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Lalla AT, Onyebuchi C, Jorgensen E, Clark N. Impact of lifestyle and dietary modifications for endometriosis development and symptom management. Curr Opin Obstet Gynecol 2024; 36:247-254. [PMID: 38869435 DOI: 10.1097/gco.0000000000000969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
PURPOSE OF REVIEW Management of endometriosis is often complex and poorly studied. Patients with endometriosis have interest in how their lifestyle may affect their diagnosis. Self-management and lifestyle changes are often used as adjunct therapy, but best practices are not concrete in treatment guidelines. RECENT FINDINGS Lifestyle impact on endometriosis and possible self-management treatment therapies are reviewed. Overall, there is a need for future studies in all topics. Data suggest a link between endocrine-disrupting chemicals (EDCs), particularly persistent EDCs, and endometriosis. More work is needed to isolate and quantify exposures and explore their connection to endometriosis in order to provide guidance for clinical practice recommendations. There is insufficient evidence to support a superior diet for management of endometriosis; however, the Mediterranean diet may have the most benefit without nutrition concerns. Exercise may be another tool to improve endometriosis symptoms, but once again data are limited and best type and frequency is not well studied. Best evidence supports body-mind practices such as yoga, although new evidence suggests benefit from a holistic combination of several types of exercises. SUMMARY Overall, data on lifestyle effects and associated therapies are limited. Future high-quality studies are needed to guide practice.
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Affiliation(s)
- Amber Trujillo Lalla
- Massachusetts General Hospital, Division of Minimally Invasive Gyne-cologic Surgery, Department of Obstetrics and Gynecology, Boston, Massachusetts, USA
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2
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Messelink B, Flink I, Dos Santos A, Adamse C. Chronic pelvic pain; more than just the bladder. Curr Opin Urol 2024; 34:69-76. [PMID: 37823725 DOI: 10.1097/mou.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
PURPOSE OF REVIEW Chronic pelvic pain is much of a burden to those who suffer from it. Additionally, in many patients medical doctors, such as urologists are unable to identify a cause or clear pathology that can explain the pain. Still numerous patients and doctors keep on searching for a cause, focussing particularly on the pelvic organs. Lots of diagnostics and treatment methods are used but often without success. In recent years, we have gained increased insight into the mechanisms of pain and adapted the terminology accordingly. RECENT FINDINGS Two aspects of chronic pelvic pain have gained more attention. First, the myofascial aspects, especially the role of the pelvic floor muscles in maintaining the pain and as a therapeutic option. Second, the role of the brain and the psychological aspects intertwine with the pain and its consequences also open up for alternative management options. In terminology chronic pain is now included in the ICD-11, a historical change. Introducing chronic primary pain (no cause found) helps us to look away from the organ and deal with the patient as a whole human being. SUMMARY The findings reported here are helpful for your daily practice. Looking from a broad perspective gives the patient the feeling of being seen and heard. Working together in a multidisciplinary team makes your work easier and gives more satisfaction. VIDEO ABSTRACT http://links.lww.com/COU/A44.
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Affiliation(s)
- Bert Messelink
- Medical Centre Leeuwarden, Department of Urology, Leeuwarden, The Netherlands
| | - Ida Flink
- Karlstad University, Karlstad, Sweden
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de C Williams AC, McGrigor H. A thematic synthesis of qualitative studies and surveys of the psychological experience of painful endometriosis. BMC Womens Health 2024; 24:50. [PMID: 38238741 PMCID: PMC10795225 DOI: 10.1186/s12905-023-02874-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/28/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Endometriosis is a widespread problem in women of reproductive age, causing cyclical and non-cyclical pain in the pelvis and elsewhere, and associated with fatigue, fertility problems, and other symptoms. As a chronic pain problem, psychological variables are important in adjustment and quality of life, but have not been systematically studied. METHODS A systematic search of multiple databases was conducted to obtain surveys and qualitative studies of women's experience of pain from endometriosis. Surveys were combined narratively; qualitative studies were combined by thematic synthesis, and the latter rated for methodological quality. RESULTS Over 2000 records were screened on title and abstract, and provided 22 surveys and 33 qualitative studies from which accounts could be extracted of the psychological components of pain in endometriosis. Surveys mostly addressed quality of life in endometriosis, with poorer quality of life associated with higher levels of pain and of distress, but few referred to coherent psychological models. Qualitative studies focused rather on women's experience of living with endometriosis, including trajectories of diagnosis and treatment, with a few addressing meaning and identity. Thematic synthesis provided 10 themes, under the groupings of internal experience of endometriosis (impact on body, emotions, and life); interface with the external world (through self-regulation and social regulation); effects on interpersonal and social life, and encounters with medical care. CONCLUSIONS The psychological components of pain from endometriosis only partly corresponded with standard psychological models of pain, derived from musculoskeletal pain studies, with fewer fears about physical integrity and more about difficulties of managing pain and other symptoms in social settings, including work. Better understanding of the particular psychological threats of endometriosis, and integration of this understanding into medical care with opportunities for psychologically-based pain management, would substantially improve the experience and quality of life of women with painful endometriosis.
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Affiliation(s)
- Amanda C de C Williams
- Research Dept of Clinical, Educational & Health Psychology, University College London, Gower St, London, WC1E 6BT, UK.
| | - Honor McGrigor
- Research Dept of Clinical, Educational & Health Psychology, University College London, Gower St, London, WC1E 6BT, UK
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Escriva-Boulley G, Philip CA, Warembourg S, Lenotre L, Flore P, Faure P, Michy T, Letouzey V, Arnold C, Piluso C, Chalmel L, Kacem R, Blum GF, Detayrac R, Trocmé C, Brigaud I, Herbach U, Branche P, Faller E, Chalabaev A. Effects of a physical activity and endometriosis-based education program delivered by videoconference on endometriosis symptoms: the CRESCENDO program (inCRease physical Exercise and Sport to Combat ENDOmetriosis) protocol study. Trials 2023; 24:759. [PMID: 38012776 PMCID: PMC10680283 DOI: 10.1186/s13063-023-07792-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Endometriosis is a chronic disease characterized by growth of endometrial tissue outside the uterine cavity which could affect 200 million women (The term "woman" is used for convenience. Individuals gendered as man or as nonbinary can also suffer from this disease) worldwide. One of the most common symptoms of endometriosis is pelvic chronic pain associated with fatigue. This pain can cause psychological distress and interpersonal difficulties. As for several chronic diseases, adapted physical activity could help to manage the physical and psychological symptoms. The present study will investigate the effects of a videoconference-based adapted physical activity combined with endometriosis-based education program on quality of life, pain, fatigue, and other psychological symptoms and on physical activity. METHODS This multicentric randomized-controlled trial will propose to 200 patients with endometriosis to be part of a trial which includes a 6-month program with 45 min to more than 120 min a week of adapted physical activity and/or 12 sessions of endometriosis-based education program. Effects of the program will be compared to a control group in which patients will be placed on a waiting list. All participants will be followed up 3 and 6 months after the intervention. None of the participants will be blind to the allocated trial arm. The primary outcome measure will be quality of life. Secondary outcomes will include endometriosis-related perceived pain, fatigue, physical activity, and also self-image, stereotypes, motivational variables, perceived support, kinesiophobia, basic psychological need related to physical activity, and physical activity barriers. General linear models and multilevel models will be performed. Predictor, moderator, and mediator variables will be investigated. DISCUSSION This study is one of the first trials to test the effects of a combined adapted physical activity and education program for improving endometriosis symptoms and physical activity. The results will help to improve care for patients with endometriosis. TRIAL REGISTRATION ClinicalTrials.gov, NCT05831735 . Date of registration: April 25, 2023.
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Affiliation(s)
- Géraldine Escriva-Boulley
- Université de Haute-Alsace, Université de Strasbourg, Université de Lorraine, LISEC UR 2310, F-68100, Mulhouse, France.
| | - Charles-André Philip
- Clinique gynécologique et obstétricale, Hôpital de la Croix-Rousse, groupe hospitalier Nord, CHU de Lyon-HCL, 103, grande rue de la Croix-Rousse, 69317, Lyon cedex, France
| | - Sophie Warembourg
- Clinique gynécologique et obstétricale, Hôpital de la Croix-Rousse, groupe hospitalier Nord, CHU de Lyon-HCL, 103, grande rue de la Croix-Rousse, 69317, Lyon cedex, France
| | - Lionel Lenotre
- Faculté des Sciences et Techniques, Université de Haute-Alsace, 18 Rue des Frères Lumière, 68200, Mulhouse, France
- PASTA - Processus aléatoires spatio-temporels et leurs applications, Inria Nancy - Grand Est, Villers-lès-, Nancy, France
| | - Patrice Flore
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000, Grenoble, France
| | - Patrice Faure
- Grenoble University Hospital, Avenue Maquis du Grésivaudan, 38700, La Tronche, France
| | - Thierry Michy
- Department of Gynecology, Grenoble University Hospital, Avenue Maquis du Grésivaudan, 38700, La Tronche, France
| | | | - Carole Arnold
- Université de Lorraine, Inserm, UMRS 1256, NGERE - Nutrition, Genetics, and Environmental Risk Exposure, F-54000, Nancy, France
| | - Claire Piluso
- Université de Haute-Alsace, Université de Strasbourg, SAGE, F-68100, Mulhouse, France
| | - Loic Chalmel
- Université de Haute-Alsace, Université de Strasbourg, Université de Lorraine, LISEC UR 2310, F-68100, Mulhouse, France
| | - Ramzi Kacem
- Service gynécologie GHRMSA, Hôpital Emile Muller, Mulhouse, France
| | - Georges Fabrice Blum
- Cabinet Médical, Clinique du Diaconat-Fonderie et Université de Haute-Alsace, Mulhouse, France
| | | | - Candice Trocmé
- Grenoble University Hospital, Avenue Maquis du Grésivaudan, 38700, La Tronche, France
| | - Isabelle Brigaud
- Université de Haute-Alsace, CNRS, IS2M UMR 7361, Mulhouse, France
| | - Ulysse Herbach
- Université de Lorraine, CNRS, Inria, IECL, F-54000, Nancy, France
| | - Patricia Branche
- Service d'Anesthésie Réanimation Chirurgicale, Hospices Civils de Lyon, Groupement Hospitalier Nord Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, F-69317, Lyon, France
| | - Emilie Faller
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67200, Strasbourg, France
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Sachs MK, Dedes I, El-Hadad S, Haufe A, Rueff D, Kohl Schwartz AS, Haeberlin F, von Orelli S, Eberhard M, Leeners B. Physical Activity in Women with Endometriosis: Less or More Compared with a Healthy Control? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6659. [PMID: 37681799 PMCID: PMC10487726 DOI: 10.3390/ijerph20176659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/15/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Endometriosis, i.e., endometrial-like tissue outside the uterus, is a chronic inflammatory condition affecting physical functioning. However, the specific levels of physical activity (PA) in the context of endometriosis and different disease symptoms remain unclear. METHODS This multi-center, cross-sectional study compared PA levels and influencing factors in endometriosis patients and non-endometriosis patients. Data were collected through questionnaires. Endometriosis was surgically confirmed. A statistical analysis was performed with appropriate tests. RESULTS The study included 460 women with endometriosis and 460 age-matched women without this condition. The two groups did not differ significantly in terms of age, education level, or stable partnership. Women with endometriosis exhibited lower PA levels, practicing fewer hours of sports weekly and climbing fewer stairs daily compared to the control group. These differences remained significant after controlling for confounding factors. Factors such as endometriosis, current dysmenorrhea, and depression were associated with decreased PA. CONCLUSIONS These findings suggest that women with endometriosis engage in less PA compared to those without this condition. These results highlight the need for interventions to promote increased PA in endometriosis patients and harness the associated health benefits. Further research is warranted to explore the underlying mechanisms and develop tailored exercise therapies for this population.
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Affiliation(s)
- Maike Katja Sachs
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (S.E.-H.); (A.H.); (D.R.); (B.L.)
| | - Ioannis Dedes
- Division of Gynecology and Obstetrics, Inselspital Bern, 3010 Bern, Switzerland;
| | - Samia El-Hadad
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (S.E.-H.); (A.H.); (D.R.); (B.L.)
| | - Annika Haufe
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (S.E.-H.); (A.H.); (D.R.); (B.L.)
| | - Dalia Rueff
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (S.E.-H.); (A.H.); (D.R.); (B.L.)
| | | | - Felix Haeberlin
- Department of Gynecology and Obstetrics, Canton Hospital St. Gallen, 9007 St. Gallen, Switzerland;
| | - Stephanie von Orelli
- Department of Gynecology and Obstetrics, Triemli Hospital Zurich, 8063 Zurich, Switzerland;
| | - Markus Eberhard
- Department of Gynecology and Obstetrics, Canton Hospital Schaffhausen, 8208 Schaffhausen, Switzerland;
| | - Brigitte Leeners
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (S.E.-H.); (A.H.); (D.R.); (B.L.)
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Cetera GE, Merli CEM, Facchin F, Viganò P, Pesce E, Caprara F, Vercellini P. Non-response to first-line hormonal treatment for symptomatic endometriosis: overcoming tunnel vision. A narrative review. BMC Womens Health 2023; 23:347. [PMID: 37391793 PMCID: PMC10311799 DOI: 10.1186/s12905-023-02490-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/18/2023] [Indexed: 07/02/2023] Open
Abstract
One-fourth to one-third of women with endometriosis receiving first-line hormonal treatment lacks an adequate response in terms of resolution of painful symptoms. This phenomenon has been ascribed to "progesterone resistance", an entity that was theorized to explain the gap between the ubiquity of retrograde menstruation and the 10% prevalence of endometriosis among women of reproductive age.Nevertheless, the hypothesis of progesterone resistance is not free of controversies. As our understanding of endometriosis is increasing, authors are starting to set aside the traditionally accepted tunnel vision of endometriosis as a strictly pelvic disease, opening to a more comprehensive perspective of the condition. The question is: are patients not responding to first-line treatment because they have an altered signaling pathway for such treatment, or have we been overlooking a series of other pain contributors which may not be resolved by hormonal therapy?Finding an answer to this question is evermore impelling, for two reasons mainly. Firstly, because not recognizing the presence of further pain contributors adds a delay in treatment to the already existing delay in diagnosis of endometriosis. This may lead to chronicity of the untreated pain contributors as well as causing adverse consequences on quality of life and psychological health. Secondly, misinterpreting the consequences of untreated pain contributors as a non-response to standard first-line treatment may imply the adoption of second-line medical therapies or of surgery, which may entail non-negligible side effects and may not be free of physical, psychological and socioeconomic repercussions.The current narrative review aims at providing an overview of all the possible pain contributors in endometriosis, ranging from those strictly organic to those with a greater neuro-psychological component. Including these aspects in a broader psychobiological approach may provide useful suggestions for treating those patients who report persistent pain symptoms despite receiving first-line hormonal medical treatment.
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Affiliation(s)
- Giulia Emily Cetera
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Federica Facchin
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Paola Viganò
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Pesce
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Francesca Caprara
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Vercellini
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Artacho-Cordón F, Lorenzo Hernando E, Pereira Sánchez A, Quintas-Marquès L. Conceptos actuales en dolor y endometriosis: diagnóstico y manejo del dolor pélvico crónico. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2023. [DOI: 10.1016/j.gine.2023.100843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Mardon AK, Leake HB, Hayles C, Henry ML, Neumann PB, Moseley GL, Chalmers KJ. The Efficacy of Self-Management Strategies for Females with Endometriosis: a Systematic Review. Reprod Sci 2023; 30:390-407. [PMID: 35488093 PMCID: PMC9988721 DOI: 10.1007/s43032-022-00952-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/15/2022] [Indexed: 11/26/2022]
Abstract
Self-management is critical for the care of endometriosis. Females with endometriosis frequently use self-management strategies to manage associated symptoms; however, the efficacy of such strategies is unknown. The aim of this review was to systematically appraise the evidence concerning efficacy of self-management strategies for endometriosis symptoms. Electronic databases, including Medline, Embase, Emcare, Web of Science Core Collection, Scopus, and the Cochrane Central Register of Controlled Trials, were searched from inception to March 2021. We included peer-reviewed experimental studies published in English evaluating the efficacy of self-management strategies in human females laparoscopically diagnosed with endometriosis. Studies underwent screening, data extraction, and risk of bias appraisal (randomised studies: Risk of Bias 2 tool; non-randomised studies: Risk Of Bias In Non-randomized Studies - of Interventions tool). Of the fifteen studies included, 10 evaluated dietary supplements, three evaluated dietary modifications, one evaluated over-the-counter medication, and one evaluated exercise. Most studies had a high-critical risk of bias. Many self-management strategies were not more effective at reducing endometriosis symptoms compared to placebo or hormonal therapies. Where studies suggest efficacy for self-management strategies, no recommendations can be made due to the poor quality and heterogeneity of evidence. High-quality empirical evidence is required to investigate the efficacy of self-management strategies for females with endometriosis.
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Affiliation(s)
- Amelia K Mardon
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Hayley B Leake
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
- Centre for IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Cathy Hayles
- University of South Australia, Adelaide, SA, Australia
| | - Michael L Henry
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | | | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - K Jane Chalmers
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia.
- Western Sydney University, Campbelltown, NSW, Australia.
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Abril-Coello R, Correyero-León M, Ceballos-Laita L, Jiménez-Barrio S. Benefits of physical therapy in improving quality of life and pain associated with endometriosis: A systematic review and meta-analysis. Int J Gynaecol Obstet 2022. [PMID: 36571475 DOI: 10.1002/ijgo.14645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/17/2022] [Accepted: 12/17/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess whether non-pharmacologic conservative therapeutic interventions are beneficial in improving pain intensity and quality of life in women with endometriosis compared with placebo. METHODS A systematic review with meta-analysis was designed. A literature search was performed in the following databases: PubMed, PEDro, Embase, CINAHL, Isi Web of Science, Enfispo, and Cochrane. Randomized controlled trials included women with endometriosis treated with conservative treatment versus placebo. The quality of the studies was assessed using the PEDro scale, and the risk of bias of the individual studies was assessed using the Cochrane Risk of Bias tool. For the overall quality of the studies, the GRADE guidelines were used. RESULTS Meta-analysis included six studies. Significant results were obtained for pain intensity (standardized mean difference [SMD] -0.89; 95% confidence interval [CI] -1.21 to -0.57; I2 69%) and concerning quality of life, significant results were only obtained for the sub-variable physical function (SMD -1.49; 95% CI -2.88 to -0.10; I2 95%). No statistically significant differences were found for the rest of the variables analyzed. CONCLUSION Non-pharmacologic conservative therapies are a therapeutic option for women with endometriosis for improving pain intensity and physical function.
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Affiliation(s)
- Rebeca Abril-Coello
- Department of Surgery, Opthalmology, Otorhinolaryngology, and Physiotherapy, Facult of Health Sciences, University of Valladolid, Soria, Spain
| | - Marta Correyero-León
- Department of Surgery, Opthalmology, Otorhinolaryngology, and Physiotherapy, Facult of Health Sciences, University of Valladolid, Soria, Spain
| | - Luis Ceballos-Laita
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology, Otorhinolaryngology, and Physiotherapy, Faculty of Health Sciences, University of Valladolid, Soria, Spain
| | - Sandra Jiménez-Barrio
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology, Otorhinolaryngology, and Physiotherapy, Faculty of Health Sciences, University of Valladolid, Soria, Spain
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Amro B, Ramirez Aristondo ME, Alsuwaidi S, Almaamari B, Hakim Z, Tahlak M, Wattiez A, Koninckx PR. New Understanding of Diagnosis, Treatment and Prevention of Endometriosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116725. [PMID: 35682310 PMCID: PMC9180566 DOI: 10.3390/ijerph19116725] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022]
Abstract
For 100 years, pelvic endometriosis has been considered to originate from the implantation of endometrial cells following retrograde menstruation or metaplasia. Since some observations, such as the clonal aspect, the biochemical variability of lesions and endometriosis in women without endometrium, the genetic-epigenetic (G-E) theory describes that endometriosis only begins after a series of cumulative G-E cellular changes. This explains that the endometriotic may originate from any pluripotent cell apart from the endometrium, that 'endometrium-like cells' can harbour important G-E differences, and that the risk is higher in predisposed women with more inherited incidents. A consequence is a high risk after puberty which decreases progressively thereafter. Considering a 10-year delay between initiation and performing a laparoscopy, this was observed in the United Arab Emirates, Belgium, France and USA. The subsequent growth varies with the G-E changes and the environment but is self-limiting probably because of the immunologic reaction and fibrosis. That each lesion has a different set of G-E incidents explains the variability of pain and the response to hormonal treatment. New lesions may develop, but recurrences after surgical excision are rare. The fibrosis around endometriosis belongs to the body and does not need to be removed. This suggests conservative excision or minimal bowel without safety margins and superficial treatment of ovarian endometriosis. This G-E concept also suggests prevention by decreasing oxidative stress from retrograde menstruation or the peritoneal microbiome. This suggests the prevention of vaginal infections and changes in the gastrointestinal microbiota through food intake and exercise. In conclusion, a higher risk of initiating endometriosis during adolescence was observed in UAE, France, Belgium and USA. This new understanding and the limited growth opens perspectives for earlier diagnosis and better treatment.
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Affiliation(s)
- Bedayah Amro
- Latifa Hospital, Dubai 9115, United Arab Emirates; (B.A.); (M.E.R.A.); (S.A.); (B.A.); (Z.H.); (M.T.); (A.W.)
| | | | - Shaima Alsuwaidi
- Latifa Hospital, Dubai 9115, United Arab Emirates; (B.A.); (M.E.R.A.); (S.A.); (B.A.); (Z.H.); (M.T.); (A.W.)
| | - Basma Almaamari
- Latifa Hospital, Dubai 9115, United Arab Emirates; (B.A.); (M.E.R.A.); (S.A.); (B.A.); (Z.H.); (M.T.); (A.W.)
| | - Zeinab Hakim
- Latifa Hospital, Dubai 9115, United Arab Emirates; (B.A.); (M.E.R.A.); (S.A.); (B.A.); (Z.H.); (M.T.); (A.W.)
| | - Muna Tahlak
- Latifa Hospital, Dubai 9115, United Arab Emirates; (B.A.); (M.E.R.A.); (S.A.); (B.A.); (Z.H.); (M.T.); (A.W.)
| | - Arnaud Wattiez
- Latifa Hospital, Dubai 9115, United Arab Emirates; (B.A.); (M.E.R.A.); (S.A.); (B.A.); (Z.H.); (M.T.); (A.W.)
- Department of OBGYN, Faculty of Medicine, University Strasbourg, 6081 Strasbourg, France
| | - Philippe R. Koninckx
- Latifa Hospital, Dubai 9115, United Arab Emirates; (B.A.); (M.E.R.A.); (S.A.); (B.A.); (Z.H.); (M.T.); (A.W.)
- Department of OBGYN, Faculty of Medicine, Katholieke University Leuven, 3000 Leuven, Belgium
- Department of OBGYN, Faculty of Medicine, University of Oxford, Oxford OX1 2JD, UK
- Department of OBGYN, Faculty of Medicine, University of Cattolica, 20123 Milano, Italy
- Department of OBGYN, Faculty of Medicine, Moscow State University, 119991 Moscow, Russia
- Correspondence:
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11
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Siqueira-Campos VM, de Deus MSC, Poli-Neto OB, Rosa-E-Silva JC, de Deus JM, Conde DM. Current Challenges in the Management of Chronic Pelvic Pain in Women: From Bench to Bedside. Int J Womens Health 2022; 14:225-244. [PMID: 35210869 PMCID: PMC8863341 DOI: 10.2147/ijwh.s224891] [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: 11/15/2021] [Accepted: 02/04/2022] [Indexed: 12/11/2022] Open
Abstract
Chronic pelvic pain (CPP) affects a significant proportion of women worldwide And has a negative impact on several aspects of these women’s lives including mental health, work, relationships and sexual function, among others. This set of factors ultimately reflects negatively on quality Of life. The physiopathology of CPP is complex and remains to be fully clarified; however, recent advances have increased understanding of the mechanisms involved in chronic pain in general, and more specifically, CPP. Nonetheless, even when a detailed clinical history is obtained, meticulous physical examination is performed and imaging resources are appropriately used, the organic cause of the pain may still fail to be identified in a substantial number of women with CPP. Management of CPP may therefore be challenging. This narrative review was aimed at adding to the available literature on the subject, presenting and discussing the principal characteristics of CPP in women. The paper highlights gaps in the literature while providing the most up-to-date evidence associated with the physiopathology and classification of pain, its diagnosis and treatment. In addition, current challenges in the management of women with CPP are discussed.
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Affiliation(s)
- Vânia Meira Siqueira-Campos
- Department of Obstetrics and Gynecology, School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | - Omero Benedicto Poli-Neto
- Laboratory for Translational Data Science, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.,Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Julio Cesar Rosa-E-Silva
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - José Miguel de Deus
- Department of Obstetrics and Gynecology, School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Délio Marques Conde
- Department of Obstetrics and Gynecology, School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
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Gutke A, Sundfeldt K, De Baets L. Lifestyle and Chronic Pain in the Pelvis: State of the Art and Future Directions. J Clin Med 2021; 10:jcm10225397. [PMID: 34830680 PMCID: PMC8622577 DOI: 10.3390/jcm10225397] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/07/2021] [Accepted: 11/16/2021] [Indexed: 12/13/2022] Open
Abstract
During their lifespan, many women are exposed to pain in the pelvis in relation to menstruation and pregnancy. Such pelvic pain is often considered normal and inherently linked to being a woman, which in turn leads to insufficiently offered treatment for treatable aspects related to their pain experience. Nonetheless, severe dysmenorrhea (pain during menstruation) as seen in endometriosis and pregnancy-related pelvic girdle pain, have a high impact on daily activities, school attendance and work ability. In the context of any type of chronic pain, accumulating evidence shows that an unhealthy lifestyle is associated with pain development and pain severity. Furthermore, unhealthy lifestyle habits are a suggested perpetuating factor of chronic pain. This is of specific relevance during lifespan, since a low physical activity level, poor sleep, or periods of (di)stress are all common in challenging periods of women’s lives (e.g., during menstruation, during pregnancy, in the postpartum period). This state-of-the-art paper aims to review the role of lifestyle factors on pain in the pelvis, and the added value of a lifestyle intervention on pain in women with pelvic pain. Based on the current evidence, the benefits of physical activity and exercise for women with pain in the pelvis are supported to some extent. The available evidence on lifestyle factors such as sleep, (di)stress, diet, and tobacco/alcohol use is, however, inconclusive. Very few studies are available, and the studies which are available are of general low quality. Since the role of lifestyle on the development and maintenance of pain in the pelvis, and the value of lifestyle interventions for women with pain in the pelvis are currently poorly studied, a research agenda is presented. There are a number of rationales to study the effect of promoting a healthy lifestyle (early) in a woman’s life with regard to the prevention and management of pain in the pelvis. Indeed, lifestyle interventions might have, amongst others, anti-inflammatory, stress-reducing and/or sleep-improving effects, which might positively affect the experience of pain. Research to disentangle the relationship between lifestyle factors, such as physical activity level, sleep, diet, smoking, and psychological distress, and the experience of pain in the pelvis is, therefore, needed. Studies which address the development of management strategies for adapting lifestyles that are specifically tailored to women with pain in the pelvis, and as such take hormonal status, life events and context, into account, are required. Towards clinicians, we suggest making use of the window of opportunity to prevent a potential transition from localized or periodic pain in the pelvis (e.g., dysmenorrhea or pain during pregnancy and after delivery) towards persistent chronic pain, by promoting a healthy lifestyle and applying appropriate pain management.
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Affiliation(s)
- Annelie Gutke
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 40350 Gothenburg, Sweden
- Correspondence:
| | - Karin Sundfeldt
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40350 Gothenburg, Sweden;
- Department of Gynecology, Sahlgrenska University Hospital, 41346 Gothenburg, Sweden
| | - Liesbet De Baets
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussel, Belgium;
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