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Lu C, Xu J, Li K, Wang J, Dai Y, Chen Y, Chai R, Xu C, Kang Y. Chronic Stress Blocks the Endometriosis Immune Response by Metabolic Reprogramming. Int J Mol Sci 2023; 25:29. [PMID: 38203209 PMCID: PMC10778859 DOI: 10.3390/ijms25010029] [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: 10/10/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Studies have shown that the occurrence and development of endometriosis are closely linked to long-term psychological stress. The specific contribution of chronic stress to the metabolic adaptations in patients with endometriosis is still unknown. Lesions were removed from ten endometriosis patients during an operation, and the participants were divided into two groups using a psychological questionnaire. An mRNA Human Gene Expression Microarray analysis was applied to compare the mRNA expression profiles between the chronic stress group and the control group. In addition, the reliability of the mRNA Human Gene Expression Microarray analysis was verified by using research on metabolites based on both the liquid chromatography (LC-MS/MS) technique and quantitative reverse transcription polymerase chain reaction (RT-PCR). A microarray analysis of significantly up-regulated, differentially expressed genes between the chronic stress and the control groups showed genes that were principally related to metabolism-related processes and immune-related processes, such as the immune response process, negative regulation of T cell proliferation, the leucine metabolic process, and the L-cysteine metabolic process (p < 0.05). LC-MS showed that the differential metabolites were primarily concerned with arginine and proline metabolism, D-glutamine and D-glutamate metabolism, aspartate metabolism, glycine, serine metabolism, and tyrosine metabolism (p < 0.05). The possibility of chronic stress blocks the endometriosis immune response through metabolic reprogramming. Chronic stress reduces the supply of energy substrates such as arginine and serine, down-regulates T immune cell activation, and affects the anti-tumor immune response, thereby promoting the migration and invasion of endometriosis lesions in patients with chronic stress.
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Affiliation(s)
- Chong Lu
- Gynecology Department, The Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai 200011, China
| | - Jing Xu
- Gynecology Department, The Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai 200011, China
| | - Ke Li
- Gynecology Department, The Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai 200011, China
| | - Jing Wang
- Gynecology Department, The Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai 200011, China
| | - Yilin Dai
- Gynecology Department, The Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai 200011, China
| | - Yiqing Chen
- Gynecology Department, The Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai 200011, China
| | - Ranran Chai
- Gynecology Department, The Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai 200011, China
| | - Congjian Xu
- Gynecology Department, The Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai 200011, China
| | - Yu Kang
- Gynecology Department, The Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai 200011, China
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Szypłowska M, Tarkowski R, Kułak K. The impact of endometriosis on depressive and anxiety symptoms and quality of life: a systematic review. Front Public Health 2023; 11:1230303. [PMID: 37744486 PMCID: PMC10512020 DOI: 10.3389/fpubh.2023.1230303] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Endometriosis is a common gynecological disorder affecting approximately 10-15% of women of reproductive age. The main complaints of patients with endometriosis are pain and fertility problems. Symptoms of endometriosis can impact the psychological functioning of the patients and significantly compromise their mental health. Methods The aim of this review was to assess the prevalence of depressive and anxiety symptoms and quality of life in endometriosis patients. For this systematic review, we searched the PubMed, MEDLINE, ProQuest, EMBASE, Cochrane, CINAHL, Google Scholar, Scopus, and ScienceDirect electronic databases up to March 2023 to identify potentially relevant studies. The systematic review in the present paper is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Results Of four records identified, 18 were eligible to be reviewed on the association between endometriosis and symptoms of depression and anxiety. Of 8,901 records identified, 28 were reviewed on the association between endometriosis and quality of life. The reviewed articles showed a prevalence ranging from 9.8 to 98.5% for depressive symptoms and 11.5 to 87.5% for anxiety. The quality of life in patients with endometriosis was significantly impaired, regardless of the tool used for evaluation. Discussion This systematic review shows that endometriosis is associated with depressive and anxiety symptoms and impaired HRQoL. Broad correlating factors modulate mental health outcomes, indicating the complex relationship between the disease and the psychological health of the patients.
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Affiliation(s)
- Małgorzata Szypłowska
- Chair and Department of Oncological Gynecology and Gynecology, Medical University of Lublin, Lublin, Poland
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3
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Barberis N, Cannavò M, Cuzzocrea F, Saladino V, Verrastro V. "Illness perceptions and factors of distress as mediators between trait emotional intelligence and quality of life in endometriosis". PSYCHOL HEALTH MED 2023; 28:1818-1830. [PMID: 36747368 DOI: 10.1080/13548506.2023.2175878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/22/2023] [Indexed: 02/08/2023]
Abstract
Past findings highlighted the presence of distress symptoms and poor quality of life in people with endometriosis. Several studies showed that trait Emotional Intelligence (trait EI) is a key component of one's wellbeing, whilst Illness Perceptions may play an important role in psychological distress and perceived quality of life. The current study sought to test the hypothesis that an association between trait EI and Quality of Life in individuals with endometriosis would be mediated by Illness Perceptions, examining also the relations with General Distress (depression, anxiety, and stress). 364 women with endometriosis aged between 18 and 58 years old (M = 33.87; SD = 8.64) filled a protocol to assess Trait EI, Illness Perceptions, General Distress, and Quality of Life. Structural Equation Modelling was used to assess the relationship between the observed variables. Illness Perception was a mediator in the relationship between Trait EI, General Distress, and Quality of Life. Moreover, General Distress was a mediator between Trait EI and Quality of Life, and between Illness Perceptions and Quality of Life. Results showed that both Trait EI and Illness perceptions are key components for levels of distress and quality of life in women with endometriosis.
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Affiliation(s)
- Nadia Barberis
- Dipartimento di Scienze della Salute, Università degli Studi MagnaGraecia di Catanzaro, viale Europa, Catanzaro (CZ), Italy
| | - Marco Cannavò
- Dipartimento di Scienze della Salute, Università degli Studi MagnaGraecia di Catanzaro, viale Europa, Catanzaro (CZ), Italy
| | - Francesca Cuzzocrea
- Dipartimento di Scienze della Salute, Università degli Studi MagnaGraecia di Catanzaro, viale Europa, Catanzaro (CZ), Italy
| | - Valeria Saladino
- Dipartimento di Scienze umane, sociali e della salute, Università degli studi di Cassino e del Lazio Meridionale, viale dell'Università, Cassino (FR), Italy
| | - Valeria Verrastro
- Dipartimento di Scienze della Salute, Università degli Studi MagnaGraecia di Catanzaro, viale Europa, Catanzaro (CZ), Italy
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van Stein K, Schubert K, Ditzen B, Weise C. Understanding Psychological Symptoms of Endometriosis from a Research Domain Criteria Perspective. J Clin Med 2023; 12:4056. [PMID: 37373749 DOI: 10.3390/jcm12124056] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Endometriosis is currently the second most common gynecological disease and is associated with severe pain, vegetative impairment, and infertility. In association, there are considerable psychological symptoms that limit the quality of life of those affected. In this narrative review, the Research Domain Criteria (RDoC) framework was utilized to display the different transdiagnostic processes involved in disease progression and maintenance in regard to psychosocial functioning. Using the RDoC framework, it becomes clear that immune/endocrinological dysregulation is interlocked with (pelvic) pain chronification processes and psychological symptoms such as depressive mood, loss of control, higher vigilance toward the onset or worsening of symptoms, social isolation, and catastrophizing. This paper will discuss and identify promising treatment approaches, in addition to medical care, as well as further research implications. Endometriosis can come with substantial psychosomatic and social burden, requiring more research to understand the interdependence of different factors involved in its chronic development pathway. However, it is already clear that standard care should be extended with multifaceted treatments addressing pain, as well as the psychological and social burden, in order to halt the cycle of aggravation of symptoms and to improve quality of life for patients.
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Affiliation(s)
- Katharina van Stein
- Heidelberg University Hospital, Institute for Medical Psychology, 69115 Heidelberg, Germany
- Faculty of Behavioral and Cultural Studies, Ruprecht Karls-University, 69115 Heidelberg, Germany
| | - Kathrin Schubert
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, 35032 Marburg, Germany
| | - Beate Ditzen
- Heidelberg University Hospital, Institute for Medical Psychology, 69115 Heidelberg, Germany
- Faculty of Behavioral and Cultural Studies, Ruprecht Karls-University, 69115 Heidelberg, Germany
| | - Cornelia Weise
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, 35032 Marburg, Germany
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Nieves-Vázquez CI, Detrés-Marquéz AC, Torres-Reverón A, Appleyard CB, Llorens-De Jesús AP, Resto IN, López-Rodríguez V, Ramos-Echevarría PM, Castro EM, Flores I. Feasibility and acceptability of an adapted environmental enrichment intervention for endometriosis: A pilot study. Front Glob Womens Health 2023; 3:1058559. [PMID: 36683601 PMCID: PMC9846621 DOI: 10.3389/fgwh.2022.1058559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/28/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction We have previously shown that Environmental Enrichment (EE)-consisting of social support, novelty, and open spaces-decreased disease progression and anxiety in a rat model of endometriosis. We developed a novel EE intervention to be tested in a pilot randomized clinical trial (RCT) in patients with endometriosis, a painful, stressful disease. Objective To translate and evaluate the feasibility and acceptability of an adapted EE intervention as an adjuvant to standard-of-care for endometriosis patients. Methods Feasibility was assessed through recruitment, enrollment, and adherence rates. Acceptability was evaluated through a post-intervention survey and focus group discussion 3-months after the end of the intervention. Results Of the 103 subjects recruited, 64 were randomized to the intervention group and 39 to the control group. At the start of the intervention, the study groups consisted of 29 (intervention) and 27 (control) subjects. Enrollment rates were 45.3% and 69.2%, and adherence rates were 41.4% and 100% for the intervention and control groups, respectively. Delays resulting from natural events (earthquakes, the COVID-19 pandemic) impacted enrollment and adherence rates. The most common reasons for missing an intervention were period pain (39.1%) and work-study (34.8%). There was high acceptability (>80%) of the intervention's logistics. The majority (82.4%) of subjects would continue participating in support groups regularly, and 95.7% would recommend the intervention to other patients. Conclusions We showed that EE could be translated into an acceptable integrative multi-modal therapy perceived as valuable among participants who completed the intervention. High attrition/low adherence indicates that additional refinements would be needed to improve feasibility. Acceptability data indicate that EE has the potential to be integrated into the clinical management of patients with endometriosis and other inflammatory, painful disorders. Studies are ongoing to assess the efficacy of EE in improving pain symptoms, mental health, and quality of life (QoL).
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Affiliation(s)
| | | | - Annelyn Torres-Reverón
- Department of Basic Sciences, Ponce Health Science University, Ponce, Puerto Rico
- Sur180 Therapeutics, LLC, McAllen, TX, United States
| | - Caroline B. Appleyard
- School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico
- Department of Basic Sciences, Ponce Health Science University, Ponce, Puerto Rico
- Sur180 Therapeutics, LLC, McAllen, TX, United States
| | | | - Ivana N. Resto
- School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico
| | | | | | - Eida M. Castro
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Idhaliz Flores
- School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico
- Department of Basic Sciences, Ponce Health Science University, Ponce, Puerto Rico
- Sur180 Therapeutics, LLC, McAllen, TX, United States
- Department of Obstetrics and Gynecology, Ponce Health Sciences University, Ponce, Puerto Rico
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Learning from Online Video Education (LOVE) improves confidence in fertility treatments: a randomized controlled trial. NPJ Digit Med 2022; 5:128. [PMID: 36038614 PMCID: PMC9424217 DOI: 10.1038/s41746-022-00673-y] [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: 02/01/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Fertility treatments like in vitro fertilization (IVF) or oocyte cryopreservation (OC) require the daily use of injectable gonadotropins and has been associated with treatment burden and attrition from fertility treatment. We conducted a randomized clinical trial to determine (1) whether educational videos about fertility medications improved infertility self-efficacy scale (ISES), fertility quality of life treatment (FertiQoL-T), and Perceived stress scale (PSS) scores and (2) if such videos improved confidence and reduced medication errors during a first ovarian stimulation cycle. Participants were given access to an online portal with randomized access to either placebo control videos focused on an orientation to IVF or experimental videos that reviewed the preparation and administration of medications used during ovarian stimulation in addition to the placebo videos. Participants completed pre and post-treatment questionnaires. 368 patients enrolled and 257 participants completed the study. There were no differences in ISES, FertiQoL-T or PSS scores between the two groups in an intention-to-treat (p = 0.18, 0.72, and 0.92, respectively) or per-protocol analysis (p = 0.11, 0.38, and 0.37, respectively). In the per protocol analysis, participants who watched experimental videos were four-fold more likely to report confidence administering medications OR 4.70 (95% CI: 2.10, 11.1; p < 0.01) and were 63% less likely to make medication errors OR 0.37 (95% CI: 0.14, 0.90; p = 0.03). Participants had similar likelihoods of rating videos as helpful and recommending videos to others (p = 0.06 and 0.3, respectively). Educational videos about fertility medications may not influence psychological well-being but might improve confidence in medication administration and reduce medication errors. Trial registration number: NCT02979990.
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Vannuccini S, Clemenza S, Rossi M, Petraglia F. Hormonal treatments for endometriosis: The endocrine background. Rev Endocr Metab Disord 2022; 23:333-355. [PMID: 34405378 PMCID: PMC9156507 DOI: 10.1007/s11154-021-09666-w] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 12/25/2022]
Abstract
Endometriosis is a benign uterine disorder characterized by menstrual pain and infertility, deeply affecting women's health. It is a chronic disease and requires a long term management. Hormonal drugs are currently the most used for the medical treatment and are based on the endocrine pathogenetic aspects. Estrogen-dependency and progesterone-resistance are the key events which cause the ectopic implantation of endometrial cells, decreasing apoptosis and increasing oxidative stress, inflammation and neuroangiogenesis. Endometriotic cells express AMH, TGF-related growth factors (inhibin, activin, follistatin) CRH and stress related peptides. Endocrine and inflammatory changes explain pain and infertility, and the systemic comorbidities described in these patients, such as autoimmune (thyroiditis, arthritis, allergies), inflammatory (gastrointestinal/urinary diseases) and mental health disorders.The hormonal treatment of endometriosis aims to block of menstruation through an inhibition of hypothalamus-pituitary-ovary axis or by causing a pseudodecidualization with consequent amenorrhea, impairing the progression of endometriotic implants. GnRH agonists and antagonists are effective on endometriosis by acting on pituitary-ovarian function. Progestins are mostly used for long term treatments (dienogest, NETA, MPA) and act on multiple sites of action. Combined oral contraceptives are also used for reducing endometriosis symptoms by inhibiting ovarian function. Clinical trials are currently going on selective progesterone receptor modulators, selective estrogen receptor modulators and aromatase inhibitors. Nowadays, all these hormonal drugs are considered the first-line treatment for women with endometriosis to improve their symptoms, to postpone surgery or to prevent post-surgical disease recurrence. This review aims to provide a comprehensive state-of-the-art on the current and future hormonal treatments for endometriosis, exploring the endocrine background of the disease.
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Affiliation(s)
- Silvia Vannuccini
- Obstetrics and Gynecology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Sara Clemenza
- Obstetrics and Gynecology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Margherita Rossi
- Obstetrics and Gynecology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Felice Petraglia
- Obstetrics and Gynecology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy.
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Missmer SA, Tu F, Soliman AM, Chiuve S, Cross S, Eichner S, Antunez Flores O, Horne A, Schneider B, As-Sanie S. Impact of endometriosis on women's life decisions and goal attainment: a cross-sectional survey of members of an online patient community. BMJ Open 2022; 12:e052765. [PMID: 35477879 PMCID: PMC9047767 DOI: 10.1136/bmjopen-2021-052765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 03/28/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To examine women's perceptions of endometriosis-associated disease burden and its impact on life decisions and goal attainment. DESIGN An anonymous online survey was distributed in October 2018 through the social media network MyEndometriosisTeam.com. PARTICIPANTS Women aged 19 years and older living in several English-speaking countries who self-identified as having endometriosis. OUTCOME MEASURES Patients' perspectives on how endometriosis has affected their work, education, relationships, overall life decisions and attainment of goals. Subanalyses were performed for women who identified as 'less positive about the future' (LPAF) or had 'not reached their full potential' (NRFP) due to endometriosis. RESULTS 743 women completed the survey. Women reported high levels of pain when pain was at its worst (mean score, 8.9 on severity scale of 0 (no pain) to 10 (worst imaginable pain)) and most (56%, n=415) experienced pain daily. Women reported other negative experiences attributed to endometriosis, including emergency department visits (66%, n=485), multiple surgeries (55%, n=406) and prescription treatments for symptoms of endometriosis (72%, n=529). Women indicated that they believed endometriosis had a negative impact on their educational and professional achievements, social lives/relationships and overall physical health. Most women 'somewhat agreed'/'strongly agreed' that endometriosis caused them to lose time in life (81%, n=601), feel LPAF (80%, n=589) and feel they had NRFP (75%, n=556). Women who identified as LPAF or NRFP generally reported more negative experiences than those who were non-LPAF or non-NRFP. CONCLUSIONS Women who completed this survey reported pain and negative experiences related to endometriosis that were perceived to negatively impact major life-course decisions and attainment of goals. Greater practitioner awareness of the impact that endometriosis has on a woman's life course and the importance of meaningful dialogue with patients may be important for improving long-term management of the disease and help identify women who are most vulnerable.
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Affiliation(s)
- Stacey A Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Boston Center for Endometriosis, Boston, Massachusetts, USA
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids, Michigan, USA
| | - Frank Tu
- Department of Obstetrics and Gynecology, NorthShore University Health System, Evanston, Illinois, USA
- Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Evanston, Illinois, USA
| | | | | | | | | | | | - Andrew Horne
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | | | - Sawsan As-Sanie
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
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Schubert K, Lohse J, Kalder M, Ziller V, Weise C. Internet-based cognitive behavioral therapy for improving health-related quality of life in patients with endometriosis: study protocol for a randomized controlled trial. Trials 2022; 23:300. [PMID: 35414092 PMCID: PMC9006397 DOI: 10.1186/s13063-022-06204-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/26/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The trial investigates the efficacy of internet-based cognitive behavioral therapy (iCBT) in improving health-related QoL in patients with endometriosis, which is a chronic gynecological condition affecting up to 15% of people with female-assigned reproductive organs. Endometriosis is stress-related and comes with various physical symptoms such as pelvic pain and infertility. It has a substantial impact on health-related quality of life (QoL), and mind-body interventions seem promising in reducing the psychological burden. METHODS This is a monocentric randomized-controlled trial recruiting 120 patients with endometriosis. The intervention consists of eight iCBT modules focusing on psychoeducation, cognitive restructuring, pacing, and emotion regulation. Participants will receive written feedback from a trained therapist weekly. The comparator is a waitlist control group. All participants will be followed up 3 months after the intervention, and the intervention group will additionally be followed up 12 months after the intervention. Trial participants will not be blinded to the allocated trial arm. Primary outcome measures are endometriosis-related QoL, pain, and pain-related disability. Secondary outcomes include coping, illness representations, and psychological flexibility. Statistical analyses will be performed following intention-to-treat principles. DISCUSSION This randomized-controlled trial is the first trial to test the efficacy of iCBT for improving endometriosis-related QoL. Potential predictor variables and key mechanisms in treatment will be investigated to enable further progression in medical and psychological care for patients with endometriosis. TRIAL REGISTRATION ClinicalTrials.gov , NCT05098444 Registered on October 28, 2021.
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Affiliation(s)
- Kathrin Schubert
- Dept. of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Johanna Lohse
- Dept. of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Matthias Kalder
- Clinic for Gynecology and Obstetrics, University Hospital of Giessen and Marburg (UKGM), Marburg, Germany
| | - Volker Ziller
- Clinic for Gynecology and Obstetrics, University Hospital of Giessen and Marburg (UKGM), Marburg, Germany
| | - Cornelia Weise
- Dept. of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany.
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10
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Casalechi M, Vieira-Lopes M, Quessada MP, Arão TC, Reis FM. Endometriosis and related pelvic pain: association with stress, anxiety and depressive symptoms. Minerva Obstet Gynecol 2021; 73:283-289. [PMID: 34008383 DOI: 10.23736/s2724-606x.21.04704-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endometriosis is a chronic inflammatory disease affecting 10% of women in reproductive age and manifested as infertility and pelvic pain, which may be severe and incapacitating. This review aims to address the latest evidence on the association of endometriosis with chronic stress, anxiety and depression, and to find out whether the effective treatment of endometriosis has the additional benefit of attenuating these psychological comorbidities. Studies have found that women with endometriosis, especially those with painful symptoms, have higher levels of stress and a decreased quality of life compared to healthy women. Importantly, depression and anxiety are more prevalent in women with endometriosis, and the presence of psychiatric disorders correlates more to the severity of the endometriosis-related pain than to other disease characteristics. Considering therapeutic implications, controlled clinical trials found that medical and surgical treatments of endometriosis also ameliorated perceived stress, anxiety and depressive symptoms. In conclusion, current evidence indicates that women with endometriosis have an increased prevalence of psychological disorders which correlate more with pain itself than with endometriosis per se. In addition, the effective treatment of endometriosis may reduce the psychological burden of the disease.
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Chen H, Vannuccini S, Capezzuoli T, Ceccaroni M, Mubiao L, Shuting H, Wu Y, Huang H, Petraglia F. Comorbidities and Quality of Life in Women Undergoing First Surgery for Endometriosis: Differences Between Chinese and Italian Population. Reprod Sci 2021; 28:2359-2366. [PMID: 33751460 PMCID: PMC8289763 DOI: 10.1007/s43032-021-00487-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 02/02/2021] [Indexed: 12/20/2022]
Abstract
An observational cross-sectional study was conducted in a group (n = 371) of fertile age women with endometriosis, by administering a structured questionnaire, in order to evaluate the incidence of gynecological and systemic comorbidities and the impact on quality of life (QoL) in two different groups of Italian and Chinese patients affected by endometriosis. Chinese (n = 175) and Italian (n = 196) women were compared regarding systemic (inflammatory, autoimmune, and mental) and gynecological comorbidities, pain symptoms, and QoL, by using the Short Form 12 (SF-12). Italian patients resulted younger at the diagnosis and suffered more frequently from severe pain than Chinese ones. Deep infiltrating endometriosis (DIE) and mixed phenotypes were more frequent in Italian patients, whereas ovarian (OMA) and superficial endometriosis (SUP) were more common in the Chinese. The Italian group showed more systemic comorbidities, and those disorder were already present before the diagnosis of endometriosis. Furthermore, the Italian group showed lower SF-12 physical and mental scores, suggesting a worse health-related QoL in Italian endometriotic patients. A number of differences has been observed between Italian and Chinese women with endometriosis in terms of comorbidities and QoL, which may be related to the ethnicity, the different health system organization and the social and cultural background.
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Affiliation(s)
- Huixi Chen
- Obstetrics and Gynecology, Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy.,International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Silvia Vannuccini
- Obstetrics and Gynecology, Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy.,Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Tommaso Capezzuoli
- Obstetrics and Gynecology, Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Marcello Ceccaroni
- Gynecology and Obstetrics, Gynecologic Oncology, Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Liu Mubiao
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Huang Shuting
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Yanting Wu
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Hefeng Huang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Felice Petraglia
- Obstetrics and Gynecology, Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy.
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12
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Missmer SA, Tu FF, Agarwal SK, Chapron C, Soliman AM, Chiuve S, Eichner S, Flores-Caldera I, Horne AW, Kimball AB, Laufer MR, Leyland N, Singh SS, Taylor HS, As-Sanie S. Impact of Endometriosis on Life-Course Potential: A Narrative Review. Int J Gen Med 2021; 14:9-25. [PMID: 33442286 PMCID: PMC7800443 DOI: 10.2147/ijgm.s261139] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/08/2020] [Indexed: 12/16/2022] Open
Abstract
Endometriosis may exert a profound negative influence on the lives of individuals with the disorder, adversely affecting quality of life, participation in daily and social activities, physical and sexual functioning, relationships, educational and work productivity, mental health, and well-being. Over the course of a lifetime, these daily challenges may translate into limitations in achieving life goals such as pursuing or completing educational opportunities; making career choices or advancing in a chosen career; forming stable, fulfilling relationships; or starting a family, all of which ultimately alter one's life trajectory. The potential for endometriosis to impact the life course is considerable, as symptom onset generally occurs at a time of life (menarche through menopause, adolescence through middle age) when multiple life-changing and trajectory-defining decisions are made. Using a life-course approach, we examine how the known effects of endometriosis on life-domain satisfaction may impact health and well-being across the life course of affected individuals. We provide a quasi-systematic, narrative review of the literature as well as expert opinion on recommendations for clinical management and future research directions.
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Affiliation(s)
- Stacey A Missmer
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
| | - Frank F Tu
- Department of Obstetrics and Gynecology, NorthShore University Health System, Evanston, IL, USA
| | - Sanjay K Agarwal
- Department of Reproductive Medicine, Center for Endometriosis Research and Treatment, University of California San Diego, La Jolla, CA, USA
| | - Charles Chapron
- Department of Gynecology Obstetrics II and Reproductive Medicine, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, Paris, France
| | | | | | | | - Idhaliz Flores-Caldera
- Department of Obstetrics and Gynecology, Ponce Health Sciences University - Ponce Research Institute, School of Medicine, Ponce, Puerto Rico
| | - Andrew W Horne
- Department of Gynaecology and Reproductive Sciences, MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Alexandra B Kimball
- Harvard Medical Faculty Physicians, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Marc R Laufer
- Department of Obstetrics, Gynecology, and Reproductive Biology, Boston Center for Endometriosis and Boston Children's Hospital and Brigham and Women's Hospital, Boston, MA, USA
| | - Nicholas Leyland
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, Ontario, Canada
| | - Sukhbir S Singh
- Department of Obstetrics and Gynaecology, University of Ottawa, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Sawsan As-Sanie
- Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, MI, USA
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13
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Capezzuoli T, Vannuccini S, Mautone D, Sorbi F, Chen H, Reis FM, Ceccaroni M, Petraglia F. Long-term hormonal treatment reduces repetitive surgery for endometriosis recurrence. Reprod Biomed Online 2020; 42:451-456. [PMID: 33277193 DOI: 10.1016/j.rbmo.2020.09.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/05/2020] [Accepted: 09/17/2020] [Indexed: 12/16/2022]
Abstract
RESEARCH QUESTION How effective is medical hormonal treatment in preventing endometriosis recurrence and in improving women's clinical symptoms and quality of life? DESIGN This observational cross-sectional study evaluated the effects of hormonal medical treatment (progestins, gonadotrophin-releasing hormone analogues or continuous oral contraceptives) on endometriosis recurrence, current clinical symptoms and quality of life in three groups of patients: Group A (n = 34), no hormonal treatment either before or after the first endometriosis surgery; Group B (n = 76), on hormonal treatment after the first endometriosis surgery; and Group C (n = 75), on hormonal treatment both before and after the first endometriosis surgery. RESULTS Group C patients were characterized by a lower rate of endometriosis reoperation (P = 0.011) and a lower rate of dysmenorrhoea (P = 0.006). Women who experienced repetitive endometriosis surgery showed worse physical (P = 0.004) and mental (P = 0.012) status than those who received a single surgery, independent of the treatment. CONCLUSION Hormonal treatments represent a valid cornerstone of endometriosis management and may be useful as an alternative to surgery, but also before surgery, to plan better, and after surgery in order to reduce the risk of recurrence. Medical counselling is very helpful in choosing the correct and individualized endometriosis treatment. In fact, the gold standard for modern endometriosis management is the individualized approach and surgery should be considered, depending on the clinical situation and a patient's symptoms.
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Affiliation(s)
- Tommaso Capezzuoli
- Department of Clinical Experimental and Biomedical Sciences, University of Florence Florence, Italy
| | - Silvia Vannuccini
- Obstetrics and Gynecology, Department of Maternity and Infancy, AOU Careggi Florence, Italy; Department of Molecular and Developmental Medicine, University of Siena Siena, Italy
| | - Daniele Mautone
- Gynecology and Obstetrics, Gynecologic Oncology, Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacro Cuore Don Calabria Hospital, Negar di Valpolicella, Verona, Italy
| | - Flavia Sorbi
- Department of Clinical Experimental and Biomedical Sciences, University of Florence Florence, Italy
| | - Huixi Chen
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai, China
| | - Fernando M Reis
- Universidade Federal de Minas Gerais, Division of Human Reproduction, Belo Horizonte, Brazil
| | - Marcello Ceccaroni
- Gynecology and Obstetrics, Gynecologic Oncology, Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacro Cuore Don Calabria Hospital, Negar di Valpolicella, Verona, Italy
| | - Felice Petraglia
- Department of Clinical Experimental and Biomedical Sciences, University of Florence Florence, Italy.
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14
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Reis FM, Coutinho LM, Vannuccini S, Luisi S, Petraglia F. Is Stress a Cause or a Consequence of Endometriosis? Reprod Sci 2020; 27:39-45. [PMID: 32046437 DOI: 10.1007/s43032-019-00053-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/05/2019] [Indexed: 12/18/2022]
Abstract
Clinical studies clearly indicate that endometriosis is a condition associated with high levels of chronic stress. The stress intensity correlates with pain severity and disease extension. However, it is unknown whether chronic stress represents a primary cause of endometriosis and, therefore, if avoiding or treating chronic stress may reduce the risk of developing endometriosis. Repeated, uncontrolled stress either before or after experimental endometriosis induction promotes disease mechanisms and accelerates lesion growth in rodents. Furthermore, patients with endometriosis have a heightened risk of other inflammatory and immune-related diseases, many of which have also been associated with stress. Here, we review the latest evidences regarding the relationship between chronic stress and endometriosis and discuss the potential bidirectional aspect of such association. Further research may clarify if endometriosis is a cause and/or a consequence of stress and whether stress-reducing therapies are effective to mitigate symptoms and slow down the development of endometriotic lesions.
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Affiliation(s)
- Fernando M Reis
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Larissa M Coutinho
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Department of Maternal and Child Health, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Silvia Vannuccini
- Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Florence, Careggi University Hospital, Largo G. Alessandro Brambilla, 3, 50134, Florence, FI, Italy.,Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University Hospital of Siena, Siena, Italy
| | - Stefano Luisi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University Hospital of Siena, Siena, Italy
| | - Felice Petraglia
- Department of Experimental, Clinical and Biomedical Sciences, Obstetrics and Gynecology, University of Florence, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
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15
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Brasil DL, Montagna E, Trevisan CM, La Rosa VL, Laganà AS, Barbosa CP, Bianco B, Zaia V. Psychological stress levels in women with endometriosis: systematic review and meta-analysis of observational studies. Minerva Med 2019; 111:90-102. [PMID: 31755674 DOI: 10.23736/s0026-4806.19.06350-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, associated with chronic and inflammatory reaction. Symptoms range from dysmenorrhea, dyspareunia, chronic pelvic pain, unexplained infertility to asymptomatic. The patients' quality of life is affected by anxiety, depression and stress. We aimed to verify the prevalence and levels of psychological stress among women with endometriosis. EVIDENCE ACQUISITION The systematic review followed the PRISMA statement and the MOOSE guideline. Databases searched were MEDLINE, EMBASE, PsychNET and SciELO. The risk of bias was assessed with a modified Newcastle-Ottawa Scale. The meta-analysis of proportions used inverse variance method for pooling and random-effects model. For the stress levels we used the restricted maximum likelihood estimator for summary effects. Heterogeneity was assessed through I2 and Q statistics. Publication bias was assessed through funnel plots. Meta-regression adopted a mixed-effects model, considering patient age, endometriosis staging, stress assessment tool and data collection as categorical moderators. EVIDENCE SYNTHESIS We included 15 studies encompassing 4,619 women with endometriosis. The overall prevalence of mild/high stress was 68% (95%CI:57%-79%), I2=98% and τ2=0.0228. The mean level of stress was 41.78% (95%CI =34.05%-49.51%), I2=99.9% and τ2=83.35. Meta-regression showed relationship with endometriosis staging. CONCLUSIONS This is the first meta-analysis exploring the association between endometriosis and psychological stress. The interdisciplinary management of the disease should expand the mental health support in this patient care, beyond pain management. Finally, the attitude of the medical team acknowledging the patients' psychological stress may positively affect their treatment.
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Affiliation(s)
- Diogo L Brasil
- Facultade de Medicine do ABC/Centro Universitário Saúde ABC, Santo André, Brazil
| | - Erik Montagna
- Facultade de Medicine do ABC/Centro Universitário Saúde ABC, Santo André, Brazil -
| | - Camila M Trevisan
- Facultade de Medicine do ABC/Centro Universitário Saúde ABC, Santo André, Brazil
| | - Valentina L La Rosa
- Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Catania, Italy
| | - Antonio S Laganà
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Caio P Barbosa
- Facultade de Medicine do ABC/Centro Universitário Saúde ABC, Santo André, Brazil.,Discipline of Sexual and Reproductive Health and Populational Genetics, Department of Collective Health, Faculdade de Medicina do ABC/Centro Universitário Saúde ABC, Santo André, Brazil
| | - Bianca Bianco
- Facultade de Medicine do ABC/Centro Universitário Saúde ABC, Santo André, Brazil.,Discipline of Sexual and Reproductive Health and Populational Genetics, Department of Collective Health, Faculdade de Medicina do ABC/Centro Universitário Saúde ABC, Santo André, Brazil
| | - Victor Zaia
- Facultade de Medicine do ABC/Centro Universitário Saúde ABC, Santo André, Brazil.,Discipline of Sexual and Reproductive Health and Populational Genetics, Department of Collective Health, Faculdade de Medicina do ABC/Centro Universitário Saúde ABC, Santo André, Brazil
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16
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Vannuccini S, Reis FM, Coutinho LM, Lazzeri L, Centini G, Petraglia F. Surgical treatment of endometriosis: prognostic factors for better quality of life. Gynecol Endocrinol 2019; 35:1010-1014. [PMID: 31155975 DOI: 10.1080/09513590.2019.1616688] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The present study investigated the effect of surgical treatment of endometriosis on physical and mental health. We undertook a prospective survey including 153 premenopausal women with histological diagnosis of endometriosis. The Short Form 12 (SF-12) questionnaire comprising physical and mental component scales was used. Two groups of patients were distinguished: Group A (n = 42) with SF-12 scores above the median in both physical and mental scales; Group B (n = 111) with SF-12 scores below the median in either physical or mental scale. Group A was diagnosed and operated for endometriosis for the first time at an older age (30 vs. 26 years), had undergone more frequently a single surgical intervention (64% vs. 46%), was less affected by symptom or lesion recurrence and had reported less intense current pain symptoms than Group B. Having the first endometriosis surgery at a later age was an independent predictor of better health status (adjusted odds ratio 1.146 per year, 95% confidence interval 1.058-1.242) after accounting for the potential confounding effects of reoperation, pelvic pain and time elapsed since the first surgery. In conclusion, patients with endometriosis who had a single surgery at an older age have good symptom control and better quality of life (QoL).
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Affiliation(s)
- Silvia Vannuccini
- Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Florence, Careggi University Hospital , Florence , Italy
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University Hospital of Siena , Siena , Italy
| | - Fernando M Reis
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Larissa M Coutinho
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
- Department of Maternal and Child Health, Universidade Federal de Juiz de Fora , Juiz de Fora , Brazil
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University Hospital of Siena , Siena , Italy
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University Hospital of Siena , Siena , Italy
| | - Felice Petraglia
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital , Florence , Italy
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17
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Vannuccini S, Lazzeri L, Orlandini C, Morgante G, Bifulco G, Fagiolini A, Petraglia F. Mental health, pain symptoms and systemic comorbidities in women with endometriosis: a cross-sectional study. J Psychosom Obstet Gynaecol 2018; 39:315-320. [PMID: 29027829 DOI: 10.1080/0167482x.2017.1386171] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Endometriosis is a gynecological disease with a severe impact on quality of life. The aim of this study is to assess mental health status in a group of women with endometriosis, investigating their clinical history, pain symptoms and systemic comorbidities. METHODS An observational cross-sectional study was performed on a group of Italian Caucasian women with endometriosis (n = 134). All patients filled the 'Patient Health Questionnaire' (PHQ), a self-administered screening tool for mental health disorders. The characteristics of endometriosis, pain symptoms and their severity, the presence and types of comorbid systemic disorders were added into the same survey. RESULTS According to PHQ algorithms, 59% of patients were affected by at least one psychiatric disorder, with a significant correlation with pain symptoms (p = 0.0026). Patients with severe pain showed a higher incidence of multiple psychiatric disorders (p = 0.026) and somatoform disorder than those with mild pain (p = 0.0009). There was no correlation between the presence of psychiatric disorders and age, BMI, parity, infertility, need for surgery, number of intervention, localization of endometriotic lesions and systemic comorbidities. DISCUSSION Women with endometriosis showed a high frequency of PHQ results positive for psychiatric disorders, with a significant association with pain severity.
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Affiliation(s)
- Silvia Vannuccini
- a Obstetrics and Gynecology, Department of Molecular and Developmental Medicine , University of Siena, "S. Maria alle Scotte" , Siena , Italy
| | - Lucia Lazzeri
- a Obstetrics and Gynecology, Department of Molecular and Developmental Medicine , University of Siena, "S. Maria alle Scotte" , Siena , Italy
| | - Cinzia Orlandini
- a Obstetrics and Gynecology, Department of Molecular and Developmental Medicine , University of Siena, "S. Maria alle Scotte" , Siena , Italy
| | - Giuseppe Morgante
- a Obstetrics and Gynecology, Department of Molecular and Developmental Medicine , University of Siena, "S. Maria alle Scotte" , Siena , Italy
| | - Giuseppe Bifulco
- b Obstetrics and Gynecology, Department of Neuroscience, Reproductive Medicine and Dentistry , University of Naples 'Federico II' , Naples , Italy
| | - Andrea Fagiolini
- c Psychiatry, Department of Molecular Medicine , University of Siena, "S. Maria alle Scotte" , Siena , Italy
| | - Felice Petraglia
- d Obstetrics and Gynecology, Department of Biomedical, Experimental and Clinical Sciences "Mario Serio" , University of Florence, Careggi University Hospital, Largo Brambilla , Florence , Italy
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18
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Ramin-Wright A, Schwartz ASK, Geraedts K, Rauchfuss M, Wölfler MM, Haeberlin F, von Orelli S, Eberhard M, Imthurn B, Imesch P, Fink D, Leeners B. Fatigue – a symptom in endometriosis. Hum Reprod 2018; 33:1459-1465. [DOI: 10.1093/humrep/dey115] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 04/20/2018] [Accepted: 05/13/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
- Annika Ramin-Wright
- University Hospital Zurich, Dept of Reproductive Endocrinology, Frauenklinikstrasse 10, Zurich, Switzerland
| | - Alexandra Sabrina Kohl Schwartz
- University Hospital Zurich, Dept of Reproductive Endocrinology, Frauenklinikstrasse 10, Zurich, Switzerland
- University Women’s Hospital, Division of Gynecological Endocrinology and Reproductive Medicines, Effingerstrasse 102, Bern, Switzerland
| | - Kirsten Geraedts
- University Hospital Zurich, Dept of Reproductive Endocrinology, Frauenklinikstrasse 10, Zurich, Switzerland
| | - Martina Rauchfuss
- Charité Berlin, Dept of Psychosomatics, Sauerbruchweg 5, Berlin, Germany
| | - Monika Martina Wölfler
- University Hospital Graz, Dept of Gynecology and Obstetrics, Auenbruggerplatz 1, Graz, Austria
| | - Felix Haeberlin
- Canton Hospital St. Gallen, Dept of Gynecology and Obstetrics, St. Gallen, Rorschacherstrasse 501, St. Gallen, Switzerland
| | - Stephanie von Orelli
- Triemli Hospital Zurich, Dept of Gynecology and Obstetrics, Birmesdorferstrasse 497, Zurich, Switzerland
| | - Markus Eberhard
- Canton Hospital Schaffhausen, Dept of Gynecology and Obstetrics, Geissbergstrasse 81, Schaffhausen, Switzerland
| | - Bruno Imthurn
- University Hospital Zurich, Dept of Reproductive Endocrinology, Frauenklinikstrasse 10, Zurich, Switzerland
| | - Patrick Imesch
- University Hospital Zurich, Dept of Gynecology, Frauenklinikstrasse 10, Zurich, Switzerland
| | - Daniel Fink
- University Hospital Zurich, Dept of Gynecology, Frauenklinikstrasse 10, Zurich, Switzerland
| | - Brigitte Leeners
- University Hospital Zurich, Dept of Reproductive Endocrinology, Frauenklinikstrasse 10, Zurich, Switzerland
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19
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Dienogest Treatment Improves Quality of Life in Women with Endometriosis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2016. [DOI: 10.5301/je.5000232] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The aim of this study was to assess the efficacy of dienogest treatment in improving quality of life in women with endometriosis. Methods This was a prospective observational multicenter study at the universities of Siena, Milano, Cagliari, Perugia, Busto Arstizio, Pisa, Padova, Palermo, Foggia, Roma, Pescara and Catanzaro, including 142 patients with a diagnosis of endometriosis who received dienogest 2 mg once daily, for up to 90 days. Each patient underwent an evaluation of pelvic pain measured by visual analogue scale (VAS) from 0 to 10 points, and of quality of life measured by a mental and physical index before and after treatment. Results The mean ± SD of VAS was 8.2 ± 1.6 in women with endometriosis, and this progressively and significantly decreased to 5.9 ± 2.6 at the end of the study. Mental index score values increased from 39.0 ± 9.8 to 46.0 ± 9.1 (p<0.001); likewise, the physical index increased from 39.6 ± 9.6 to 47.7 ± 8.5 (p<0.001). During the treatment period, the most frequent adverse events (AEs) were headache (30.8%), followed by bleeding (29.4%), depression (26.6%), breast tenderness (23.8%) and acne (2.0%), but these were transitory, and none led to withdrawal from the study. Conclusions The present prospective study showed that dienogest is an effective and well-tolerated treatment improving the quality of life in endometriotic women.
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20
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Staal A, van der Zanden M, Nap A. Diagnostic Delay of Endometriosis in the Netherlands. Gynecol Obstet Invest 2016; 81:321-4. [DOI: 10.1159/000441911] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/15/2015] [Indexed: 11/19/2022]
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