis was experimentally induced in nine normal cycling female adult olive baboons (Papio anubis) by i.p. inoculation of autologous menstrual endometrium on Day 2 of menses for two consecutive menstrual cycles. Diagnostic laparoscopies were performed between Day 8-12 post-ovulation at 1, 3, 6, 9 and 12 months, followed by a necropsy at 15 months, after the second inoculation. In two animals, lesions were excised/ablated at 6 months and they were monitored for lesion recurrence and morphological changes by serial laparoscopy. Furthermore, five control animals underwent surgeries conducted at the same time points but without inoculation. RESULTS A total of 542 endometriotic lesions were observed. The location, macroscopic (different colours) and microscopic appearance confirmed distinct endometriosis pathology in line with human disease. The majority of the lesions found 1 month after tissue inoculation were red lesions, which frequently changed colour during the disease progression. In contrast, blue lesions remained consistently blue while white lesions were evident at the later stages of the disease process and often regressed. There were significantly lower numbers of powder burn, blister and multicoloured lesions observed per animal in comparison to black and blue lesions (P-value≤0.05). New lesions were continually arising and persisted up to 15 months post-inoculation. Lesions reoccurred as early as 3 months after removal and 69% of lesions excised/ablated had reoccurred 9 months later. Interestingly, endometriotic lesions were also found in the non-inoculated animals, starting at the 6-month time point following multiple surgeries. CONCLUSIONS Documentation of lesion turnover in baboons indicated that lesions changed their colour from red to white over time. Different lesion types underwent metamorphosis at different rates. A classification of lesions based on morphological appearance may help disease prognosis and examination of the effect of the lesion on disease symptoms, and provide new opportunities for targeted therapies in order to prevent or treat endometriosis. Surgical removal of endometriotic lesions resulted in a high incidence of recurrence. Spontaneous endometriosis developed in control baboons in the absence of inoculation suggesting that repetitive surgical procedures alone can induce the spontaneous evolution of the chronic disease. Although lesion excision/ablation may have short-term benefits (e.g. prior to an IVF cycle in subfertile women), for long-term relief of symptoms perhaps medical therapy is more effective than surgical therapy.
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Affiliation(s)
- P Harirchian
- Global Drug Discovery, Bayer HealthCare, Berlin, Germany
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Shishkova N, Kuznetsova O, Berezov T. Photodynamic therapy for gynecological diseases and breast cancer. Cancer Biol Med 2012; 9:9-17. [PMID: 23691448 PMCID: PMC3643637 DOI: 10.3969/j.issn.2095-3941.2012.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 01/12/2012] [Indexed: 12/19/2022] Open
Abstract
Photodynamic therapy (PDT) is a minimally invasive and promising new method in cancer treatment. Cytotoxic reactive oxygen species (ROS) are generated by the tissue-localized non-toxic sensitizer upon illumination and in the presence of oxygen. Thus, selective destruction of a targeted tumor may be achieved. Compared with traditional cancer treatment, PDI has advantages including higher selectivity and lower rate of toxicity. The high degree of selectivity of the proposed method was applied to cancer diagnosis using fluorescence. This article reviews previous studies done on PDT treatment and photodetection of cervical intraepithelial neoplasia, vulvar intraepithelial neoplasia, ovarian and breast cancer, and PDT application in treating non-cancer lesions. The article also highlights the clinical responses to PDT, and discusses the possibility of enhancing treatment efficacy by combination with immunotherapy and targeted therapy.
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Affiliation(s)
- Natashis Shishkova
- Department of Biochemistry, School of Medicine, People's Friendship University of Russia, Moscow 117198, Russia
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Postoperative Levonorgestrel-Releasing Intrauterine System for Pelvic Endometriosis-Related Pain. Obstet Gynecol 2012; 119:519-26. [DOI: 10.1097/aog.0b013e31824264c3] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Warren JW, Morozov V, Howard FM. Could chronic pelvic pain be a functional somatic syndrome? Am J Obstet Gynecol 2011; 205:199.e1-5. [PMID: 21620363 DOI: 10.1016/j.ajog.2011.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 03/14/2011] [Accepted: 04/04/2011] [Indexed: 12/18/2022]
Abstract
The cause of noncyclical chronic pelvic pain (CPP) in many women is unknown: 30% have no identifiable pelvic pathology, and in those who do the relationship of CPP and the pathology is often unclear. Moreover, epidemiologic studies demonstrate that the common findings of endometriosis and adhesions do not greatly increase the odds of having CPP. CPP and the functional somatic syndromes (fibromyalgia, irritable bowel syndrome, and others) share many characteristics including pain as a prominent symptom and comorbidity. For the functional somatic syndromes, the initial focus of etiologic investigations has been on local mechanisms and then on systemic pathogeneses. We believe that the research trajectories of the functional somatic syndromes and CPP are converging. Their juncture might reveal an important pathologic mechanism for CPP in some women that is primarily outside the pelvis. This observation would open up new areas of exploration and treatment of CPP.
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Affiliation(s)
- John W Warren
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Al-Jefout M. Brief update on endometriosis treatment. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2011. [DOI: 10.1016/j.mefs.2011.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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