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Mortlock S, Houshdaran S, Kosti I, Rahmioglu N, Nezhat C, Vitonis AF, Andrews SV, Grosjean P, Paranjpe M, Horne AW, Jacoby A, Lager J, Opoku-Anane J, Vo KC, Manvelyan E, Sen S, Ghukasyan Z, Collins F, Santamaria X, Saunders P, Kober K, McRae AF, Terry KL, Vallvé-Juanico J, Becker C, Rogers PAW, Irwin JC, Zondervan K, Montgomery GW, Missmer S, Sirota M, Giudice L. Global endometrial DNA methylation analysis reveals insights into mQTL regulation and associated endometriosis disease risk and endometrial function. Commun Biol 2023; 6:780. [PMID: 37587191 PMCID: PMC10432557 DOI: 10.1038/s42003-023-05070-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/23/2023] [Indexed: 08/18/2023] Open
Abstract
Endometriosis is a leading cause of pain and infertility affecting millions of women globally. Herein, we characterize variation in DNA methylation (DNAm) and its association with menstrual cycle phase, endometriosis, and genetic variants through analysis of genotype data and methylation in endometrial samples from 984 deeply-phenotyped participants. We estimate that 15.4% of the variation in endometriosis is captured by DNAm and identify significant differences in DNAm profiles associated with stage III/IV endometriosis, endometriosis sub-phenotypes and menstrual cycle phase, including opening of the window for embryo implantation. Menstrual cycle phase was a major source of DNAm variation suggesting cellular and hormonally-driven changes across the cycle can regulate genes and pathways responsible for endometrial physiology and function. DNAm quantitative trait locus (mQTL) analysis identified 118,185 independent cis-mQTLs including 51 associated with risk of endometriosis, highlighting candidate genes contributing to disease risk. Our work provides functional evidence for epigenetic targets contributing to endometriosis risk and pathogenesis. Data generated serve as a valuable resource for understanding tissue-specific effects of methylation on endometrial biology in health and disease.
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Affiliation(s)
- Sally Mortlock
- The Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4072, Australia.
| | - Sahar Houshdaran
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Idit Kosti
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA, USA
| | - Nilufer Rahmioglu
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's and Reproductive Health, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Camran Nezhat
- Stanford University Medical Center, Palo Alto, CA, USA
- University of California San Francisco, San Francisco, CA, USA
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Woodside, CA, USA
| | - Allison F Vitonis
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Shan V Andrews
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA, USA
| | - Parker Grosjean
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA, USA
| | - Manish Paranjpe
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA, USA
| | - Andrew W Horne
- MRC Centre for Reproductive Health, University of Edinburgh, QMRI, Edinburgh, UK
| | - Alison Jacoby
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Jeannette Lager
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Jessica Opoku-Anane
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Kim Chi Vo
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Evelina Manvelyan
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Sushmita Sen
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Zhanna Ghukasyan
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Frances Collins
- MRC Centre for Reproductive Health, University of Edinburgh, QMRI, Edinburgh, UK
| | - Xavier Santamaria
- Carlos Simon Foundation, Health Research Institute, Valencia, Spain
- Group of Biomedical Research in Gynecology, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Philippa Saunders
- Centre for Inflammation Research, Institute for Regeneration and Repair University of Edinburgh, Edinburgh, UK
| | - Kord Kober
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA, USA
- Department of Physiological Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Allan F McRae
- The Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Kathryn L Terry
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, MA, USA
| | - Júlia Vallvé-Juanico
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
- Group of Biomedical Research in Gynecology, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Christian Becker
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's and Reproductive Health, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Peter A W Rogers
- University of Melbourne Department of Obstetrics and Gynaecology, Royal Women's Hospital, Melbourne, Australia
| | - Juan C Irwin
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Krina Zondervan
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's and Reproductive Health, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Grant W Montgomery
- The Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Stacey Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, MA, USA
- Division of Adolescent and Young Adult Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Marina Sirota
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA, USA
- Department of Pediatrics, Division of Neonatology, University of California San Francisco, San Francisco, CA, USA
| | - Linda Giudice
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
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2
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Deepak Kumar K, Huntriss R, Green E, Bora S, Pettitt C. Development of a nutrition screening tool to identify need for dietetic intervention in female infertility. J Hum Nutr Diet 2023; 36:154-168. [PMID: 35762584 PMCID: PMC10087620 DOI: 10.1111/jhn.13055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND One in seven couples are impacted by infertility in the UK, and female infertility is often associated with several health conditions impacted by nutrition. Despite many studies aimed at identifying the critical role of nutrition in infertility, there is currently no screening tool that identifies nutritional risk factors for infertility. AIM To propose a self-administered screening tool to identify women who would benefit from nutritional intervention to promote fertility. METHODS A narrative review was carried out to identify and summarise modifiable nutritional risk factors that can influence female fertility, including comorbidities that can influence nutrition intake, absorption, and metabolism. KEY FINDINGS A nutrition screening tool outlining modifiable nutrition risk factors potentially improving female fertility has been proposed, comprising of BMI, medical history and quality of diet and lifestyle which would aid in designing evidence based dietetic services for female infertility.
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Affiliation(s)
| | | | | | | | - Claire Pettitt
- Nutrition and Dietetic Research Group, Faculty of Medicine, Imperial College London, UK
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3
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Matar SG, Nourelden AZ, Assar A, Bahbah EI, Alfryjat AM, Hasabo EA, Matar SA, Bishtawi SN, Alhoubani M, Yahia AB, Ragab KM, Salameh LM, Salameh LSE, Zaazouee MS, Al‐kafarna M, Elshanbary AA, Almadhoon HW, Bakdash ST, Adam OAB, Malih AN, Habash SAE, Basiouny RMT, Ahmad A, Hamid RMA, Habib BY, Elokl DN, Abdalraheem HH, Atia EA, Yousif NIA, Al‐Ali FH, Alshaer IM, Abdulali FE, Ayesh HA, Jabari AY, Egzait RA, Munshar NAA, Alkhraibat AA, ibreerah AH, Basheti IA. Effect of COVID-19 vaccine on menstrual experience among females in six Arab countries: A cross sectional study. Influenza Other Respir Viruses 2022; 17:e13088. [PMID: 36578138 PMCID: PMC9835440 DOI: 10.1111/irv.13088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/29/2022] [Accepted: 12/04/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There have been varying reports on the potential occurrence and severity of changes to menstruation including the median cycle length, days of bleeding, bleeding heaviness, and menstrual pain, following receipt of COVID-19 vaccinations. We aimed to assess potential postvaccination menstrual changes in women residing in the Middle East. METHODS We implemented a cross-sectional online survey-based study. Data about the participants' demographic characteristics, menstruation experience, and vaccination status were collected and analyzed among six Arab countries. RESULTS Among 4942 menstruating females included in this study, females who had received one or more doses of COVID-19 vaccination reported a higher frequency of back pain, nausea, tiredness, pelvic pain with periods, unprescribed analgesics use, and passage of loose stools. They also reported higher scores describing average and worst menstrual pain. Fully vaccinated females reported heavier flow and more days of bleeding. CONCLUSION Our findings indicate that COVID-19 vaccine may have an effect on menstruation in terms of menstrual pain and bleeding heaviness. The evidence needs to be further investigated in longitudinal studies.
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Affiliation(s)
- Sajeda Ghassan Matar
- International Medical Research Association (IMedRA)CairoEgypt,School of PharmacyApplied Science Private UniversityAmmanJordan
| | - Anas Zakarya Nourelden
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of MedicineAl‐Azhar UniversityCairoEgypt
| | - Ahmed Assar
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of MedicineMenoufia UniversityShebin El‐KomEgypt
| | | | | | - Elfatih A. Hasabo
- International Medical Research Association (IMedRA)CairoEgypt,Department of Anatomy, Faculty of MedicineUniversity of KhartoumKhartoumSudan
| | - Suzan A. Matar
- Department of Clinical Laboratory SciencesThe University of Jordan, School of ScienceAmmanJordan
| | | | | | | | - Khaled Mohamed Ragab
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of MedicineMinia UniversityMiniaEgypt
| | | | | | - Mohamed Sayed Zaazouee
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of MedicineAl‐Azhar UniversityAssuitEgypt
| | - Mohammed Al‐kafarna
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of PharmacyAl‐Azhar University – GazaGaza StripPalestine
| | - Alaa Ahmed Elshanbary
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of MedicineAlexandria UniversityAlexandriaEgypt
| | - Hossam Waleed Almadhoon
- International Medical Research Association (IMedRA)CairoEgypt,Institute of Biodiversity, One Health and Veterinary MedicineUniversity of GlasgowGlasgowUK
| | - Shahed Toulaq Bakdash
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of MedicineKalamoon UniversityRif‐DimashqSyria
| | - Ola Awad Babiker Adam
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of MedicineAl‐Neelain UniversityKhartoumSudan
| | - Abdelkader Nabeel Malih
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of MedicineKalamoon UniversityRif‐DimashqSyria
| | - Shimaa Abo elfotoh Habash
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of MedicineTanta UniversityTantaEgypt
| | - Rakia Mohamed Taha Basiouny
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of MedicineOctober 6 UniversityGizaEgypt
| | - Afaf Ahmad
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of MedicineDamascus UniversityDamascusSyria
| | - Raghda Mohammed Ahmed Hamid
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of PharmacyUniversity of KhartoumKhartoumSudan
| | - Balsam Younan Habib
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of MedicineTartus UniversityTartus CitySyria
| | - Dalia Nasr Elokl
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of MedicineTanta UniversityTantaEgypt
| | - Hiba Hatim Abdalraheem
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of PharmacyAl‐Neelain UniversityKhartoumSudan
| | - Esraa Adel Atia
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of MedicineAl‐Azhar UniversityDamiettaEgypt
| | - Nazik Ibrahim Ahmed Yousif
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of MedicineUniversity of KhartoumKhartoumSudan
| | - Fida Hussien Al‐Ali
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of MedicinePalestine Polytechnic University‐ HebronWest BankPalestine
| | - Israa Mohammed Alshaer
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of MedicineTripoli UniversityTripoliLibya
| | - Fatima Elsidieg Abdulali
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of MedicineMisurata UniversityMisurataLibya
| | - Hadil Abu Ayesh
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of MedicineAl‐Azhar University – GazaGaza StripPalestine
| | - Anwar Yousef Jabari
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of MedicinePalestine Polytechnic University‐ HebronWest BankPalestine
| | - Raneem Ahmed Egzait
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of MedicineMisurata UniversityMisurataLibya
| | - Nameer Amer Abu Munshar
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of MedicinePalestine Polytechnic University‐ HebronWest BankPalestine
| | - Aseel Ahmad Alkhraibat
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of PharmacyJordan University of Science and TechnologyIrbidJordan
| | - Aisha Hasan ibreerah
- International Medical Research Association (IMedRA)CairoEgypt,Faculty of MedicineMisurata UniversityMisurataLibya
| | - Iman A. Basheti
- Department of Clinical Pharmacy and TherapeuticsFaculty of Pharmacy Applied Science Private UniversityAmmanJordan,Faculty of PharmacyThe University of SydneySydneyAustralia
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4
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Ahmadpour P, Jahangiry L, Bani S, Iravani M, Mirghafourvand M. Validation of the Iranian version of the ENDOPAIN-4D questionnaire for measurement of painful symptoms of endometriosis. J OBSTET GYNAECOL 2022; 42:2341-2348. [PMID: 35482817 DOI: 10.1080/01443615.2022.2049726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Endometriosis is one of the leading gynecological disorders in reproductive ages. About two-thirds of women with endometriosis experience chronic pelvic pain. There are different methods for the assessment of pain in endometriosis. One of these questionnaires is endometriosis painful symptoms-4 dimensions (ENDOPAIN-4D) questionnaire, which has not been validated in Iran. Therefore, we decided to conduct a study to determine the psychometric properties of this questionnaire. In this study, we randomly selected 169 women with endometriosis from two educational-medical centres of Al-Zahra and Taleghani in Tabriz, Iran, in 2020. We evaluated the validity of ENDOPAIN-4D in terms of face, content, and structure (through exploratory and confirmatory factor analyses). We used internal consistency assessment and test-retest reliability to determine the questionnaire reliability. In this study, the CVI and CVR for the ENDOPAIN-4D instrument were obtained as 0.99 and 0.98, respectively. In the exploratory factor analysis, we extracted a four-factor structure, and the confirmatory factor analysis gave a good fit for the extracted model. We obtained Cronbach's alpha coefficient as 0.96 and the intra-class correlation coefficient (ICC) (at 95% confidence interval) as 0.94 (0.85 to 0.98). The Persian version of ENDOPAIN-4D has acceptable content validity, construct validity and reliability for the evaluation of pelvic pain and gynaecology in Iranian women with endometriosis.Impact StatementWhat is already known on this subject? There are different methods for the assessment of pain in endometriosis. But there is no specific psychometric instrument to determine the painful symptoms of endometriosis in Iran so far.What do the results of this study add? The Persian version of ENDOPAIN-4D is a valid and reliable instrument for the evaluation of pelvic pain and gynaecology in Iranian women with endometriosis.What are the implications of these findings for clinical practice and/or future research? The validation of the Persian version of the ENDOPAIN-4D questionnaire leads to correct assessment of painful symptoms in Iranian women with endometriosis and will be useful in evaluating the patients' pain intensity and the response to treatment in practice.
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Affiliation(s)
- Parivash Ahmadpour
- Research Committee, Midwifery Department, Tabriz University of Medical sciences, Tabriz, Iran
| | - Leila Jahangiry
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Soheila Bani
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mina Iravani
- Department of Midwifery, Menopause Andropause Research Center, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mojgan Mirghafourvand
- Social determinants of Health Research Center, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
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5
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Matías-González Y, Sánchez-Galarza AN, Flores I, Rivera-Segarra E. "Es que tú eres una changa": stigma experiences among Latina women living with endometriosis. J Psychosom Obstet Gynaecol 2021; 42:67-74. [PMID: 32964770 PMCID: PMC8893272 DOI: 10.1080/0167482x.2020.1822807] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Endometriosis is a chronic inflammatory gynecologic disease affecting 5-10% of women of reproductive age of all ethnicities. Symptoms of this painful condition impact the physical, mental health, and quality of life of patients. Stigma is a social determinant of health documented to negatively impact people living with chronic conditions and have been associated with social exclusion, high levels of stress, and interference with medical care. The purpose of this study was to document stigma experiences among Latina women living with endometriosis. METHODS A qualitative design using focus groups was implemented. Thematic analysis was conducted for data interpretation. A total of 50 women participated in five focus groups. RESULTS The main theme "changuería" emerged as a label applied across multiple contexts and interactions in the lives of participants, suggesting that stigmatization is an ever-present barrier among women living with endometriosis. Participants reported that relatives, partners and health professionals perceive pain during menstruation as something women should be able to manage, producing a sense of inability to disclose the extent of suffering. CONCLUSION These results highlight the importance of addressing stigma as a way to foster healthcare seeking and minimize its impact on physical, mental health, and wellbeing.
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Affiliation(s)
| | | | - Idhaliz Flores
- Department of Basic Sciences, Ponce Health Sciences University, Ponce, Puerto Rico,Department of Obstetrics and Gynecology, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Eliut Rivera-Segarra
- School of Behavior and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
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6
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Soliman AM, Coyne KS, Gries KS, Castelli-Haley J, Snabes MC, Surrey ES. The Effect of Endometriosis Symptoms on Absenteeism and Presenteeism in the Workplace and at Home. J Manag Care Spec Pharm 2018. [PMID: 28650252 PMCID: PMC10398072 DOI: 10.18553/jmcp.2017.23.7.745] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Characterized by pain symptoms, endometriosis affects women's productivity in their prime working years. OBJECTIVE To evaluate the effect of individual endometriosis symptoms on household chore and employment productivity as measured by presenteeism and absenteeism in a population survey of women with endometriosis. METHODS An online survey of U.S. women was conducted to evaluate the prevalence of endometriosis, as well as symptoms, demographics, and clinical characteristics of the respondents. Women aged 18-49 years (inclusive) with endometriosis completed the Health-related Productivity Questionnaire to assess presenteeism and absenteeism for employed and household work. Descriptive statistics were used to describe the sample, survey responses, and the effect of endometriosis symptom severity on household chore and employment productivity. Regression analyses were performed to examine the effect of individual endometriosis symptoms on employment and household productivity lost because of presenteeism and absenteeism. RESULTS Of 59,411 women who completed the prevalence screener, 5,879 women (9.9%) met the inclusion criteria for completing the survey; 1,318 women (2.2%) reported endometriosis and at least 1 hour of scheduled household chores in the past 7 days. Of these, 810 women had least 1 hour of scheduled employment in the past 7 days. Mean age was 34.6 years (standard error [SE] ± 0.32); 77.2% of the women were white; 59.3% were married or in a civil union; and 59.1% were employed full or part time. Women with endometriosis had a weekly loss of an average of 5.3 hours (SE ± 0.4) because of employment presenteeism, 1.1 hours (SE ± 0.2) of employment absenteeism, 2.3 (SE ± 0.2) hours of household presenteeism, and 2.5 (SE ± 0.2) hours of household absenteeism. Hourly losses in employment and household chore productivity were significantly greater with increasing symptom severity (mild vs. severe: 1.9 vs. 15.8 total employment hours lost and 2.5 vs. 10.1 total household hours lost; P < 0.0001). Women who experienced 3 endometriosis symptoms concurrently lost a significantly greater number of employment hours because of absenteeism and presenteeism compared with those experiencing 1 or 2 symptoms (P < 0.001). Regression analyses showed that a range of endometriosis symptoms predicted employment and household losses because of presenteeism and absenteeism. CONCLUSIONS There was a significant relationship between the number and patient-reported severity of endometriosis symptoms experienced and hours of employment and household productivity lost because of presenteeism and absenteeism. Study findings indicate a need for guidance strategies to help women and employers manage endometriosis so as to reduce productivity loss. DISCLOSURES The design and financial support for this study was provided by AbbVie. AbbVie participated in data analysis, interpretation of data, review, and approval of the manuscript. Coyne and Gries are employees of Evidera- Evidence, Value & Access by PPD and were paid scientific consultants for AbbVie in connection with this study. Soliman, Castelli-Hayley, and Snabes are AbbVie employees and may own AbbVie stock or stock options. Surrey is affiliated with Colorado Center for Reproductive Medicine and was paid by AbbVie as a consultant for this project. Surrey serves as a consultant for AbbVie outside of this project. All authors participated in data analysis and interpretation, and contributed to the development of the manuscript. The authors maintained control over the final contents of the manuscript and the decision to publish. Study concept and design were contributed by Soliman, Coyne, Gries, and Castelli-Haley. Soliman, Castelli-Haley, Coyne, and Gries collected the data, and data interpretation was performed by Snabes, Surrey, Soliman, Coyne, and Gries. The manuscript was written and revised by Soliman, Coyne, and Gries, along with the other authors.
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Affiliation(s)
| | - Karin S Coyne
- 2 Evidera-Evidence, Value & Access by PPD, Bethesda, Maryland
| | | | | | | | - Eric S Surrey
- 4 Colorado Center for Reproductive Medicine, Lone Tree, Colorado
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7
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Adamson GD, Kennedy S, Hummelshoj L. Creating Solutions in Endometriosis: Global Collaboration through the World Endometriosis Research Foundation. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/228402651000200102] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Endometriosis affects an estimated 176 million women worldwide during the prime years of their lives. Yet many clinical questions remain unanswered, treatment failures are common, and there is little investment in investigating disease mechanisms. The World Endometriosis Research Foundation (WERF) has been created to provide a global platform where resources and intelligence are pooled to enable international collaboration in order to find answers so that treatments for endometriosis can be improved and prevention can become reality in future generations of women. WERF is now working with 30 centres in 19 countries conducting prospective studies investigating the impact of endometriosis, disease predictability, and personal and societal cost. (Journal of Endometriosis 2010; 2: 3–6)
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Affiliation(s)
- G. David Adamson
- World Endometriosis Research Foundation (WERF), London - England and Palo Alto (CA) - USA
| | - Stephen Kennedy
- World Endometriosis Research Foundation (WERF), London - England and Palo Alto (CA) - USA
| | - Lone Hummelshoj
- World Endometriosis Research Foundation (WERF), London - England and Palo Alto (CA) - USA
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8
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Pain cognition versus pain intensity in patients with endometriosis: toward personalized treatment. Fertil Steril 2017; 108:679-686. [DOI: 10.1016/j.fertnstert.2017.07.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/15/2017] [Accepted: 07/17/2017] [Indexed: 11/19/2022]
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9
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Brüggmann D, Elizabeth-Martinez A, Klingelhöfer D, Quarcoo D, Jaque JM, Groneberg DA. Endometriosis and its global research architecture: an in-depth density-equalizing mapping analysis. BMC WOMENS HEALTH 2016; 16:64. [PMID: 27653503 PMCID: PMC5031306 DOI: 10.1186/s12905-016-0336-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/10/2016] [Indexed: 01/22/2023]
Abstract
Background Endometriosis is one of the most common gynecological diseases. It is still a chameleon in many aspects and urges intense research activities in the fields of diagnosis, therapy and prevention. Despite the need to foster research in this area, no in-depth analysis of the global architecture of endometriosis research exists yet. Methods We here used the NewQIS platform to conduct a density equalizing mapping study, using the Web of Science as database with endometriosis related entries between 1900 and 2009. Density equalizing maps of global endometriosis research encompassing country-specific publication activities, and semi-qualitative indices such as country specific citations, citation rates, h-Indices were created. Results In total, 11,056 entries related to endometriosis were found. The USA was leading the field with 3705 publications followed by the United Kingdom (952) and Japan (846). Concerning overall citations and country-specific h-Indices, the USA again was the leading nation with 74,592 citations and a modified h-Index of 103, followed by the UK with 15,175 citations (h-Index 57). Regarding the citation rate, Sweden and Belgium were at top positions with rates of 22.46 and 22.26, respectively. Concerning collaborative studies, there was a steep increase in numbers present; analysis of the chronological evolution indicated a strong increase in international collaborations in the past 10 years. Conclusions This study is the first analysis that illustrates the global endometriosis research architecture. It shows that endometriosis research is constantly gaining importance but also underlines the need for further efforts and investments to foster research and ultimately improve endometriosis management on a global scale. Electronic supplementary material The online version of this article (doi:10.1186/s12905-016-0336-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dörthe Brüggmann
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, 2020 Zonal Ave, IRD 509, Los Angeles, 90089-9300, CA, USA. .,Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Theodor-Stern Kai 7, 60590, Frankfurt, Germany.
| | - Alexandra Elizabeth-Martinez
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - Doris Klingelhöfer
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - David Quarcoo
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - Jenny M Jaque
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, 2020 Zonal Ave, IRD 509, Los Angeles, 90089-9300, CA, USA
| | - David A Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
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Caruso S, Iraci M, Cianci S, Fava V, Casella E, Cianci A. Comparative, open-label prospective study on the quality of life and sexual function of women affected by endometriosis-associated pelvic pain on 2 mg dienogest/30 µg ethinyl estradiol continuous or 21/7 regimen oral contraceptive. J Endocrinol Invest 2016; 39:923-31. [PMID: 27023105 DOI: 10.1007/s40618-016-0460-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/15/2016] [Indexed: 01/20/2023]
Abstract
PURPOSE To evaluate the effects of a continuous regimen combined oral contraceptive (COC) containing 2 mg dienogest and 30 µg ethinyl estradiol (DNG/EE) compared to a 21/7 regimen on the quality of life (QoL) and sexual function in women affected by endometriosis-associated pelvic pain. METHODS Sixty-three women constituted the Study group treated with DNG/EE COC continuous regimen; 33 women were given DNG/EE COC in a 21/7 regimen. To define the endometriosis-associated pelvic pain, the Visual Analogic Scale was used. The Short Form-36, Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS) were used to assess QoL, sexual function and sexual distress, respectively. The study included two follow-ups. RESULTS At 3 and 6 months of treatment there was an improvement in pain of the Study group (p < 0.001). The Control group underwent pain improvement at the second follow-up (p < 0.05). At the first and the second follow-ups, the Study group reported QoL improvements in all categories (p < 0.001). The Control group reported QoL improvements in all categories at the second follow-up (p < 0.05). At the first and the second follow-ups of the Study group, the FSFI total score had risen (p < 0.001), and the FSDS score had dropped (p < 0.001). An improvement of the FSFI score and a reduction of the FSDS score of the Control group was observed at the second follow-up (p < 0.001), but not at the first follow-up (p = NS). CONCLUSIONS Women on DNG/EE COC continuous regimen reported a reduction of endometriosis-associated pelvic pain and there was an improvement of their sexual activity and their QoL that was better than the DNG/EE 21/7 conventional regimen.
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Affiliation(s)
- S Caruso
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, Policlinico Universitario, Via S.Sofia 78, 95124, Catania, Italy.
- Research Group for Sexology, Catania, Italy.
| | - M Iraci
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, Policlinico Universitario, Via S.Sofia 78, 95124, Catania, Italy
| | - S Cianci
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, Policlinico Universitario, Via S.Sofia 78, 95124, Catania, Italy
| | - V Fava
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, Policlinico Universitario, Via S.Sofia 78, 95124, Catania, Italy
- Research Group for Sexology, Catania, Italy
| | - E Casella
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, Policlinico Universitario, Via S.Sofia 78, 95124, Catania, Italy
| | - A Cianci
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, Policlinico Universitario, Via S.Sofia 78, 95124, Catania, Italy
- Research Group for Sexology, Catania, Italy
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Caruso S, Iraci M, Cianci S, Casella E, Fava V, Cianci A. Quality of life and sexual function of women affected by endometriosis-associated pelvic pain when treated with dienogest. J Endocrinol Invest 2015; 38:1211-8. [PMID: 26337183 DOI: 10.1007/s40618-015-0383-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 08/18/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of the study was to evaluate the effects of dienogest (DNG) on quality of life (QoL) and sexual function of women affected by endometriosis pain. METHODS Fifty-four women constituted the study group and were given 2 mg/daily DNG; 48 women were given non-steroidal anti-inflammatory drugs and constitut ed the control group. To define the endometriosis-associated pelvic pain, the Visual Analogic Scale (VAS) was used. The Short Form-36 (SF-36), the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS) were used to assess the QoL, the sexual function and the sexual distress, respectively. The study included two follow-ups at 3 and 6 months. RESULTS Pain improvement was observed in the study group at 3 (p < 0.05) and 6 months (p < 0.001) of treatment. At the 1st follow-up, women reported QoL improvements in some functions (p < 0.05); at the 2nd follow-up, they reported improvement in all categories (p < 0.001). The FSFI score did not change at the 1st follow-up (p = NS). On the contrary, at the 2nd follow-up, it improved with respect to the baseline (p < 0.05). At the 2nd follow-up, the FSFI score had risen to 27.8 (p < 0.001) and the FSDS score had dropped to 11.3 (p < 0.001). No change was observed in the control group (p = NS). CONCLUSIONS The progressive reduction of the pain syndrome reported by women over the treatment period could contribute to improve the QoL and sexual life of women on DNG.
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Affiliation(s)
- S Caruso
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic of the Policlinico Universitario, Via S.Sofia 78, 95124, Catania, Italy.
- Research Group for Sexology, Catania, Italy.
| | - M Iraci
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic of the Policlinico Universitario, Via S.Sofia 78, 95124, Catania, Italy
| | - S Cianci
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic of the Policlinico Universitario, Via S.Sofia 78, 95124, Catania, Italy
| | - E Casella
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic of the Policlinico Universitario, Via S.Sofia 78, 95124, Catania, Italy
| | - V Fava
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic of the Policlinico Universitario, Via S.Sofia 78, 95124, Catania, Italy
| | - A Cianci
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic of the Policlinico Universitario, Via S.Sofia 78, 95124, Catania, Italy
- Research Group for Sexology, Catania, Italy
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Endometriosis and associated symptoms among Nigerian women. Int J Gynaecol Obstet 2015; 130:190-4. [DOI: 10.1016/j.ijgo.2015.02.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 01/21/2015] [Accepted: 04/13/2015] [Indexed: 11/24/2022]
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Bokor A, Koszorús E, Brodszky V, D’Hooghe T, Rigó J. The impact of endometriosis on quality of life in Hungary. Orv Hetil 2013; 154:1426-34. [DOI: 10.1556/oh.2013.29699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction: Endometriosis is one of the most common gynaecological diseases affecting 70 million women worldwide. Aim: The aims of this study were to determinate the diagnostic delay of endometriosis, to assess the effectiveness of surgical and combined therapy and to analyse the quality of life of women suffering from this disease. Method: Of the 240 patients with endometriosis enrolled in the study, 84 patients filled in a prospective as well as a retrospective questionnaire. Results: There was a 3.9 year delay from the onset of symptoms to the definitive diagnosis. Before therapy, 89% of the patients reported endometriosis related pain, while after therapy only 28% in the prospectively investigated months (p = 0.025). There was no significant difference between the outcome of surgical treatment alone and combined operative and medical therapy (p = 0.85). Reduced productivity at work was present in 47% of the patients and 40% of the patients reported impaired personal relationship, too. Endometriosis-associated symptoms generated 0.147 quality-adjusted life years per woman. Conclusions: This study is the first ever prospective survey to investigate the impact of endometriosis on the quality of life in Hungary. The results indicated a long diagnostic delay. Both surgical and combined therapies proved to be efficient. Endometriosis impaired health-related quality of life, but adequate therapy attenuated the severity of symptoms. Orv. Hetil., 2013, 154, 1426–1434.
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Affiliation(s)
- Attila Bokor
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Szülészeti és Nőgyógyászati Klinika Budapest Baross u. 27. 1088
| | - Erszébet Koszorús
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Szülészeti és Nőgyógyászati Klinika Budapest Baross u. 27. 1088
| | - Valentin Brodszky
- Budapesti Corvinus Egyetem Egészség-gazdaságtani és Egészségügyi Technológiaelemzési Kutatóközpont Budapest
| | - Thomas D’Hooghe
- Katholieke Universiteit Leuven Department of Development and Regeneration Leuven Belgium
| | - János Rigó
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Szülészeti és Nőgyógyászati Klinika Budapest Baross u. 27. 1088
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Fauconnier A, Staraci S, Huchon C, Roman H, Panel P, Descamps P. Comparison of patient- and physician-based descriptions of symptoms of endometriosis: a qualitative study. Hum Reprod 2013; 28:2686-94. [DOI: 10.1093/humrep/det310] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Nnoaham KE, Hummelshoj L, Kennedy SH, Jenkinson C, Zondervan KT. Developing symptom-based predictive models of endometriosis as a clinical screening tool: results from a multicenter study. Fertil Steril 2012; 98:692-701.e5. [PMID: 22657249 PMCID: PMC3679490 DOI: 10.1016/j.fertnstert.2012.04.022] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Revised: 04/02/2012] [Accepted: 04/13/2012] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To generate and validate symptom-based models to predict endometriosis among symptomatic women prior to undergoing their first laparoscopy. DESIGN Prospective, observational, two-phase study, in which women completed a 25-item questionnaire prior to surgery. SETTING Nineteen hospitals in 13 countries. PATIENT(S) Symptomatic women (n = 1,396) scheduled for laparoscopy without a previous surgical diagnosis of endometriosis. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Sensitivity and specificity of endometriosis diagnosis predicted by symptoms and patient characteristics from optimal models developed using multiple logistic regression analyses in one data set (phase I), and independently validated in a second data set (phase II) by receiver operating characteristic (ROC) curve analysis. RESULT(S) Three hundred sixty (46.7%) women in phase I and 364 (58.2%) in phase II were diagnosed with endometriosis at laparoscopy. Menstrual dyschezia (pain on opening bowels) and a history of benign ovarian cysts most strongly predicted both any and stage III and IV endometriosis in both phases. Prediction of any-stage endometriosis, although improved by ultrasound scan evidence of cyst/nodules, was relatively poor (area under the curve [AUC] = 68.3). Stage III and IV disease was predicted with good accuracy (AUC = 84.9, sensitivity of 82.3% and specificity 75.8% at an optimal cut-off of 0.24). CONCLUSION(S) Our symptom-based models predict any-stage endometriosis relatively poorly and stage III and IV disease with good accuracy. Predictive tools based on such models could help to prioritize women for surgical investigation in clinical practice and thus contribute to reducing time to diagnosis. We invite other researchers to validate the key models in additional populations.
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Affiliation(s)
- Kelechi E Nnoaham
- Department of Public Health, University of Oxford, Oxford, United Kingdom.
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Nnoaham KE, Hummelshoj L, Webster P, d'Hooghe T, de Cicco Nardone F, de Cicco Nardone C, Jenkinson C, Kennedy SH, Zondervan KT. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril 2011; 96:366-373.e8. [PMID: 21718982 PMCID: PMC3679489 DOI: 10.1016/j.fertnstert.2011.05.090] [Citation(s) in RCA: 865] [Impact Index Per Article: 66.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 05/06/2011] [Accepted: 05/25/2011] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess the impact of endometriosis on health-related quality of life (HRQoL) and work productivity. DESIGN Multicenter cross-sectional study with prospective recruitment. SETTING Sixteen clinical centers in ten countries. PATIENT(S) A total of 1,418 premenopausal women, aged 18-45 years, without a previous surgical diagnosis of endometriosis, having laparoscopy to investigate symptoms or to be sterilized. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Diagnostic delay, HRQoL, and work productivity. RESULT(S) There was a delay of 6.7 years, principally in primary care, between onset of symptoms and a surgical diagnosis of endometriosis, which was longer in centers where women received predominantly state-funded health care (8.3 vs. 5.5 years). Delay was positively associated with the number of pelvic symptoms (chronic pelvic pain, dysmenorrhoea, dyspareunia, and heavy periods) and a higher body mass index. Physical HRQoL was significantly reduced in affected women compared with those with similar symptoms and no endometriosis. Each affected woman lost on average 10.8 hours (SD 12.2) of work weekly, mainly owing to reduced effectiveness while working. Loss of work productivity translated into significant costs per woman/week, from US$4 in Nigeria to US$456 in Italy. CONCLUSION(S) Endometriosis impairs HRQoL and work productivity across countries and ethnicities, yet women continue to experience diagnostic delays in primary care. A higher index of suspicion is needed to expedite specialist assessment of symptomatic women. Future research should seek to clarify pain mechanisms in relation to endometriosis severity.
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Simoens S, Hummelshoj L, Dunselman G, Brandes I, Dirksen C, D’Hooghe T. Endometriosis Cost Assessment (the EndoCost Study): A Cost-of-Illness Study Protocol. Gynecol Obstet Invest 2011; 71:170-6. [DOI: 10.1159/000316055] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 05/27/2010] [Indexed: 11/19/2022]
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