1
|
Li HJ, Esencan E, Song Y, Taylor HS, Cho Y, Vash-Margita A. Medical Management of Endometriosis in Adolescent and Young Adult Women: A Review of 91 Cases of Biopsy-Confirmed Endometriosis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102562. [PMID: 38759792 DOI: 10.1016/j.jogc.2024.102562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/10/2024] [Accepted: 04/24/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVES To characterise contemporary trends in the hormonal management of endometriosis in adolescent and young adult patients with biopsy-proven endometriosis. METHODS Retrospective chart review of women aged 14-25 years who underwent laparoscopy for pelvic pain with biopsy-proven endometriosis between January 2011 and September 2020 at an academic tertiary hospital system. The final sample included 91 patients with biopsy-confirmed endometriosis. RESULTS Combined oral contraceptives (COCs) were the most common initial treatment (64% of patients). Progestin-only formulations (low- and high-dose norethindrone acetate) were offered to younger patients (age 15.9 ± 2.7 years) than those offered COCs (19.9 ± 3.3 years) and levonorgestrel intrauterine devices (LNG-IUDs) (21.9 ± 1.7 years). Current treatments varied widely and included COCs (32%), LNG-IUDs (18%), oral progestins (low- and high-dose norethindrone, medroxyprogesterone) (14%), elagolix (9%), and leuprolide (8%). Oral adjuncts to LNG-IUD were common: usually low- or high-dose norethindrone (37% of patients with an LNG-IUD), but also included progesterone, COCs, and elagolix. CONCLUSIONS Oral progestins, LNG-IUDs, and COCs were the mainstay of initial treatment. Subsequent treatments varied widely and included COCs, LNG-IUDs, oral progestins, elagolix, leuprolide, and combinations of these agents. We observed that most young women switched between therapies, suggesting that a personalised approach is often used to determine treatment plans among the wide range of options currently available. This study helps define the spectrum of treatment regimens for endometriosis in adolescent females.
Collapse
Affiliation(s)
- Howard J Li
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Ecem Esencan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Yue Song
- Yale School of Public Health, Yale University, New Haven, CT, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Yonghee Cho
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Alla Vash-Margita
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA.
| |
Collapse
|
2
|
Allahqoli L, Mazidimoradi A, Momenimovahed Z, Günther V, Ackermann J, Salehiniya H, Alkatout I. Appendiceal Endometriosis: A Comprehensive Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13111827. [PMID: 37296678 DOI: 10.3390/diagnostics13111827] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023] Open
Abstract
Objective: the purpose of this review was to evaluate the prevalence of appendiceal endometriosis and the safety of concomitant appendectomy in women with endometriosis or pelvic pain. Materials and Methods: We searched the electronic databases Medline (PubMed), Scopus, Embase, and Web of Science (WOS). The search was not subject to any limitation in terms of time or method. The primary research question was: what is the prevalence of appendiceal endometriosis? The secondary research question was: is it safe to perform appendectomy during surgery for endometriosis? Publications that reported data about appendiceal endometriosis or appendectomy in women with endometriosis were reviewed regarding the inclusion criteria. Results: We found 1418 records. After review and screening, we included 75 studies published between 1975 and 2021. With regard to the first question of the review, we found 65 eligible studies and divided these into the following two categories: (a) endometriosis of the appendix presenting as acute appendicitis, and (b) endometriosis of the appendix as an incidental finding in gynecological surgery. Forty-four case reports described appendiceal endometriosis in women who were admitted for the treatment of pain in the right-sided lower abdomen. Endometriosis of the appendix was observed in 2.67% (range, 0.36-23%) of women who were admitted due to acute appendicitis. In addition, appendiceal endometriosis was an incidental finding during gynecological surgery in 7.23% of cases (range, 1-44.3%). With regard to the second question of the review, which was the safety of appendectomy in women with endometriosis or pelvic pain, we found 11 eligible studies. Reviewed cases had no significant intraoperative or follow-up complications during the 12 weeks. Conclusion: Based on the reviewed studies, coincidental appendectomy appears reasonably safe and was associated with no complications in the cases reviewed for the present report.
Collapse
Affiliation(s)
- Leila Allahqoli
- Ministry of Health and Medical Education, Tehran 1467664961, Iran
| | - Afrooz Mazidimoradi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz 7134814336, Iran
| | - Zohre Momenimovahed
- Department of Midwifery and Reproductive Health, Qom University of Medical Sciences, Qom 3716993456, Iran
| | - Veronika Günther
- University Hospitals Schleswig-Holstein, Kiel School of Gynaecological Endoscopy, Campus Kiel, Arnold-Heller-Str. 3, Haus 24, 24105 Kiel, Germany
| | - Johannes Ackermann
- University Hospitals Schleswig-Holstein, Kiel School of Gynaecological Endoscopy, Campus Kiel, Arnold-Heller-Str. 3, Haus 24, 24105 Kiel, Germany
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand 9717853577, Iran
| | - Ibrahim Alkatout
- University Hospitals Schleswig-Holstein, Kiel School of Gynaecological Endoscopy, Campus Kiel, Arnold-Heller-Str. 3, Haus 24, 24105 Kiel, Germany
| |
Collapse
|
3
|
Krämer B, Andress J, Neis F, Hoffmann S, Brucker S, Kommoss S, Höller A. Improvement in Fertility and Pain after Endometriosis Resection and Adhesion Prevention with 4DryField ® PH: Follow-up of a Randomized Controlled Clinical Trial. J Clin Med 2023; 12:jcm12103597. [PMID: 37240703 DOI: 10.3390/jcm12103597] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/06/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Adhesions after endometriosis resection are frequent and the most common causes for chronic pain and secondary infertility. Primary results of our randomized controlled trial (RCT) on adhesion prevention after deep infiltrating endometriosis (DIE) resection using the gel barrier 4DryField® PH showed 85% adhesion reduction in second-look surgeries. Secondary endpoint data on fertility and pain development were collected during 12-month follow-ups. METHODS This RCT comprised 50 patients. Preoperatively and after 1, 6 and 12 months, pain scores for cycle-independent pelvic pain, dysmenorrhea, dyspareunia, dyschezia, and dysuria, as well as the number of pregnancies, were recorded,. RESULTS The pregnancy rate in the intervention group was significantly higher (p < 0.05). Pain development was also improved: after 12 months, all 5 subscores were lower in the intervention group and improvements were more pronounced, most prominently concerning cycle-independent pelvic pain and dysmenorrhea, the two subcategories with the highest preoperative scores and, therefore, the highest relevance for the patients. Cycle-independent pelvic pain even recurred in the control group, while barrier application prevented this. CONCLUSIONS Considering the known causal link between adhesions and pain, it is apparent that the favourable outcomes in the intervention group are linked to effective adhesion prevention. The significant increase in pregnancies is remarkable.
Collapse
Affiliation(s)
- Bernhard Krämer
- Department for Women's Health, University Hospital Tübingen, Calwerstr. 7, 72076 Tübingen, Germany
| | - Jürgen Andress
- Department for Women's Health, University Hospital Tübingen, Calwerstr. 7, 72076 Tübingen, Germany
| | - Felix Neis
- Department for Women's Health, University Hospital Tübingen, Calwerstr. 7, 72076 Tübingen, Germany
| | - Sascha Hoffmann
- Department for Women's Health, University Hospital Tübingen, Calwerstr. 7, 72076 Tübingen, Germany
| | - Sara Brucker
- Department for Women's Health, University Hospital Tübingen, Calwerstr. 7, 72076 Tübingen, Germany
| | - Stefan Kommoss
- Department for Women's Health, University Hospital Tübingen, Calwerstr. 7, 72076 Tübingen, Germany
| | - Alice Höller
- Department for Women's Health, University Hospital Tübingen, Calwerstr. 7, 72076 Tübingen, Germany
| |
Collapse
|
4
|
Cofini V, Muselli M, Lolli C, Fabiani L, Necozione S. Does Quality of Care (QoC) Perception Influence the Quality of Life (QoL) in Women with Endometriosis? Results from an Italian Nationwide Survey during Covid Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:625. [PMID: 36612945 PMCID: PMC9819574 DOI: 10.3390/ijerph20010625] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: Endometriosis is a chronic and progressive illness that generates a slew of issues, lowering the quality of life of women. The purpose of this study was to look at the quality of life in women with endometriosis and how it relates to the quality of care. (2) Methods: This study is an online survey performed in Italy during the COVID pandemic using the Italian version of the Health Questionnaire SF-36 and a questionnaire for assessing the quality of care received. (3) Results: 1052 women with a self-reported diagnosis of endometriosis participated in the survey. The mean levels of Physical Component Summary (PCS) and Mental Component Summary (MCS) were 38.89 ± 10.55 and 34.59 ± 11.17, respectively. A total of 77% of women judged the services they received positively, and 51% considered the coordination between healthcare professionals to be satisfactory. The satisfaction index mean was 23.11 ± 4.80. PCS was positively related to Occupation, high educational level, physical activity, and health care satisfaction. MCS was positively related to higher age, physical activity, and health care satisfaction. (4) Conclusions: The study indicated that satisfaction with health care was a significant predictor of QoL in women with endometriosis, for both physical and mental health.
Collapse
|
5
|
Mansfield C, Lenobel D, McCracken K, Hewitt G, Appiah LC. Impact of Pelvic Floor Physical Therapy on Function in Adolescents and Young Adults with Biopsy-Confirmed Endometriosis at a Tertiary Children's Hospital: A Case Series. J Pediatr Adolesc Gynecol 2022; 35:722-727. [PMID: 35830927 DOI: 10.1016/j.jpag.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/17/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
STUDY OBJECTIVE The purpose of this case series is to describe the change in capability to perform self-selected activities in adolescent and young adult patients with chronic pelvic pain and surgically proven endometriosis following pelvic floor physical therapy as part of multidisciplinary treatment. DESIGN Retrospective case series SETTING: Tertiary care pediatric hospital PARTICIPANTS: Twenty patients with ages ranging from 14 to 22 years and a median age of 16.5 years with biopsy-confirmed endometriosis INTERVENTION: Pelvic floor physical therapy MAIN OUTCOME MEASURE(S): Patient-Specific Functional Scale (PSFS) outcome measure RESULTS: Patients had a clinically significant functional improvement (median score of 6.0 points on the PSFS outcome measure; interquartile range, 3.8-13.5) over the course of care (median number of 12 visits; range 4-48 visits) (P < .001). CONCLUSIONS Patients with chronic pelvic pain and surgically proven endometriosis experienced significant functional improvement after physical therapy treatment. The results of this case series suggest that physical therapy is a viable additional intervention for adolescents and young adults with chronic pelvic pain and endometriosis and warrants further research.
Collapse
Affiliation(s)
- Christine Mansfield
- Sports and Orthopedic Therapies, Nationwide Children's Hospital, Columbus, OH, United States
| | - Dana Lenobel
- Pediatric and Adolescent Gynecology, Outpatient Care Center, Nationwide Children's Hospital, 555 S 18th St #5, Columbus, OH 43205, United States.
| | - Kate McCracken
- Pediatric and Adolescent Gynecology, Outpatient Care Center, Nationwide Children's Hospital, 555 S 18th St #5, Columbus, OH 43205, United States
| | - Geri Hewitt
- Pediatric and Adolescent Gynecology, Outpatient Care Center, Nationwide Children's Hospital, 555 S 18th St #5, Columbus, OH 43205, United States
| | - Leslie C Appiah
- Obsetrics and Gynecology, University of Colorado Hospital, Aurora, CO, United States
| |
Collapse
|
6
|
Li J, He Y, Liang T, Wang J, Jiang X, Zhang G. Identification of potential differentially methylated gene-related biomarkers in endometriosis. Epigenomics 2022; 14:1157-1179. [DOI: 10.2217/epi-2022-0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To identify epigenetic alterations of differentially expressed genes and screen out targeted therapeutic drugs in endometriosis. Methods: Based on the Gene Expression Omnibus database and a series of biological information analysis tools, supplemented by validation of clinical samples, aberrant DNA methylation-driven genes and their functions were explored, as well as possible targeted drugs. Results: This study screened out a range of DNA methylation-driven genes that were associated with powerful properties and corresponding pathways. Among them, BDNF and CCL2 were key genes in the development of endometriosis. Four chemical agents have been flagged as potential treatments for endometriosis. Conclusion: These candidate genes and small-molecule agents may be further explored as potential targets and drugs for endometriosis diagnosis and therapy, respectively.
Collapse
Affiliation(s)
- Jixin Li
- Department of Gynecology, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 15000, China
| | - Yanan He
- Department of Gynecology, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 15000, China
| | - Tian Liang
- Department of Gynecology, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 15000, China
| | - Jing Wang
- Department of Gynecology, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 15000, China
| | - Xinyan Jiang
- Department of Gynecology, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 15000, China
| | - Guangmei Zhang
- Department of Gynecology, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 15000, China
| |
Collapse
|
7
|
Rasp E, Saavalainen L, But A, Gissler M, Härkki P, Heikinheimo O, Rönö K. Surgically confirmed endometriosis in adolescents in Finland-A register-based cross-sectional cohort study. Acta Obstet Gynecol Scand 2022; 101:1065-1073. [PMID: 35818936 PMCID: PMC9812065 DOI: 10.1111/aogs.14419] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/05/2022] [Accepted: 06/18/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Increasing awareness of endometriosis in adolescents requires data on the nature of the disease and its management. Our objective was to investigate the subtypes of surgically confirmed endometriosis in adolescents (aged <20 years) and trends in the incidence rates and endometriosis-related procedures during the study period, 1987-2012. MATERIAL AND METHODS In this register-based cohort study, we identified 526 adolescents receiving their initial surgical diagnosis of endometriosis between 1987 and 2012 from the Finnish Hospital Discharge Register. The age-specific incidence rate of surgically confirmed endometriosis was calculated by dividing the number of adolescents during specific periods by person-years. We calculated the relative differences in incidence rates between the periods using crude incidence ratios. RESULTS Adolescents were divided into three age groups, <17, 17-18, and 19 years, which comprised 8.2% (43/526), 39.7% (209/526), and 52.1% (274/526) of the study cohort, respectively. Peritoneal endometriosis and ovarian endometriosis were the most common types (379/526 [72%] and 119/526 [23%], respectively). The incidence rate of surgically confirmed endometriosis per 100 000 person-years varied from 5.63 (95% confidence interval [CI] 4.24-7.33) to 11.42 (95% CI 9.64-13.44). The incidence rate in 2001-2005 was significantly higher and was 1.6- to 2.0-fold that of the periods 1987-1990 and 2006-2012, respectively. Comparing the periods in which International Classification of Diseases, Ninth Revision (ICD-9; 1987-1995) and Tenth Revision (ICD-10; 1996-2012) codes were used, the use of laparoscopy (78.2% vs 88.9%), day surgery (10.3% vs 31.6%), and procedures for ovarian (18.8% vs 34.1%) and deep (0.6% vs 10.8%) endometriosis increased. The types of endometriosis and procedures did not differ between the age groups. CONCLUSIONS Peritoneal endometriosis was the most common type of endometriosis overall and by age group. During the 26-year period, the incidence rate of initial surgical diagnosis of endometriosis peaked in 2001-2005 and decreased thereafter. The proportion of procedures performed for ovarian and deep endometriosis increased, as did the use of laparoscopy and day surgery.
Collapse
Affiliation(s)
- Elina Rasp
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Liisu Saavalainen
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Anna But
- Biostatistics consulting, Department of Public HealthUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Mika Gissler
- Finnish Institute for Health and Welfare (THL)HelsinkiFinland,Academic Primary Health Care CenterRegion StockholmStockholmSweden,Department of Molecular Medicine and SurgeryKarolinska InstituteStockholmSweden
| | - Päivi Härkki
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Oskari Heikinheimo
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Kristiina Rönö
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| |
Collapse
|
8
|
Nai M, Zhang Y, Li L, Jin Y, Li Y, Wang L, Ren C. Effects of miR-363 on the Biological Activities of Eutopic Endometrial Stromal Cells in Endometriosis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7663379. [PMID: 35378789 PMCID: PMC8976632 DOI: 10.1155/2022/7663379] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 11/25/2022]
Abstract
EMs is a kind of benign disease with certain malignant behaviors. The adhesion, invasive growth, and angiogenesis of ectopic endometrial cells are the pathological basis of EMs occurrence, but its etiology and pathogenesis have not been completely illustrated yet. In our research, we aim to investigate the role of miR-363 in the pathogenesis of endometriosis. Real-time quantitative PCR was used to detect the expression of miR-363 before and after ESC/NSC transfection. CCK-8, flow cytometry, and transwell assay were used to detect the effect of the miR-363 expression on cell proliferation, apoptosis, and invasion. The effects of the miR-363 expression on the contents of Fas/APO-1 and ICAM-1 in cell culture supernatant were detected by ELISA. qRT-PCR and WB assay were used to detect the effects of the miR-363 expression on the mRNA and protein expression levels of ICAM-1, MMP-7, and VEGF in ESC. The increased expression of miR-363 could inhibit the proliferation and invasion of ESC, promote apoptosis, and inhibit the secretion of FAS/APO-1 and ICAM-1. The knockdown expression of miR-363 promoted proliferation and invasion of NSC, inhibited apoptosis, and promoted secretion of FAS/APO-1 and ICAM-1. VCAM-1, VEGF, and MMP-7 were detected in ESCs before transfection. The protein expression level was higher than that of NSCs. Compared with pretransfection, the protein levels of VCAM-1, VEGF, and MMP-7 in the M-363 group were significantly downregulated. The downregulated expression of miR-363 was associated with a stronger cell proliferation ability, a lower cell apoptosis rate, and a stronger ESC. Migration is associated with invasiveness, proliferation, angiogenesis, and immune escape. The low expression of miR-363 promotes endogenesis through posttranscriptional regulation of target genes VCAM-1, MMP-7, and VEGF. The differential expression of miR-363 between ESC and NSC may be an important factor in the many biological differences between ESC and NSC.
Collapse
Affiliation(s)
- Manman Nai
- Department of Gynecology and Obstetrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan Province, China
| | - Yingying Zhang
- Department of Gynecology and Obstetrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan Province, China
| | - Lei Li
- Department of Gynecology and Obstetrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan Province, China
| | - Yuxi Jin
- Department of Gynecology and Obstetrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan Province, China
| | - Yangge Li
- Department of Gynecology and Obstetrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan Province, China
| | - Luwen Wang
- Department of Gynecology and Obstetrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan Province, China
| | - Chenchen Ren
- Department of Gynecology and Obstetrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan Province, China
| |
Collapse
|
9
|
Benagiano G, Guo S. Age-dependent phenotypes of ovarian endometriomas. Reprod Med Biol 2022; 21:e12438. [PMID: 35386381 PMCID: PMC8967305 DOI: 10.1002/rmb2.12438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose To analyze the characteristics of the ovarian endometrioma (OE) across the life span of a woman. In the past, the OE has traditionally been viewed as a single, monolithic disease. Today, there are emerging data indicating that OE phenotypes differ according to the age of the woman. Method A narrative review of original articles on OE indexed by PubMed. Results When appearing in infancy and early adolescence, OE may be the consequence of endometrial cells retrogradely shed with neonatal uterine bleeding. The post-menarcheal variant, manifesting itself during full adolescence, is singularly frequent in the presence of vaginal or uterine outflow obstructive anomalies. The typical and most frequent adult phenotype is characterized by increasing fibrosis and a tendency to progress; its mere presence exerts a detrimental effect on the surrounding healthy ovarian tissue. In postmenopause, an old lesion may be reactivated in the presence of exogenous or endogenous estrogens, or even be produced ex novo; rarely, it can spread to a variety of organs and structures and even degenerate causing malignancies. Conclusions Given the existence of these variants, it is important to agree on management guidelines that take into consideration these different phenotypes.
Collapse
Affiliation(s)
| | - Sun‐Wei Guo
- Shanghai Obstetrics and Gynecology HospitalFudan UniversityShanghaiChina
| |
Collapse
|
10
|
Guo Y, Liu FY, Shen Y, Xu JY, Xie LZ, Li SY, Ding DN, Zhang DQ, Han FJ. Complementary and Alternative Medicine for Dysmenorrhea Caused by Endometriosis: A Review of Utilization and Mechanism. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:6663602. [PMID: 34306150 PMCID: PMC8272670 DOI: 10.1155/2021/6663602] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/09/2021] [Accepted: 06/22/2021] [Indexed: 02/07/2023]
Abstract
Endometriosis (EM) is a common and benign estrogen-dependent gynecological disorder among women of reproductive age, and secondary dysmenorrhea is one of the more severe symptoms. However, the mechanism behind the development of dysmenorrhea is poorly understood, and there is a lack of effective methods for diagnosing and treating EM dysmenorrhea. In this regard, complementary and alternative medicine (CAM) has recently come into widespread use due to its limited adverse reactions and high efficiency. This review updates the progress of CAM in the treatment of EM dysmenorrhea and seeks to identify the therapeutic efficacy as well as the mechanisms behind these effects based on the available clinical and experimental studies. According to the literature, CAM therapy for EM dysmenorrhea, including herbs (herbal prescriptions, extracts, and patents), acupuncture, and Chinese herbal medicine enema (CHM enema), is effective for relieving dysmenorrhea with fewer unpleasant side effects when compared to hormonal and surgical treatments. In addition, we discuss and analyze the existing gaps in the literature. We hope to provide some instructive suggestions for clinical treatment and experimental research in the future.
Collapse
Affiliation(s)
- Ying Guo
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Fang-Yuan Liu
- Department of Obstetrics and Gynecology, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Ying Shen
- Department of Obstetrics and Gynecology, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Jia-Yue Xu
- Department of Obstetrics and Gynecology, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Liang-Zhen Xie
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150040, China
- Department of Obstetrics and Gynecology, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Shi-Ying Li
- Department of Obstetrics and Gynecology, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Dan-Ni Ding
- Department of Obstetrics and Gynecology, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Dan-Qi Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Feng-Juan Han
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150040, China
| |
Collapse
|
11
|
Ectopic endometriosis, menstruation, and acute appendicitis: A thought-provoking case. Int J Surg Case Rep 2021; 80:105605. [PMID: 33592417 PMCID: PMC7893425 DOI: 10.1016/j.ijscr.2021.01.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Ectopic endometrium in the appendix is rare. The relationships between ectopic endometrium in the alimentary tract and digestive symptoms and between digestive symptoms due to ectopic endometriosis and periodic menstruation are controversial. We herein describe the successful treatment of acute appendicitis that we suspect was caused by ectopic endometriosis and periodic menstruation. PRESENTATION OF CASE A 38.9-year-old multipara with uterine didelphys developed lower abdominal pain during menstruation, and she was clinically diagnosed with acute appendicitis. She received conservative management with cephem antibiotics, and her pain disappeared uneventfully. However, the lower abdominal pain during menstruation later recurred, and she again received conservative treatment. Laparoscopic appendectomy was subsequently performed because for 4 months, her appendicitis-induced digestive symptoms had recurred in association with periodic menstruation. Ectopic endometrial gland proliferations were histopathologically observed in the proper muscular layer of the appendiceal tip. She developed no further episodes of digestive symptoms postoperatively. CLINICAL DISCUSSION Ectopic endometriosis of the alimentary tract may be accompanied by digestive symptoms; moreover, these symptoms may be related to periodic menstruation. However, the sensitivity of ectopic endometrium to hormones shows considerable variation among patients. We speculate that the acute appendicitis might have been triggered by ectopic endometriosis in our case because the patient developed repeated digestive symptoms in association with periodic menstruation. Ectopic endometrium may be incidentally observed in histopathological assessments of resected specimens. The therapeutic strategy should be carefully decided on a case-by-case basis. CONCLUSION We hope this thought-provoking case provides a timely reminder for gastrointestinal clinicians and general surgeons.
Collapse
|
12
|
Cromeens MG, Thoyre S, Carey ET, Knafl K, Robinson WR. Inquiry into women's pathways to diagnosis of endometriosis: A qualitative study protocol. J Adv Nurs 2020; 77:1017-1026. [PMID: 33107642 DOI: 10.1111/jan.14616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/05/2020] [Indexed: 12/19/2022]
Abstract
AIMS This protocol describes a study aiming to: (1) describe pathways and experiences of women's symptom recognition, appraisal and management of endometriosis; and (2) identify differences in pathways and experiences among a socioeconomically and racially diverse group of women. DESIGN Descriptive qualitative study with stratified purposeful sampling. METHODS Data will be collected from a minimum of 24 women with provider-presumed or surgically confirmed diagnoses across two time points. The study will recruit across socioeconomic status (SES) and race/ethnicity (non-Hispanic White, non-Hispanic Black, and Hispanic/Latina) to ensure diversity of the sample. Recruitment will occur at a large public hospital in the southeastern United States (US). Participants will be interviewed using semi-structured interview guides informed by Elder and Giele's Life Course perspective approaching women as active beings in dynamic systems shaped by: 1) their location in time and space; 2) linked lives; and 3) human agency, and 4) the time of their lives. Each woman's experiences, symptoms, and contacts with health-care systems will be mapped to trace their diagnostic pathways. Coded interviews and data will undergo within- and across-case analysis to identify similarities and differences in their experiences. Institutional review board approval was obtained June 2019. DISCUSSION The participants' diagnostic maps will enable us to distinguish the differences in pathways and experiences between and across groups. Findings will inform the development of interventions aimed at shortening the time to diagnosis. IMPACT This will be the first study to compare pathways to diagnosis of endometriosis in a socioeconomically and racially diverse sample of US women using the life course perspective. The results from this research stand to inform future interventions aimed at helping women achieve more timely diagnoses.
Collapse
Affiliation(s)
- Martha G Cromeens
- School of Nursing, University of North Carolina, Chapel Hill, NC, USA
| | - Suzanne Thoyre
- School of Nursing, University of North Carolina, Chapel Hill, NC, USA
| | - Erin T Carey
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Kathleen Knafl
- School of Nursing, University of North Carolina, Chapel Hill, NC, USA
| | - Whitney R Robinson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
13
|
Terzic M, Rapisarda AMC, Della Corte L, Manchanda R, Aimagambetova G, Norton M, Garzon S, Riemma G, King CR, Chiofalo B, Cianci A. Diagnostic work-up in paediatric and adolescent patients with adnexal masses: an evidence-based approach. J OBSTET GYNAECOL 2020; 41:503-515. [DOI: 10.1080/01443615.2020.1755625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Milan Terzic
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan
- Department of Obstetrics and Gynecology, National Research Center of Mother and Child Health, University Medical Center, Astana, Kazakhstan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Rahul Manchanda
- Department of Gynae Endoscopy, Manchanda’s Endoscopic Centre, Pushawati Singhania Research Institute, Delhi, India
| | - Gulzhanat Aimagambetova
- Department of Obstetrics and Gynecology, National Research Center of Mother and Child Health, University Medical Center, Astana, Kazakhstan
- Department of Biomedical Sciences, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Melanie Norton
- Department of Urogynaecology, Whittington Hospital, London, UK
| | - Simone Garzon
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Cara Robinson King
- Obstetrics, Gynecology, and Womens Health Institute, Section of Minimally Invasive Gynecologic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, “Regina Elena” National Cancer Institute, Rome, Italy
| | - Antonio Cianci
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| |
Collapse
|