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Farenga E, Bulfon M, Dalla Zonca C, Tersar C, Ricci G, Di Lorenzo G, Clarici A. A Psychological Point of View on Endometriosis and Quality of Life: A Narrative Review. J Pers Med 2024; 14:466. [PMID: 38793048 PMCID: PMC11121802 DOI: 10.3390/jpm14050466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
Endometriosis is a chronic gynecological disorder with a multifactorial etiology that has not yet been fully elucidated. What is known, however, are the pathological tissue dynamics that lead to the complex symptoms that women suffer from. The known symptoms are mainly fertility problems and pain. Both dimensions have an impact that varies from case to case, but that is certainly decisive concerning a woman's health, specifically by affecting the overall quality of life (QoL). In this publication, we will deal with the descriptive aspects of endometriosis's pathology and then present a review of the aspects impacting QoL and their psycho-social consequences. Finally, the experience of pain in the context of the mind-brain-body relationship will be discussed, describing the complexity of this dimension and emphasizing the importance of a multi-professional approach that considers the relevance of the contribution that a psychotherapy intervention based on up-to-date neurobiological models can make for women with endometriosis. A review of the literature and current knowledge on the neural and psychological aspects of pain lead to the conclusion that it is of the utmost importance to provide informed psychological support, alongside medical treatments and sexual counseling, to patients with endometriosis.
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Affiliation(s)
- Elisa Farenga
- S.C.U. Obstetrics and Gynaecology Clinic, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Via dell’Istria, 65, 34137 Trieste, Italy
| | - Matteo Bulfon
- S.C.U. Obstetrics and Gynaecology Clinic, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Via dell’Istria, 65, 34137 Trieste, Italy
| | - Cristiana Dalla Zonca
- S.C.U. Obstetrics and Gynaecology Clinic, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Via dell’Istria, 65, 34137 Trieste, Italy
| | - Costanza Tersar
- S.C.U. Obstetrics and Gynaecology Clinic, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Via dell’Istria, 65, 34137 Trieste, Italy
| | - Giuseppe Ricci
- S.C.U. Obstetrics and Gynaecology Clinic, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Via dell’Istria, 65, 34137 Trieste, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste (UniTS), Cattinara Hospital, Strada di Fiume, 447, 34149 Trieste, Italy;
| | - Giovanni Di Lorenzo
- S.C.U. Obstetrics and Gynaecology Clinic, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Via dell’Istria, 65, 34137 Trieste, Italy
| | - Andrea Clarici
- Department of Medical, Surgical and Health Sciences, University of Trieste (UniTS), Cattinara Hospital, Strada di Fiume, 447, 34149 Trieste, Italy;
- Centro Formazione e Ricerca in Psicoterapia a Orientamento Psicoanalitico, Via Antonio Canova, 2, 34129 Trieste, Italy
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Bentefouet TL, Thiam I, Senghor F, Kebe CT, Gaye M, Ahouidi MJD, Dial CMM. [Epidemiological and anatomopathological profile of endometriosis in Dakar: retrospective study over a period of 20 years]. Ann Pathol 2024; 44:57-64. [PMID: 37953128 DOI: 10.1016/j.annpat.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Endometriosis is a gynecological pathology defined by the presence and abnormal development of endometrial tissue outside the uterine cavity. Our objective was to draw up an epidemiological profile and to describe the anatomical clinical forms of endometriosis in Dakar. PATIENTS AND METHODS This is a retrospective study of all cases of external and internal endometriosis diagnosed in an anatomy and pathology laboratory in Dakar over a period of twenty (20) years. The study parameters were collected from anonymous data sheets. Data entry and analysis were performed using version 22 of the EPI INFO and SPSS software. RESULTS Our study involved 104 female patients. The mean age was 47.3±10.0. Among the patients with an adenomyosis condition, the mean age was 49.8 years. Patients with an external endometriosis condition had a mean age of 37.6 years. The location of the endometriosis was statistically correlated with the age of patients and with parity. Anatomically and pathologically, the surgical specimen 89.4% (n=93) was the main type of sampling that was found. The uterine body was the main location of the pathology, with 78.9% (n=82), followed by the umbilical location with 9.6% (n=10). Leiomyomas 44.07% (n=26) were the main associated lesions. CONCLUSION Endometriosis is a gynecological pathology that is unfortunately not well known, and which is under diagnosed in Senegal.
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Affiliation(s)
- Tonleu Linda Bentefouet
- Unité de formation et de recherche en sciences de la santé de Thiès. Dixieme-Thiès, Thies, Senegal.
| | - Ibou Thiam
- Université Cheikh Anta Diop de Dakar, 5005 Dakar -Fann, Senegal
| | - Fabrice Senghor
- Université Assane Seck de Ziguinchor, Diabir-Ziguinchor, Senegal
| | | | - Magib Gaye
- Université Cheikh Anta Diop de Dakar, 5005 Dakar -Fann, Senegal
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Alpha-Lipoic Acid Plays a Role in Endometriosis: New Evidence on Inflammasome-Mediated Interleukin Production, Cellular Adhesion and Invasion. Molecules 2021; 26:molecules26020288. [PMID: 33430114 PMCID: PMC7826935 DOI: 10.3390/molecules26020288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/01/2021] [Accepted: 01/04/2021] [Indexed: 12/12/2022] Open
Abstract
Endometriosis is an estrogen-linked gynecological disease defined by the presence of endometrial tissue on extrauterine sites where it forms invasive lesions. Alterations in estrogen-mediated cellular signaling seems to have an essential role in the pathogenesis of endometriosis. Higher estrogen receptor (ER)-β levels and enhanced ER-β activity were detected in endometriotic tissues. It is well known that ER-β interacts with components of the cytoplasmic inflammasome-3 (NALP-3), the NALP-3 activation increases interleukin (IL)-1β and IL-18, enhancing cellular adhesion and proliferation. Otherwise, the inhibition of ER-β activity suppresses the ectopic lesions growth. The present study aims to investigate the potential effect of α-lipoic acid (ALA) on NALP-3 and ER-β expression using a western blot analysis, NALP-3-induced cytokines production by ELISA, migration and invasion of immortalized epithelial (12Z) and stromal endometriotic cells (22B) using a 3D culture invasion assay, and matrix-metalloprotease (MMPs) activity using gelatin zymography. ALA significantly reduces ER-β, NALP-3 protein expression/activity and the secretion of IL-1β and IL-18 in both 12Z and 22B cells. ALA treatment reduces cellular adhesion and invasion via a lower expression of adhesion molecules and MMPs activities. These results provide convincing evidence that ALA might inhibit endometriosis progression.
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Case-control study to develop and validate a questionnaire for the secondary prevention of endometriosis. PLoS One 2020; 15:e0230828. [PMID: 32226031 PMCID: PMC7105104 DOI: 10.1371/journal.pone.0230828] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/09/2020] [Indexed: 12/19/2022] Open
Abstract
Background Endometriosis is a debilitating gynecologic disease characterized by the implantation of endometrial tissue in ectopic locations, with signs of severe and chronic inflammation. The new knowledge on endometriosis has highlighted the value of secondary prevention through the early diagnosis and treatment of lesions to reduce serious consequences, first of all, infertility and chronic pelvic pain. The purpose of this study is to assess the reliability and validity of the questionnaire, as a tool to precociously identify women with endometriosis, to prevent the progression of symptoms. Method We reviewed the literature and selected risk factors, symptoms, and phenotypic traits of the women affected by endometriosis to create the questionnaire divided into 8 modules, with 47 questions. A total of 151 women completed the questionnaires: 51 patients who have endometriosis (the cases) and 100 matched women without endometriosis (the controls). After data collection, bivariate and multivariate analyses were conducted. Results We retained four of the significant variables from a step-down logistic regression, namely chronic pelvic pain, dyspareunia with VAS≥3, painful defecation, and acne, to develop a final “predictive” logistic model achieving 90.2% sensitivity and 75% specificity. Conclusion Our pilot study demonstrated that the questionnaire provides a powerful tool for the secondary prevention of endometriosis.
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Vrekoussis T, Siafaka V, Tsitou A, Tsonis O, Navrozoglou I, Makrigiannakis A, Paschopoulos M. Endometriosis-related chronic pelvic pain: A mini review on pathophysiology and impact on mental health. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2020. [DOI: 10.1177/2284026519895829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Endometriosis-related chronic pelvic pain is a major component of the disease that affects quality of life in women of reproductive age suffering from endometriosis. The present review summarizes current evidence upon pathophysiology and its impact on mental health. It seems that endometriosis-related chronic pelvic pain is the result of chronic stress on the central nervous system as a consequence of chronic pelvic inflammation. Mental health issues may rise as a result of central nervous system derangement and further aggravate pain perception and therefore quality of life. Further properly designed studies are needed in order to elucidate the connection between mental disorders and endometriosis-related chronic pelvic pain.
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Affiliation(s)
- Thomas Vrekoussis
- Department of Obstetrics and Gynecology, School of Medicine, University of Crete, Heraklion, Greece
| | - Vassiliki Siafaka
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Alexandra Tsitou
- Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Orestis Tsonis
- Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Iordanis Navrozoglou
- Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Antonis Makrigiannakis
- Department of Obstetrics and Gynecology, School of Medicine, University of Crete, Heraklion, Greece
| | - Minas Paschopoulos
- Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Giua Marassi C, Pistone A, Parazzini F, Vannuccini S, Petraglia F. Women’s attitude toward gynecological pain in fertile age: Results from a cross-sectional study among Italian community pharmacies. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2018. [DOI: 10.1177/2284026518776148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction: Several epidemiological data on women afferent to clinics for medical treatment of pelvic pain are available, while few studies explored the general population. Thus, this study aimed to investigate women presenting with gynecological pain at the community pharmacy and to evaluate the relevance of pharmacist advice regarding medical treatment. Methods: A cross-sectional study was conducted in a sample of 10 Italian community pharmacies, by administering a structured questionnaire to fertile age women reporting pelvic pain during the last 3 months. Questions were concerning demographic information, pain characteristics, women’s behavior toward gynecological pain, and diagnosis possibly received from a physician. Results: A group of 290 women were interviewed. Severe pain was reported in 58.3%, with a mean ± SD of 4.4 ± 6.8 days of suffering, causing absenteeism from work in 45.3% of cases. Almost half of women reported that the onset of gynecological pain was before 15 years and 72.2% had consulted a physician in the past, with a mean delay of 2.5 ± 4.3 years between the onset of pain and medical consultation. However, only 28% of the overall population received a diagnosis. 51.0% received one treatment, while 39% received two or more. The first therapy was prescribed in 40.2% cases by the physician, while in the remaining it was recommended either by the pharmacist or it was a self-medication. Conclusion: Gynecological pelvic pain is a disabling problem, regardless of the underlying cause, with significant impact on social and working life and requiring a better medical management.
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Affiliation(s)
| | | | - Fabio Parazzini
- Obstetrics and Gynecology, Dipartimento di Scienze Cliniche e di Comunità, University of Milan, Milan, Italy
| | - Silvia Vannuccini
- Department of Health Sciences, University of Florence, Italy
- Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Felice Petraglia
- Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Italy
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Badipatla KR, Vupputuri A, Niazi M, Blaise MN, Nayudu SK. Colonic Endometriosis: Dig Deeper for Diagnosis. Gastroenterology Res 2017; 10:59-62. [PMID: 28270880 PMCID: PMC5330696 DOI: 10.14740/gr760e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2017] [Indexed: 12/13/2022] Open
Abstract
Endometriosis is a common gynecological condition wherein there is an ectopic implantation of the uterine endometrial tissue. While several diagnostic modalities are described for the condition, laparoscopy remains the gold standard. There is still an undiscovered area to diagnose colonic endometriosis at an earlier stage. We present a case report of a reproductive age woman with cyclical rectal bleeding diagnosed with colonic endometriosis with colonoscopy and biopsy using saline injection lift and sampling technique. We in our report try to impress the fact that this differential should always be considered in the appropriate clinical setting, especially in women of childbearing age and in such cases, deeper tissue sampling techniques should be sought for, given better diagnostic yield. This may be clinically important given that it may aid in earlier diagnosis and thereby early initiation of appropriate therapy before the disease takes a complicated route. It may also be helpful in avoiding unnecessary surgery, along with the morbidity, complications and costs associated with same.
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Affiliation(s)
- Kanthi Rekha Badipatla
- Department of Medicine, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA; Division of Gastroenterology, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Anisha Vupputuri
- Department of Medicine, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Masooma Niazi
- Department of Pathology, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Marie-Nirva Blaise
- Department of Medicine, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA; Division of Gastroenterology, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Suresh Kumar Nayudu
- Department of Medicine, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA; Division of Gastroenterology, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
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Grande G, Vincenzoni F, Milardi D, Pompa G, Ricciardi D, Fruscella E, Mancini F, Pontecorvi A, Castagnola M, Marana R. Cervical mucus proteome in endometriosis. Clin Proteomics 2017; 14:7. [PMID: 28174513 PMCID: PMC5290661 DOI: 10.1186/s12014-017-9142-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/25/2017] [Indexed: 12/14/2022] Open
Abstract
Background Endometriosis is a chronic gynecological inflammatory disease characterized by the presence of functional endometrial glands and stroma outside of the uterine cavity. It affects 7–10% of women of reproductive age and up to 50% of women with infertility. The current gold standard for the diagnosis combines laparoscopic evaluation and biopsy of the visualized lesions. However, laparoscopy requires general anesthesia and developed surgical skills and it has a high procedural cost. In addition, it is associated with the risk, although rare, of potential intraoperative or postoperative complications. To date, several noninvasive biomarkers have been proposed; however, no definite diagnostic biomarker is yet available. The aim of this study was to characterize the CM proteome in patients with endometriosis using high resolution mass spectrometry—based proteomics, implemented by bioinformatic tools for quantitative analysis, in order to investigate the pathophysiological mechanisms of endometriosis. Methods Cervical mucus samples were collected from patients affected by endometriosis and fertile controls. An aliquot of the soluble acidic fraction of each cervical mucus sample, corresponding to 0.5 mg of total protein, was left to digest with sequencing grade modified porcine trypsin. The peptides were analyzed by LC–MS/MS on a high resolution Orbitrap Elite mass spectrometer and data were evaluated using bioinformatic tools. Results We aimed at the first total profiling of the cervical mucus proteome in endometriosis. From the list of identified proteins, we detected a number of differentially expressed proteins, including some functionally significant proteins. Six proteins were quantitatively increased in endometriosis, almost all being involved in the inflammatory pattern. Nine proteins were quantitatively reduced in endometriosis, including some proteins related with local innate immunity (CRISP-3 and Pglyrp1) and protection against oxidative stress (HSPB1). Fifteen proteins were not detected in endometriosis samples including certain proteins involved in antimicrobial activity (SLURP1 and KLK13) and related to seminal plasma liquefaction and male fertility (KLK13). Conclusions This is the first application of high resolution mass spectrometry—based proteomics aimed in detecting an array of proteins in CM to be proposed for the noninvasive diagnosis of endometriosis. This chronic disease presents in CM an inflammatory protein pattern. Electronic supplementary material The online version of this article (doi:10.1186/s12014-017-9142-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Giuseppe Grande
- International Scientific Institute "Paul VI", L.go F. Vito 1, 00168 Rome, Italy
| | - Federica Vincenzoni
- Institute of Biochemistry and Clinical Biochemistry, Catholic University, L.go F. Vito 1, 00168 Rome, Italy
| | - Domenico Milardi
- International Scientific Institute "Paul VI", L.go F. Vito 1, 00168 Rome, Italy
| | - Giuseppina Pompa
- International Scientific Institute "Paul VI", L.go F. Vito 1, 00168 Rome, Italy
| | - Domenico Ricciardi
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, L.go F. Vito 1, 00168 Rome, Italy
| | - Erika Fruscella
- International Scientific Institute "Paul VI", L.go F. Vito 1, 00168 Rome, Italy
| | - Francesca Mancini
- International Scientific Institute "Paul VI", L.go F. Vito 1, 00168 Rome, Italy
| | - Alfredo Pontecorvi
- Division of Endocrinology, Catholic University, L.go F. Vito 1, 00168 Rome, Italy
| | - Massimo Castagnola
- Institute of Biochemistry and Clinical Biochemistry, Catholic University, L.go F. Vito 1, 00168 Rome, Italy
| | - Riccardo Marana
- International Scientific Institute "Paul VI", L.go F. Vito 1, 00168 Rome, Italy.,Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, L.go F. Vito 1, 00168 Rome, Italy
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Teixeira MZ, Podgaec S, Baracat EC. Protocol of randomized controlled trial of potentized estrogen in homeopathic treatment of chronic pelvic pain associated with endometriosis. HOMEOPATHY 2016; 105:240-249. [PMID: 27473545 DOI: 10.1016/j.homp.2016.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 03/01/2016] [Accepted: 03/09/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Endometriosis is a chronic inflammatory disease that causes difficult-to-treat pelvic pain. Thus being, many patients seek help in complementary and alternative medicine, including homeopathy. The effectiveness of homeopathic treatment for endometriosis is controversial due to the lack of evidences in the literature. The aim of the present randomized controlled trial is to assess the efficacy of potentized estrogen compared to placebo in the treatment of chronic pelvic pain associated with endometriosis. METHODS/DESIGN The present is a randomized, double-blind, placebo-controlled trial of a homeopathic medicine individualized according to program 'New Homeopathic Medicines: use of modern drugs according to the principle of similitude' (http://newhomeopathicmedicines.com). Women with endometriosis, chronic pelvic pain and a set of signs and symptoms similar to the adverse events caused by estrogen were recruited at the Endometriosis Unit of Division of Clinical Gynecology, Clinical Hospital, School of Medicine, University of São Paulo (Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HCFMUSP). The participants were selected based on the analysis of their medical records and the application of self-report structured questionnaires. A total of 50 women meeting the eligibility criteria will be randomly allocated to receive potentized estrogen or placebo. The primary clinical outcome measure will be severity of chronic pelvic pain. Statistical analysis will be performed on the intention-to-treat and per-protocol approaches comparing the effect of the homeopathic medicine versus placebo after 24 weeks of intervention. DISCUSSION The present study was approved by the research ethics committee of HCFMUSP and the results are expected in 2016. TRIAL REGISTRATION ClinicalTrials.gov Identifier: https://clinicaltrials.gov/ct2/show/NCT02427386.
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Affiliation(s)
- Marcus Zulian Teixeira
- Department of Obstetrics and Gynecology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
| | - Sérgio Podgaec
- Department of Obstetrics and Gynecology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Edmund Chada Baracat
- Department of Obstetrics and Gynecology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
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Baden DN, van de Ven A, Verbeek PCM. Endometriosis with an acute colon obstruction: a case report. J Med Case Rep 2015; 9:150. [PMID: 26112271 PMCID: PMC4517405 DOI: 10.1186/s13256-015-0609-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 04/28/2015] [Indexed: 01/12/2023] Open
Abstract
Introduction The presentation of an acute bowel obstruction caused by endometriosis in an emergency department setting is rare, as it usually presents through years of complaints in the absence of a distinct acute onset. In this report, we present a case of a patient who was familiar with abdominal complaints and eventually required emergency surgery to treat an acute bowel obstruction caused by endometriosis. Endometrioses present infrequently in the acute phase, and only a few cases in which emergency surgery was required have been described in the literature. Case presentation A 31-year-old Caucasian woman presented to the emergency room of our hospital with a distended abdomen, pain and nausea accompanied by a history of 14 years of chronic abdominal pain and constipation. An abdominal X-ray and subsequent computed tomographic scan showed a severely distended cecum of 9cm with stenosis in the sigmoid. Cecal blow-out was considered highly likely, and, during an emergency laparotomy, an obstructing process was found in the sigmoid. An oncologic resection of the sigmoid was performed with a primary anastomosis and loop ileostomy. A pathological examination revealed a tumor of 4cm in the sigmoid, which contained a tubelike structure with cytogenic stroma and the remains of focal bleeding. These are typical aspects of endometriosis. Conclusions Infiltrating endometriosis is an invalidating disease that can be misdiagnosed for a wide range of other diseases. Emergency room physicians and surgeons should be aware that it can present as an acute obstruction and should be considered in diagnosing women of childbearing age. After initial colonoscopy, emergency surgery is the best therapeutic approach if there is a complete obstruction.
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Affiliation(s)
- David N Baden
- Department of General Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, the Netherlands.
| | - Anthony van de Ven
- Department of General Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, the Netherlands.
| | - Paul C M Verbeek
- Department of General Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, the Netherlands.
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Riazi H, Tehranian N, Ziaei S, Mohammadi E, Hajizadeh E, Montazeri A. Clinical diagnosis of pelvic endometriosis: a scoping review. BMC Womens Health 2015; 15:39. [PMID: 25952159 PMCID: PMC4450847 DOI: 10.1186/s12905-015-0196-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 04/24/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Accurate and timely diagnosis of endometriosis is associated with confusion. Clinical manifestations, imaging techniques, biomarkers and surgical techniques are used as diagnostic approaches. This paper reviews current evidence on clinical manifestation in order to help practitioners and perhaps improve women's health. METHODS A review of the literature on clinical diagnosis of pelvic endometriosis that appeared in the English language biomedical journals was performed using PubMed, Science Direct and Google Scholar. The search strategy included the combination of key words 'endometriosis' and 'diagnosis' or 'clinical diagnosis' in the titles or abstracts of articles. The search included all papers published during the year 2000 to 2014. Then, the findings were classified in order to summarize the evidence. RESULTS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, in all 51 papers were found relevant and included in this review. In general we found three categories of diagnostic approaches for clinical manifestation including: i) diagnosis via symptoms obtained from history taking, ii) diagnosis via signs obtained from physical examination and iii) diagnosis via risk factors obtained from history taking. CONCLUSION Diagnosis of endometriosis is a matter of concern. Since the disease is associated with diverse clinical symptoms and signs, deeper and more comprehensive consideration according to patient's history and clinical findings is recommended for early and more accurate detection in order to prioritize women for further investigation and contribute to its early management.
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Affiliation(s)
- Hedyeh Riazi
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Jalal-e Al Ahmad Highway, P.O Box 14115-331, Tehran, Iran.
| | - Najmeh Tehranian
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Jalal-e Al Ahmad Highway, P.O Box 14115-331, Tehran, Iran.
| | - Saeideh Ziaei
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Jalal-e Al Ahmad Highway, P.O Box 14115-331, Tehran, Iran.
| | - Easa Mohammadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Jalal-e Al Ahmad Highway, P.O Box 14115-331, Tehran, Iran.
| | - Ebrahim Hajizadeh
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Jalal-e Al Ahmad Highway, P.O Box 14115-331, Tehran, Iran.
| | - Ali Montazeri
- Mental Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, P.O Box 13185-1488, Tehran, Iran.
- Faculty of Humanity Sciences, University of Science & Culture, ACECR, Tehran, Iran.
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Vitagliano A, Noventa M, Quaranta M, Gizzo S. Statins as Targeted "Magical Pills" for the Conservative Treatment of Endometriosis: May Potential Adverse Effects on Female Fertility Represent the "Dark Side of the Same Coin"? A Systematic Review of Literature. Reprod Sci 2015; 23:415-28. [PMID: 25929256 DOI: 10.1177/1933719115584446] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The aim of the study was to analyze all the available evidence from both in vitro and in vivo studies regarding the efficacy of statin therapy in the treatment of endometriosis, evaluating the potential efficacy, side effects, and contraindications of their administration in humans. We focused on defining the potential benefits that the administration of statins may have on patients affected by endometriosis and the possible adverse effects of such a therapy on ovarian function and fertility profile. According to our article selection criteria, we included in the review in vitro and in vivo studies performed on human or animal models. The systematic review of literature identified 24 eligible articles, 12 of which reported evidence regarding the effects of statins on endometrial/endometriotic cells and 12 regarding their effects on ovarian function and fertility. All articles seem to emphasize the utility of statin administration in the treatment of endometriosis due to their anti-proliferative/proapoptotic effects, their ability to reduce cell viability and migration, and the inhibition of angiogenesis and anti-inflammatory activities. Regarding the potential adverse effects on gonadal activities, steroidogenesis and fertility function, no conclusive data were collected in human models (excluding women affected by polycystic ovary syndrome in which significant decline of androgen levels was reported after statin treatment), while contrasting results were reported by studies conducted in in vitro and in vivo in animal models. Despite evidence supporting statins as the potential therapeutic agent for a targeted conservative treatment of endometriosis, the uncertainties regarding their impact on gonadal function may not define them as an appropriate therapy for all young fertile women.
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Affiliation(s)
| | - Marco Noventa
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Michela Quaranta
- Department of Obstetrics and Gynaecology, University of Verona, Verona, Italy
| | - Salvatore Gizzo
- Department of Woman and Child Health, University of Padua, Padua, Italy
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Fuldeore M, Yang H, Du EX, Soliman AM, Wu EQ, Winkel C. Healthcare utilization and costs in women diagnosed with endometriosis before and after diagnosis: a longitudinal analysis of claims databases. Fertil Steril 2015; 103:163-71. [DOI: 10.1016/j.fertnstert.2014.10.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 09/13/2014] [Accepted: 10/07/2014] [Indexed: 01/06/2023]
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Capobianco A, Rovere-Querini P. Endometriosis, a disease of the macrophage. Front Immunol 2013; 4:9. [PMID: 23372570 PMCID: PMC3556586 DOI: 10.3389/fimmu.2013.00009] [Citation(s) in RCA: 171] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 01/07/2013] [Indexed: 12/14/2022] Open
Abstract
Endometriosis, a common cause of pelvic pain and female infertility, depends on the growth of vascularized endometrial tissue at ectopic sites. Endometrial fragments reach the peritoneal cavity during the fertile years: local cues decide whether they yield endometriotic lesions. Macrophages are recruited at sites of hypoxia and tissue stress, where they clear cell debris and heme-iron and generate pro-life and pro-angiogenesis signals. Macrophages are abundant in endometriotic lesions, where are recruited and undergo alternative activation. In rodents macrophages are required for lesions to establish and to grow; bone marrow-derived Tie-2 expressing macrophages specifically contribute to lesions neovasculature, possibly because they concur to the recruitment of circulating endothelial progenitors, and sustain their survival and the integrity of the vessel wall. Macrophages sense cues (hypoxia, cell death, iron overload) in the lesions and react delivering signals to restore the local homeostasis: their action represents a necessary, non-redundant step in the natural history of the disease. Endometriosis may be due to a misperception of macrophages about ectopic endometrial tissue. They perceive it as a wound, they activate programs leading to ectopic cell survival and tissue vascularization. Clearing this misperception is a critical area for the development of novel medical treatments of endometriosis, an urgent and unmet medical need.
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Affiliation(s)
- Annalisa Capobianco
- Division of Regenerative Medicine, Stem Cells and Gene Therapy, San Raffaele Scientific Institute Milan, Italy
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Economic burden of surgically confirmed endometriosis in Canada. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2012; 33:830-837. [PMID: 21846438 DOI: 10.1016/s1701-2163(16)34986-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To estimate the societal economic burden of illness caused by surgically confirmed endometriosis in Canada in 2009, including direct health care costs, lost productivity, and lost leisure time costs. METHODS Using a cross-sectional design, direct health care resource use data were obtained from nine family physicians and nine gynaecologists from across Canada, who were experienced in the treatment of women with surgically confirmed endometriosis. Data on alternative treatments and health care providers, as well as work absenteeism, lost leisure time, and caregiver time were obtained from a convenience sample of 27 women with endometriosis treated at two gynaecology clinics in Alberta and Quebec. Unit costs were assigned to resource use items for treatment-seeking patients, and total costs for each resource use item were aggregated to estimate the societal costs of endometriosis in Canada in 2009, across all prevalent cases of surgically confirmed endometriosis. RESULTS The estimated mean annual societal cost of endometriosis was $5,200 per patient (95% CI $3,700 to $7,100), with lost productivity and lost leisure time costs accounting for 78%. Extrapolating these figures yields an estimated total annual cost to Canadian society of $1.8 billion (95% CI $1.3 billion to $2.4 billion) attributable to surgically confirmed endometriosis in Canada. CONCLUSION For some women, surgically confirmed endometriosis has a substantial negative impact that can result in suffering to the individual and her family, and lead to substantial productivity losses. Understanding the interplay between direct costs, lost productivity, and quality of life is critical for accurately identifying and evaluating effective treatments for this condition.
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Rocha ALL, Reis FM, Petraglia F. New trends for the medical treatment of endometriosis. Expert Opin Investig Drugs 2012; 21:905-19. [PMID: 22568855 DOI: 10.1517/13543784.2012.683783] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Endometriosis is a benign sex hormone-dependent gynecological disease, characterized by the presence and growth of endometrial tissue outside the uterus; it affects 10% of women of reproductive age and is associated with infertility and pain. Treatment of endometriosis involves conservative or radical surgery, or medical therapies. The goals for endometriosis treatment may be the relief of pain and/or a successful pregnancy achievement in infertile patients. Treatment must be individualized with a multidisciplinary approach. The classical treatments carry adverse side effects and in some cases a negative impact on quality of life. New agents promise a distinct perspective in endometriosis treatment. AREAS COVERED The aim of this paper is to systematically review the literature evidence of new medical treatments for endometriosis, defined as pharmacological treatments not yet commonly available and currently under investigation. EXPERT OPINION These new medical therapies would be used associated with surgical treatment and, in the future, will render possible the association of hormone therapy with non-hormonal treatment for endometriosis.
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Affiliation(s)
- Ana Luiza L Rocha
- Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
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Abu Hashim H. Gonadotrophin-releasing hormone analogues and endometriosis: current strategies and new insights. Gynecol Endocrinol 2012; 28:314-21. [PMID: 22303840 DOI: 10.3109/09513590.2011.650751] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Endometriosis is an estrogen-dependent chronic inflammatory disease affecting 5% to 10% of women in reproductive age and has been reported also in adolescents. Its main clinical presentations are chronic pelvic pain and infertility. OBJECTIVE To provide a comprehensive review of the recently published data concerning the mechanism of action of gonadotrophin-releasing hormone analogues (GnRHas) as well as to analyze their role in the management of endometriosis-associated pain and infertility in addition to its value in adolescent cases. Furthermore, to provide practical recommendations and new insights based on the best available information. METHODS Systematic search was performed of the Cochrane Library and Medical Literature Analysis and Retrieval System Online database looking for the different trials, reviews and various guidelines relating to GnRHas usage in the management of endometriosis-associated pain, infertility and in adolescent cases. RESULTS From a pathophysiological perspective, there is a growing scientific evidence that GnRHas exert its therapeutic effects by their classical pituitary downregulation and via a direct effect on the endometrial cells themselves. Accordingly, they represent an important medical option for the management of different aspects of this enigmatic disease. CONCLUSION GnRHas have a valuable strategic role in treatment of endometriosis-associated pain and infertility as well as in adolescents above 16 years.
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Affiliation(s)
- Hatem Abu Hashim
- Department of Obstetrics & Gynecology, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt.
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Gambadauro P, Olovsson M, Persson P. Unusually rapid growth of bilateral endometriomas and acute bilateral hydronephrosis. Gynecol Endocrinol 2011; 27:948-50. [PMID: 21495801 DOI: 10.3109/09513590.2011.569795] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Ultrasonography can detect ovarian endometriomas, but negative findings cannot exclude other localizations of endometriosis, especially in symptomatic patients. We describe a case of sudden development of large bilateral endometriomas after a series of negative ultrasound scans, causing bilateral hydronephrosis. Our patient is a 32-year-old nulligravida with long-lasting dysmenorrhea, urinary symptoms, and familiarity for endometriosis, who had voluntarily discontinued oral contraceptives. Various pelvic scans had not shown pathological findings. Five months following the last negative scan, she presented with pain and increase of abdominal girth. Ultrasonography and computed tomography showed large ovarian cysts (16 cm right - 10 cm left) and hydronephrosis bilaterally. She underwent conservative surgery followed by GnRH analogs. At a 6-months follow-up, she was symptom-free and ultrasonography showed no recurrence. Endometriosis has still an unknown mechanism of proliferation and its clinical behavior or progression is highly unpredictable. Severe uropathy is commonly related to direct ureteral involvement, but can also depend on an ab-extrinseco compression by large, rapidly growing endometriomas. Women at risk of endometriosis, who are not receiving empirical medical treatment, should be adequately and regularly assessed via pelvic ultrasonography and/or submitted to diagnostic laparoscopy in order to prevent serious consequences such as silent renal loss.
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Affiliation(s)
- Pietro Gambadauro
- Department of Obstetrics and Gynaecology, Centre for Reproduction, Uppsala University Hospital, Uppsala, 75185, Sweden.
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Capobianco A, Monno A, Cottone L, Venneri MA, Biziato D, Di Puppo F, Ferrari S, De Palma M, Manfredi AA, Rovere-Querini P. Proangiogenic Tie2(+) macrophages infiltrate human and murine endometriotic lesions and dictate their growth in a mouse model of the disease. THE AMERICAN JOURNAL OF PATHOLOGY 2011; 179:2651-9. [PMID: 21924227 PMCID: PMC3204092 DOI: 10.1016/j.ajpath.2011.07.029] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 06/15/2011] [Accepted: 07/13/2011] [Indexed: 11/19/2022]
Abstract
Endometriosis affects women of reproductive age, causing infertility and pain. Although immune cells are recruited in endometriotic lesions, their role is unclear. Tie2-expressing macrophages (TEMs) have nonredundant functions in promoting angiogenesis and growth of experimental tumors. Here we show that human TEMs infiltrate areas surrounding newly formed endometriotic blood vessels. We set up an ad hoc mouse model in which TEMs, and not Tie2-expressing endothelial cells, are targeted. We transplanted in wild-type recipients bone marrow cells expressing a suicide gene (Herpes simplex virus type 1 thymidine kinase) under the Tie2 promoter/enhancer. TEMs infiltrated endometriotic lesions. TEM depletion by ganciclovir administration arrested the growth of established lesions, without toxicity. Lesion architecture was disrupted, with: i) loss of glandular organization, ii) reduced neovascularization, and iii) activation of caspase 3 in CD31(+) endothelial cells. Thus, TEMs are important for maintaining the viability of newly formed vessels and represent a potential therapeutic target in endometriosis.
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Affiliation(s)
- Annalisa Capobianco
- Autoimmunity and Vascular Inflammation Unit, San Raffaele Scientific Institute, Milan, Italy.
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