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Baffour Awuah G, Schauberger G, Klug SJ, Tanaka LF. An age-period-cohort analysis of hysterectomy incidence trends in Germany from 2005 to 2019. Sci Rep 2024; 14:15110. [PMID: 38956303 PMCID: PMC11220048 DOI: 10.1038/s41598-024-66019-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 06/26/2024] [Indexed: 07/04/2024] Open
Abstract
Recent studies show declining trends in hysterectomy rates in several countries. The objective of this study was to analyse hysterectomy time trends in Germany over a fifteen-year period using an age-period-cohort approach. Using an ecological study design, inpatient data from Diagnoses Related Group on hysterectomies by subtype performed in Germany from 2005 to 2019 were retrieved from the German Statistical Office. Descriptive time trends and age-period-cohort analyses were then performed. A total of 1,974,836 hysterectomies were performed over the study period. The absolute number of hysterectomies reduced progressively from 155,680 (365 procedures/100,000 women) in 2005 to 101,046 (257 procedures/100,000 women) in 2019. Total and radical hysterectomy decreased by 49.7% and 44.2%, respectively, whilst subtotal hysterectomy increased five-fold. The age-period-cohort analysis revealed highest hysterectomy rates in women aged 45-49 for total and subtotal hysterectomy with 608.63 procedures/100,000 women (95% CI 565.70, 654.82) and 151.30 procedures/100,000 women (95% CI 138.38, 165.44) respectively. Radical hysterectomy peaked later at 65-69 years with a rate of 40.63 procedures/100,000 women (95% CI 38.84, 42.52). The risk of undergoing total or radical hysterectomy decreased over the study period but increased for subtotal hysterectomy. Although, overall hysterectomy rates have declined, subtotal hysterectomy rates have increased; reflecting changes in clinical practice largely influenced by the availability of uterus-sparing options, evolving guidelines and introduction of newer surgical approaches.
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Affiliation(s)
- Gifty Baffour Awuah
- Chair of Epidemiology, TUM School of Medicine and Health, Technical University of Munich, Georg-Brauchle-Ring 56, 80992, Munich, Germany.
| | - Gunther Schauberger
- Chair of Epidemiology, TUM School of Medicine and Health, Technical University of Munich, Georg-Brauchle-Ring 56, 80992, Munich, Germany
| | - Stefanie J Klug
- Chair of Epidemiology, TUM School of Medicine and Health, Technical University of Munich, Georg-Brauchle-Ring 56, 80992, Munich, Germany
| | - Luana Fiengo Tanaka
- Chair of Epidemiology, TUM School of Medicine and Health, Technical University of Munich, Georg-Brauchle-Ring 56, 80992, Munich, Germany
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Capezzuoli T, Toscano F, Ceccaroni M, Roviglione G, Stepniewska A, Fambrini M, Vannuccini S, Petraglia F. Conservative surgical treatment for adenomyosis: New options for looking beyond uterus removal. Best Pract Res Clin Obstet Gynaecol 2024; 95:102507. [PMID: 38906739 DOI: 10.1016/j.bpobgyn.2024.102507] [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: 03/05/2024] [Revised: 05/07/2024] [Accepted: 05/19/2024] [Indexed: 06/23/2024]
Abstract
Adenomyosis is a common benign uterine disorders and patients may present dysmenorrhea, dyspareunia, abnormal uterine bleeding (AUB) and infertility. The treatment is very complex, including medical, surgical or radiological approaches. Hormonal drugs represent the first line therapy of adenomyosis, highly effective on symptoms and uterine volume reduction. Radiological procedures (UAE and HIFU), RFA and hysteroscopy may be proposed in those cases in which medical therapy is ineffective. Considering surgical treatment, hysterectomy remains the only existing definitive treatment but in the last decades the desire of uterus preservation is becoming more and more diffuse. On the other hand, surgical conservative treatments of adenomyosis are very effective in ameliorating AUB and pelvic pain and in reducing uterine volume, with some post-operative risks and obstetrics complications. Cytoreductive surgery for adenomyosis may be very complex, therefore it should be performed by experienced surgeons in dedicated centers, above all in case of concomitant endometriosis.
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Affiliation(s)
- Tommaso Capezzuoli
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni, 5, 37024, Negrar, Verona, Italy
| | - Federico Toscano
- Department of Clinical Experimental and biomedical Sciences, University of Florence, Florence, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni, 5, 37024, Negrar, Verona, Italy
| | - Giovanni Roviglione
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni, 5, 37024, Negrar, Verona, Italy
| | - Anna Stepniewska
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni, 5, 37024, Negrar, Verona, Italy
| | - Massimiliano Fambrini
- Department of Clinical Experimental and biomedical Sciences, University of Florence, Florence, Italy
| | - Silvia Vannuccini
- Department of Clinical Experimental and biomedical Sciences, University of Florence, Florence, Italy
| | - Felice Petraglia
- Department of Clinical Experimental and biomedical Sciences, University of Florence, Florence, Italy.
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Meyer R, Maxey C, Hamilton KM, Nasseri Y, Barnajian M, Levin G, Truong MD, Wright KN, Siedhoff MT. Associations between race and ethnicity and perioperative outcomes among women undergoing hysterectomy for adenomyosis. Fertil Steril 2024; 121:1053-1062. [PMID: 38342374 DOI: 10.1016/j.fertnstert.2024.02.003] [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: 10/12/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE To study racial and ethnic disparities among women undergoing hysterectomy performed for adenomyosis across the United States. DESIGN A cohort study. SETTING Data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) from 2012-2020. PATIENTS Patients with an adenomyosis diagnosis. INTERVENTION Hysterectomy for adenomyosis. MAIN OUTCOME MEASURES Patients were identified using the International Classification of Diseases 9th and 10th editions codes 617.0 and N80.0 (endometriosis of the uterus). Hysterectomies were classified on the basis of the Current Procedural Terminology codes. We compared baseline and surgical characteristics and 30-day postoperative complications across the different racial and ethnic groups. Postoperative complications were classified into minor and major complications according to the Clavien-Dindo classification system. RESULTS A total of 12,599 women underwent hysterectomy for adenomyosis during the study period: 8,822 (70.0%) non-Hispanic White, 1,597 (12.7%) Hispanic, 1,378 (10.9%) non-Hispanic Black or African American, 614 (4.9%) Asian, 97 (0.8%) Native Hawaiian or Pacific Islander, and 91 (0.7%) American Indian or Alaska Native. Postoperative complications occurred in 8.8% of cases (n = 1,104), including major complications in 3.1% (n = 385). After adjusting for confounders, non-Hispanic Black race and ethnicity were independently associated with an increased risk of major complications (adjusted odds ratio 1.54, 95% confidence interval [CI] {1.16-2.04}). Laparotomy was performed in 13.7% (n = 1,725) of cases. Compared with non-Hispanic White race and ethnicity, the adjusted odd ratios for undergoing laparoscopy were 0.58 (95% CI 0.50-0.67) for Hispanic, 0.56 (95% CI 0.48-0.65) for non-Hispanic Black or African American, 0.33 (95% CI 0.27-0.40) for Asian, and 0.26 (95% CI 0.17-0.41) for Native Hawaiian or Pacific Islander race and ethnicity. CONCLUSION Among women undergoing hysterectomy for postoperatively diagnosed adenomyosis, non-Hispanic Black or African American race and ethnicity were associated with an increased risk of major postoperative complications. Compared with non-Hispanic White race and ethnicity, Hispanic ethnicity, non-Hispanic Black or African American, Asian, Native Hawaiian, or Pacific Islander race and ethnicity were less likely to undergo minimally invasive surgery.
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Affiliation(s)
- Raanan Meyer
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, California; The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
| | - Christina Maxey
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, California
| | - Kacey M Hamilton
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, California
| | - Yosef Nasseri
- Department of General Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Moshe Barnajian
- Department of General Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Gabriel Levin
- Lady Davis Institute for cancer research, Jewish General Hospital, McGill University, Quebec, Canada
| | - Mireille D Truong
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, California
| | - Kelly N Wright
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, California
| | - Matthew T Siedhoff
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, California
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Chene G, Baffet H, Cerruto E, Nohuz E, Agostini A. The role of progestin subdermal implant in the management of adenomyosis: a systematic review. EUR J CONTRACEP REPR 2024; 29:61-68. [PMID: 38426337 DOI: 10.1080/13625187.2024.2314298] [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: 10/27/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE The long-acting reversible contraception progestin subdermal implant (ENG implant) may be effective to improve endometriosis-related symptoms. Since adenomyosis is a histopathological form of endometriosis, we aimed to evaluate the effectiveness of ENG implant in adenomyosis management. MATERIALS AND METHODS Electronic search in Medline, Scopus, Embase databases and Google Scholar using combinations of the following keywords: Progestin; subdermal implant; Implanon; Nexplanon; Adenomyosis; Endometriosis. RESULTS Out of 889 articles in the initial database, 5 prospective observational studies were eligible for inclusion in our literature review. Our review involving 152 participants found a significant reduction in pelvic pain and dysmenorrhoea (baseline median VAS score ranged from 10 to 7.62 before implantation vs VAS score ranged from 1.81 to 0.1 after implantation) as well as an increase in the levels of haemoglobin after implantation of the device (from 86 g/L to 129 g/L after implantation). Moreover, the improvement may be sustained throughout the long-term follow-up visits (until 36 months). The most common adverse events were changes in bleeding patterns which were tolerable in most cases. CONCLUSION ENG implant may be a relevant and promising medical option in the management of adenomyosis. Nevertheless, randomised controlled trials and prospective studies with larger cohorts are needed to confirm the potential role of ENG implant in the management of adenomyosis.
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Affiliation(s)
- G Chene
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University of Lyon, Lyon, France
- Claude Bernard University of Lyon, Lyon, France
| | - H Baffet
- Department of Gynecology, Jeanne de Flandre Hospital, University Hospital of Lille, Lille, France
| | - E Cerruto
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University of Lyon, Lyon, France
| | - E Nohuz
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University of Lyon, Lyon, France
| | - A Agostini
- Department of Gynecology, Assistance Publique - Hôpitaux de Marseille, La Conception Hospital, Aix Marseille Université, Marseille, France
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Zheng Y, Wu S, Liu L, Guan Y, Sun W, Miao C, Li Q. Activation of HAND2-FGFR signaling pathway by lncRNA HAND2-AS1 in adenomyosis†. Biol Reprod 2024; 110:490-500. [PMID: 38084072 DOI: 10.1093/biolre/ioad171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 11/13/2023] [Accepted: 12/09/2023] [Indexed: 03/14/2024] Open
Abstract
Heart and neural crest derivatives expressed transcript 2 (HAND2) is a critical mediator of progesterone action in endometrial stromal cells. Silencing of Hand2 expression in mouse uterus leads to an unopposed FGFR-mediated action that causes female mice infertility. To investigate the involvement of HAND2-FGFR signaling in pathogenesis of adenomyosis, immunohistochemistry, in situ hybridization, and quantitative real-time PCR were employed to assess gene expression in the normal endometrium, the paired eutopic endometrium and ectopic lesions obtained from women with adenomyosis. DNA methylation in the regions of HAND2 promoter and the first exon was also monitored in these samples. Our results revealed that HAND2 expression were dramatically reduced, but FGF9 expression and FGFR-ERK1/2-mediated MAPK signaling pathway were enhanced in the eutopic endometrium and ectopic lesions of patients with adenomyosis compared to the normal controls. Interestingly, expression of HAND2-AS1, a long noncoding RNA that resides adjacent to HAND2 in genome, was also reduced in adenomyosis. DNA methylation analysis revealed that the bidirectional promoter between HAND2 and HAND2-AS1, and the first exon of HAND2 gene was heavily methylated in the eutopic endometrium and the ectopic lesions of adenomyosis. To investigate the regulation of gene expression by HAND2-AS1, HAND2-AS1 expression was silenced in human endometrial stromal cells. In contrast to the downregulation of HAND2 in response to HAND2-AS1 silencing, FGF9 expression was augmented significantly. Endometrial stromal cells lacking HAND2-AS1 exhibited enhanced proliferation and migration potentials. Collectively, our studies revealed a new molecular mechanism by which HAND2-AS1 is involved in the pathogenesis of adenomyosis via modulating HAND2-FGFR-mediated signaling.
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Affiliation(s)
- Ya Zheng
- Department of Gynecology, P.R. China
| | - Shuang Wu
- Department of Reproductive Genetics, Key Laboratory of Reproduction Engineer of Shanxi Health Committee, Heping Hospital of Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Lingli Liu
- Department of Reproductive Genetics, Key Laboratory of Reproduction Engineer of Shanxi Health Committee, Heping Hospital of Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Yining Guan
- Department of Reproductive Genetics, Key Laboratory of Reproduction Engineer of Shanxi Health Committee, Heping Hospital of Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | | | - Congxiu Miao
- Department of Reproductive Genetics, Key Laboratory of Reproduction Engineer of Shanxi Health Committee, Heping Hospital of Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Quanxi Li
- Department of Reproductive Genetics, Key Laboratory of Reproduction Engineer of Shanxi Health Committee, Heping Hospital of Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
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Donnez J, Stratopoulou CA, Dolmans MM. Endometriosis and adenomyosis: Similarities and differences. Best Pract Res Clin Obstet Gynaecol 2024; 92:102432. [PMID: 38103509 DOI: 10.1016/j.bpobgyn.2023.102432] [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: 10/12/2023] [Accepted: 10/25/2023] [Indexed: 12/19/2023]
Abstract
Deep endometriosis and uterine adenomyosis are two frequently encountered conditions affecting approximately 200 million women worldwide. They are closely related, showing similar histological patterns and multiple common pathogenic features, and share the same symptoms. It is therefore not surprising that they are often thought to have a common developmental origin. Indeed, both deep endometriosis and adenomyosis appear to derive from estrogen-dependent overproliferation of endometrial tissue and its subsequent implantation in ectopic sites. Although the scientific community has shown increasing interest in these diseases over recent years, neither pathogenesis has yet been elucidated, so there are currently no efficient treatment options. Understanding the mechanisms underlying disease development, as well as discerning their relationship, are key to improving clinical management for millions of patients. The aims of this review are to summarize current knowledge on deep endometriosis and adenomyosis pathogeneses and discuss the possibility that these two entities are actually differential phenotypes of the same disease.
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Affiliation(s)
- Jacques Donnez
- Prof Emeritus, Université Catholique de Louvain, Belgium; Society for Research into Infertility (SRI), 143 Avenue Grandchamp, 1150, Brussels, Belgium.
| | - Christina Anna Stratopoulou
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Marie-Madeleine Dolmans
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain (UCL), Brussels, Belgium; Gynecology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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7
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Jiang J, Pan Y, Yu J, Zhang Y, Yang Y, Xu H, Sun F. Laparoscopic adenomyomectomy combined with levonorgestrel-releasing intrauterine system is effective for long-term management of adenomyosis. BMC Womens Health 2024; 24:28. [PMID: 38191409 PMCID: PMC10775492 DOI: 10.1186/s12905-023-02795-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/20/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUD Laparoscopic adenomyomectomy combined with intraoperative placement of levonorgestrel-releasing intrauterine device (LNG-IUS) is a novel conservative surgical procedure for adenomyosis. Our study aimed to compare the efficacy of surgery with or without intraoperative placement of LNG-IUS treatment in adenomyosis. METHODS We retrospectively reviewed the medical records of adenomyosis patients who received laparoscopic adenomyomectomy from January 2014 to April 2020, finally including 70 patients undergoing surgery-LNG-IUS as group A and 69 patients undegoing surgery only as group B. Risk factors for three-year relapse were analyzed using Cox's multivariate proportional hazard analysis. RESULTS Visual analog scale and Mansfield-Voda-Jorgensen Menstrual Bleeding Scale scores of group A at 3, 6, 12, 24, and 36 months were significantly lower than those of group B at the corresponding points (P < .001 for both scales). Individuals in both groups showed statistically significant symptom relief. The recurrence rate in group A was significantly lower than that in group B at 36 months after the surgery (2.94% vs. 32.84%, P < .001). A cox proportional hazard model showed that relapse was significantly associated with coexisting ovarian endometriosis (adjusted hazard ratio [aHR], 2.94; 95% confidence interval [CI], 1.33-7.02, P = .015). Patients who received surgery-LNG-IUS had a lower risk of recurrence than those with surgery-alone (aHR, 0.07; 95% CI, 0.016-0.31, P < .001). CONCLUSIONS Conservative surgery with intraoperative placement of LNG-IUS is effective and well-accepted for long-term therapy with a lower recurrence rate for adenomyosis. Coexistent ovarian endometriosis is a major factor for adenomyosis relapse.
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Affiliation(s)
- Jilan Jiang
- Department of Gynecology & Obstetrics, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No.910 Hengshan Road, Xuhui District, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Speciality, Shanghai, China
| | - Yilian Pan
- Department of Gynecology & Obstetrics, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No.910 Hengshan Road, Xuhui District, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Speciality, Shanghai, China
| | - Jin Yu
- Department of Gynecology & Obstetrics, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No.910 Hengshan Road, Xuhui District, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Speciality, Shanghai, China
| | - Ye Zhang
- Department of Gynecology & Obstetrics, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No.910 Hengshan Road, Xuhui District, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Speciality, Shanghai, China
| | - Yeping Yang
- Department of Gynecology & Obstetrics, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No.910 Hengshan Road, Xuhui District, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Speciality, Shanghai, China
| | - Hong Xu
- Department of Gynecology & Obstetrics, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No.910 Hengshan Road, Xuhui District, Shanghai, China.
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
- Shanghai Municipal Key Clinical Speciality, Shanghai, China.
| | - Feng Sun
- Department of Gynecology & Obstetrics, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No.910 Hengshan Road, Xuhui District, Shanghai, China.
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
- Shanghai Municipal Key Clinical Speciality, Shanghai, China.
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Bourdon M, Maget AS, Jeljeli M, Doridot L, Marcellin L, Thomas M, Chêne C, Chouzenoux S, Batteux F, Chapron C, Santullli P. Reduced fertility in an adenomyosis mouse model is associated with an altered immune profile in the uterus during the implantation period. Hum Reprod 2024; 39:119-129. [PMID: 38011900 DOI: 10.1093/humrep/dead246] [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: 01/03/2023] [Revised: 11/03/2023] [Indexed: 11/29/2023] Open
Abstract
STUDY QUESTION Does a reduction in fertility and/or systemic immune cell change occur during the early implantation period in a mouse model of adenomyosis? SUMMARY ANSWER A reduction in fertility was observed in mice with adenomyosis, coinciding with local and systemic immune changes observed during the implantation period. WHAT IS KNOWN ALREADY Adenomyosis is a pathology responsible for impaired fertility in humans, with a still unclear pathophysiology. One hypothesis is that changes in immune cells observed in adenomyosis-affected uteri may alter fertility, notably the physiological immune environment necessary for successful implantation and a healthy pregnancy. STUDY DESIGN, SIZE, DURATION Randomly selected CD-1 female neonatal pups were orally dosed by administration of tamoxifen to induce adenomyosis (TAM group), while others received solvent only (control group). From 6 weeks of life, CD-1 mice of both groups were mated to study impaired fertility and related local and/or systemic immune cell changes during the early implantation period. PARTICIPANTS/MATERIALS, SETTINGS, METHODS To evaluate fertility and pregnancy outcomes, ultrasound imaging was performed at E (embryonic day) 7.5 and E11.5 to count the number of gestational sacs and the number of resorptions in eight mice of the TAM group and 16 mice of the control group. The mice were sacrificed at E18.5, and morphometric, functional (quantitative reverse transcription PCR; RT-qPCR), and histological analyses were performed on the placentas. To identify local and/or systemic immune changes during the early implantation period, 8 mice of the TAM group and 12 mice of the control group were sacrificed at E4.5. Uterine horns and spleens were collected for flow cytometry and RT-qPCR analyses to study the immune cell populations. To investigate the profile of the cytokines secreted during the early implantation period at the systemic level, supernatants from stimulated spleen cells were analyzed by multiplex immunoassay analysis. MAIN RESULTS AND THE ROLE OF CHANCE By ultrasound imaging, we observed a lower number of implantation sites (P < 0.005) and a higher number of resorptions (P < 0.001) in the TAM group, leading to smaller litters (average number of fetuses per litter: 1.00 [0.00; 5.25] in the TAM group versus 12.00 [9.50; 13.75] in the control group (P < 0.001). Histological and morphometric analyses of the placentas at E18.5 showed a higher junctional/labyrinthine area ratio in the TAM group (P = 0.005). The expression levels of genes that play a role in vascularization and placental growth (Vegf (P < 0.001), Plgf (P < 0.005), Pecam (P < 0.0001), and Igf2 (P = 0.002)) were reduced in the TAM group. In the TAM group, the percentages of macrophages, natural killer (NK) cells, and dendritic cells (DC) were significantly decreased in the uterus around the implantation period. However, the number of M1 macrophages was increased. Both macrophages and DC had an increased activation profile (higher expression of MCHII, P = 0.012; CD80, P = 0.015; CCR7, P = 0.043 for macrophages, and higher expression of CD206, P = 0.018; CXCR4, P = 0.010; CCR7, P = 0.006, MCHII, P = 0.010; and CD80, P = 0.012 for DC). In spleen, an increase in the activation of macrophages (CCR7, P = 0.002; MCHII, P = 0.001; and CD80, P = 0.034) and DC was observed in the TAM group (CCR7, P = 0.001; MCHII, P = 0.001; Ly6C, P = 0.015). In the uteri and the spleen, we observed increased percentages of CD4+ T lymphocytes (P = 0.0237 and P = 0.0136, respectively) in the TAM group and, in the uteri, an increased number of regulatory T cells (P = 0.036) compared with the controls. LARGE SCALE DATA Not applicable. LIMITATIONS, REASONS FOR CAUTION This study is limited by the use of an animal model and the lack of intervention. WIDER IMPLICATIONS OF THE FINDINGS These data support involvement of innate and adaptive immune cells in the implantation failure and the increased rate of resorption observed in the mouse model of adenomyosis. This substantiates the need for additional research in this domain, with the goal of addressing fertility challenges in women affected by this condition. STUDY FUNDING/COMPETING INTEREST(S) None.
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Affiliation(s)
- M Bourdon
- Department of Gynaecology Obstetrics and Reproductive Medicine, Assistance Publique-Hopitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU), Université Paris Cité, Paris, France
- Institut Cochin, INSERM, CNRS, Paris, France
| | - A S Maget
- Department of Gynaecology Obstetrics and Reproductive Medicine, Assistance Publique-Hopitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU), Université Paris Cité, Paris, France
- Institut Cochin, INSERM, CNRS, Paris, France
| | - M Jeljeli
- Institut Cochin, INSERM, CNRS, Paris, France
- Department of Immunology, Assistance Publique-Hopitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU), Université Paris Cité, Paris, France
| | - L Doridot
- Institut Cochin, INSERM, CNRS, Paris, France
| | - L Marcellin
- Department of Gynaecology Obstetrics and Reproductive Medicine, Assistance Publique-Hopitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU), Université Paris Cité, Paris, France
- Institut Cochin, INSERM, CNRS, Paris, France
| | - M Thomas
- Institut Cochin, INSERM, CNRS, Paris, France
| | - C Chêne
- Institut Cochin, INSERM, CNRS, Paris, France
| | | | - F Batteux
- Institut Cochin, INSERM, CNRS, Paris, France
- Department of Immunology, Assistance Publique-Hopitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU), Université Paris Cité, Paris, France
| | - C Chapron
- Department of Gynaecology Obstetrics and Reproductive Medicine, Assistance Publique-Hopitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU), Université Paris Cité, Paris, France
- Institut Cochin, INSERM, CNRS, Paris, France
| | - P Santullli
- Department of Gynaecology Obstetrics and Reproductive Medicine, Assistance Publique-Hopitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU), Université Paris Cité, Paris, France
- Institut Cochin, INSERM, CNRS, Paris, France
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Kim NI, Lee JS, Nam JH. Uterine rupture due to adenomyosis in an adolescent: A case report and review of literature. World J Clin Cases 2023; 11:7888-7894. [DOI: 10.12998/wjcc.v11.i32.7888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/21/2023] [Accepted: 11/08/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Uterine rupture is a fatal medical complication with a high mortality rate. Most cases of uterine rupture occur in late pregnancy or during labor and are mainly related to uterine scarring due to previous surgical procedures. Adenomyosis is a possible risk factor for uterine rupture. However, spontaneous uterine rupture due to severe adenomyosis in a non-gravida-teenaged female has not been reported in the literature to date.
CASE SUMMARY A 16-year-old girl was referred to our hospital for acute abdominal pain and hypovolemic shock with a blood pressure of 90/50 mmHg. Radiologic studies revealed a huge endometrial mass with multiple nodules in the lung, suggesting lung metastasis. The patient underwent an emergency total hysterectomy and wedge resection of the lung nodules. Histologically, the uterus showed diffuse adenomyosis with glandular and stromal dissociation. Lung nodules were endometrioma with massive hemorrhage. Immunohistochemistry demonstrated that the tumor cells were positive for PAX8, ER, and PR expression, leading to a final diagnosis of pulmonary endometriosis and uterine adenomyosis. Following surgery, the patient remains in good condition without recurrence.
CONCLUSION This is the first case of spontaneous uterine rupture due to adenomyosis in a non-gravida adolescent.
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Affiliation(s)
- Nah Ihm Kim
- Department of Pathology, Chonnam National University Hospital, Gwangju 61469, South Korea
| | - Ji Shin Lee
- Department of Pathology, Chonnam National University Hwasun Hospital, Hwasun 58128, South Korea
| | - Jong Hee Nam
- Department of Pathology, Chonnam National University Medical School, Gwangju 61469, South Korea
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10
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Liu S, Peng C, Wang Z, Zhou X, Zhang S, Li G, Yang B. Association of normalization of postoperative carbohydrate antigen 125 levels with treatment failure following uterine artery embolization for adenomyosis. J Obstet Gynaecol Res 2023; 49:2753-2760. [PMID: 37614048 DOI: 10.1111/jog.15779] [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: 05/23/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To investigate the association between carbohydrate antigen 125 (CA125) level and adenomyosis treatment failure (TF) after uterine artery embolization (UAE). METHODS We evaluated 224 patients with symptomatic adenomyosis who underwent UAE between January 2016 and December 2020. Improvements in dysmenorrhea and menorrhagia were assessed on the basis of symptom relief criteria. The factors associated with TF were investigated using a multivariate logistic regression model. Patients were analyzed for preoperative CA125 levels, postoperative CA125 levels, and the normalization of postoperative CA125 levels. Long-term symptom relief and quality of life after UAE were compared between the groups. RESULTS During the 24-month follow-up, 50 patients (22.3%) experienced TF. Compared to patients in the non-TF group, those in the TF group had significantly higher preoperative and postoperative CA125 levels (p < 0.05). Multivariate analysis revealed that failure to normalize postoperative CA125 levels was independently associated with an increased risk of TF (34.7% vs. 8.5%, p < 0.001; hazard ratio 3.953, 95% confidence interval 1.567-9.973, p = 0.004). After a 3-month follow-up period, patients who normalized their CA125 levels were more likely to achieve complete necrosis on magnetic resonance imaging than those who did not (82.1% vs. 56.8%, p < 0.001). Normalization of postoperative CA125 levels was significantly associated with fewer symptoms and better quality of life 12 months after UAE (p < 0.05). CONCLUSIONS Following UAE, normalization of postoperative CA125 levels, rather than absolute values, was the strongest predictive marker of TF.
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Affiliation(s)
- Song Liu
- Department of Obstetrics and Gynecology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Chaonan Peng
- Department of Obstetrics and Gynecology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhiliang Wang
- Department of Obstetrics and Gynecology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xi Zhou
- Department of Obstetrics and Gynecology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Shujuan Zhang
- Department of Obstetrics and Gynecology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Guangxue Li
- Department of Obstetrics and Gynecology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Bing Yang
- Department of Obstetrics and Gynecology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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Moawad G, Youssef Y, Fruscalzo A, Faysal H, Kheil M, Pirtea P, Guani B, Ayoubi JM, Feki A. The Present and the Future of Medical Therapies for Adenomyosis: A Narrative Review. J Clin Med 2023; 12:6130. [PMID: 37834773 PMCID: PMC10573655 DOI: 10.3390/jcm12196130] [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: 04/19/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 10/15/2023] Open
Abstract
Uterine Adenomyosis is a benign condition characterized by the presence of endometrium-like epithelial and stromal tissue in the myometrium. Several medical treatments have been proposed, but still, no guidelines directing the management of adenomyosis are available. While a hysterectomy is typically regarded as the definitive treatment for adenomyosis, the scarcity of high-quality data leaves patients desiring fertility with limited conservative options. Based on the available data, the levonorgestrel-IUD appears to offer the most favorable outcomes. Other treatments, including GnRH antagonists, dienogest, prolactin, and oxytocin modulators, show promise; however, further data are required to establish their efficacy definitively. Furthermore, there are many emerging therapies that have been developed that seem worthy of consideration in the near future. The aim of this narrative review was to explore the current medical treatments available for adenomyosis and to provide a glimpse of future therapies under assessment. For this scope, we performed a literature search on PubMed and Medline from incept to September 2022 using the keywords: "medical treatment", "non-steroidal anti-inflammatory", "progesterone intrauterine device", "dienogest", "combined oral contraceptives", "gonadotropin releasing hormone agonist", "gonadotropin releasing hormone antagonist", "danazol", "aromatase inhibitors", "ulipristal acetate", "anti-platelet therapy", "dopamine", "oxytocin antagonists", "STAT3", "KRAS", "MAPK", "micro-RNA", "mifepristone", "valproic acid", "levo-tetrahydropalamatine", and "andrographolide". The search was limited to articles in English, with subsequent screening of abstracts. Abstracts were screened to select relevant studies.
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Affiliation(s)
- Gaby Moawad
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC 20037, USA
- The Center for Endometriosis and Advanced Pelvic Surgery, Washington, DC 22101, USA
| | - Youssef Youssef
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY 11220, USA
| | - Arrigo Fruscalzo
- Department of Obstetrics and Gynecology, HFR—Fribourg, Chemin des Pensionnats 2-6, 1708 Fribourg, Switzerland; (A.F.)
| | - Hani Faysal
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN 46202, USA
| | - Mira Kheil
- Department of Obstetrics and Gynecology, Henry Ford Health, Detroit, MI 48202, USA
| | - Paul Pirtea
- Department of Obstetrics and Gynecology and Reproductive Medicine, Hopital Foch–Faculté de Médecine Paris, 92150 Suresnes, France
| | - Benedetta Guani
- Department of Obstetrics and Gynecology, HFR—Fribourg, Chemin des Pensionnats 2-6, 1708 Fribourg, Switzerland; (A.F.)
| | - Jean Marc Ayoubi
- Department of Obstetrics and Gynecology and Reproductive Medicine, Hopital Foch–Faculté de Médecine Paris, 92150 Suresnes, France
| | - Anis Feki
- Department of Obstetrics and Gynecology, HFR—Fribourg, Chemin des Pensionnats 2-6, 1708 Fribourg, Switzerland; (A.F.)
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12
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MacGregor B, Munro MG, Lumsden MA. Therapeutic options for the management of abnormal uterine bleeding. Int J Gynaecol Obstet 2023; 162 Suppl 2:43-57. [PMID: 37538018 DOI: 10.1002/ijgo.14947] [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] [Indexed: 08/05/2023]
Abstract
Just as the investigation of abnormal uterine bleeding (AUB) is approached systematically using the two FIGO systems for AUB in the reproductive years, treatment options can be considered similarly. Therapeutic options fall into two categories-medical and surgical-and while medical management is typically regarded as first-line therapy, there are several exceptions defined by the presenting cause or causes, mainly when infertility is a concurrent issue. In the early 1990s, up to 60% of women underwent a hysterectomy for the symptom of heavy menstrual bleeding (HMB), but this figure has decreased. The number of women undergoing a hysterectomy for benign disorders continues to decline, along with an increase in hysterectomies performed using minimally invasive techniques. Discussions about therapeutic options are tailored to the individual patient, and we include the risks and benefits of each option, including no management, to enable the patient to make an informed choice. The different types of treatment options and the factors affecting decision-making are considered in this article.
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Affiliation(s)
| | - Malcolm G Munro
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
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Gkrozou F, Vatopoulou A, Skentou C, Paschopoulos M. Diagnosis and Treatment of Adenomyosis with Office Hysteroscopy-A Narrative Review of Literature. Diagnostics (Basel) 2023; 13:2182. [PMID: 37443576 DOI: 10.3390/diagnostics13132182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Adenomyosis is a common chronic disease in women of reproductive age, characterised by the presence of ectopic endometrial tissue within myometrium. Even though adenomyosis presents with chronic pelvic pain, menorrhagia or abnormal uterine bleeding, dysmenorrhoea, and dyspareunia and is often recognised after hysterectomies. However, the development of ultrasonography and magnetic resonance imaging has improved the pre-operative diagnosis of the disease. Hysteroscopy provides information in real time from the uterine cavity and the offers the possibility of obtaining direct biopsies. MATERIAL AND METHODS The literature was searched via Pubmed and Embase with the following headings: diagnosis of adenomyosis or adenomyoma and office hysteroscopy, hysteroscopy findings of adenomyosis or adenomyoma, treatment of adenomyosis or adenomyoma with office hysteroscopy. RESULTS The literature showed that hysteroscopy can identify superficial adenomyosis. There are a variety of hysteroscopic images that can be connected with the disease. New equipment like the spirotome has been used to access deeper layers of myometrium and obtain biopsies under direct vision from the adenomyotic areas. Different methods of treatment have been also described, like enucleation of focal superficial adenomyoma, coagulation, evacuation of cystic adenomyosis when the lesion is smaller than 1.5 cm, and resection of adenomyotic nodules in case of bigger lesions (>1.5 cm). Diffuse superficial adenomyosis is also managed by resection. CONCLUSIONS Hysteroscopy has revolutionised the approach to adenomyosis. It is a useful tool in assessing mainly superficial adenomyosis. The role of hysteroscopy in surgical management of adenomyosis need to be confirmed with further studies.
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Affiliation(s)
- Fani Gkrozou
- Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, 45500 Ioannina, Greece
| | - Anastasia Vatopoulou
- Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, 45500 Ioannina, Greece
| | - Chara Skentou
- Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, 45500 Ioannina, Greece
| | - Minas Paschopoulos
- Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, 45500 Ioannina, Greece
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Liu X, Wang J, Liu Y, Luo S, Yan G, Yang H, Wan L, Huang G. High Intensity Focused Ultrasound Ablation for Juvenile Cystic Adenomyosis: Two Case Reports and Literature Review. Diagnostics (Basel) 2023; 13:diagnostics13091608. [PMID: 37174999 PMCID: PMC10178475 DOI: 10.3390/diagnostics13091608] [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: 03/06/2023] [Revised: 04/05/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Cystic adenomyosis is a rare type of uterine adenomyosis, mainly seen in young women, which is often characterized by severe dysmenorrhea. The quality of life and reproductive function of young women could be affected by misdiagnosis and delayed treatment. At present, there are no universal guidelines and consensus. We report two cases of patients with cystic adenomyosis in juveniles treated with high-intensity focused ultrasound (HIFU) ablation. In the first case, magnetic resonance imaging (MRI) indicated a cystic mass of 2.0 cm × 3.1 cm × 2.4 cm in the uterus. After she underwent HIFU treatment, her pelvic MRI showed a mass of 1.1 × 2.4 cm in size, and her dysmenorrhea symptoms gradually disappeared. In the second case, a pelvic MRI indicated a 5.1 cm × 3.3 cm × 4.7 cm cystic mass in the uterus. After she underwent HIFU and combined four consecutive cycles of GnRH-a treatment, the lesion shrunk 1.2 cm ×1.4 cm × 1.6 cm, without dysmenorrhea. Simultaneously, the report reviewed 14 cases of juvenile cystic adenomyosis over the last ten years. HIFU or HIFU-combined drugs were safe and effective in treating juvenile cystic adenomyosis, but multicenter and prospective studies may be necessary to validate this in the future.
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Affiliation(s)
- Xin Liu
- School of Medical and Life Science, Chengdu University of Traditional Chinese Medicine, Chengdu 610000, China
- Department of Gynecology, Suining Central Hospital, Suining 629000, China
| | - Jingxi Wang
- Department of Gynecology, Suining Central Hospital, Suining 629000, China
| | - Yanglu Liu
- School of Medical and Life Science, Chengdu University of Traditional Chinese Medicine, Chengdu 610000, China
| | - Shuang Luo
- Department of Gynecology, Suining Central Hospital, Suining 629000, China
| | - Gaowu Yan
- Department of Radiology and Imaging, Suining Central Hospital, Suining 629000, China
| | - Huaqi Yang
- Department of Gynecology, Suining Central Hospital, Suining 629000, China
| | - Lili Wan
- Department of Gynecology, Suining Central Hospital, Suining 629000, China
| | - Guohua Huang
- Department of Gynecology, Suining Central Hospital, Suining 629000, China
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15
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Yuan X, Wong BWX, Randhawa NK, Win TPP, Chan YH, Ma L, Yong EL. Factors associated with deep infiltrating endometriosis, adenomyosis and ovarian endometrioma. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023. [DOI: 10.47102/annals-acadmedsg.2022334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Introduction: To compare epidemiological features and clinical presentations of deep infiltrating endometriosis with endometrioma and adenomyosis, as well as to identify risk factors for the respective histologically confirmed conditions.
Method: Patients undergoing index surgery at the National University Hospital, Singapore for endometriosis or adenomyosis over a 7-year period—from 2015 to 2021—were identified from hospital databases using the Table of Surgical Procedures coding. Social and epidemiological features of cases with histologically confirmed diagnoses of endometrioma only, adenomyosis only, and deep infiltrating endometriosis were compared. Significant variables from univariate analysis were entered into 3 binary multivariate logistic regression models to obtain independent risk factors for: deep infiltrating endometriosis versus endometrioma only, deep infiltrating endometriosis versus adenomyosis only, and adenomyosis only versus endometrioma only.
Results: A total of 258 patients were included with 59 ovarian endometrioma only, 47 adenomyosis only, and 152 deep infiltrating endometrioses. Compared to endometrioma only, deep infiltrating endometriosis was associated with higher rates of severe dysmenorrhoea (odds ratio [OR] 2.80, 95% confidence interval [CI] 1.02–7.70) and out-of-pocket private surgical care (OR 4.72, 95% CI 1.85–12.04). Compared to adenomyosis only, deep infiltrating endometriosis was associated with a higher fertility desire (OR 13.47, 95% CI 1.01–180.59) and a lower body mass index (OR 0.89, 95% CI 0.79–0.99). In contrast, heavy menstrual bleeding was the hallmark of adenomyosis, being less common in patients with endometriosis.
Conclusion: Deep infiltrating endometriosis is associated with severe dysmenorrhoea, pain related to urinary and gastrointestinal tracts, higher fertility desire and infertility rate. Patients with pain symptomatology and subfertility should be referred early to a tertiary centre with the capability to diagnose and manage deep infiltrating endometriosis.
Keywords: Adenomyosis, deep infiltrating endometriosis, obstetrics and gynaecology, ovarian endometrioma, public health
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Affiliation(s)
- Xi Yuan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Beverly WX Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Thu PP Win
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yiong Huak Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Li Ma
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Eu-Leong Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Stratopoulou CA, Cussac S, d'Argent M, Donnez J, Dolmans MM. M2 macrophages enhance endometrial cell invasiveness by promoting collective cell migration in uterine adenomyosis. Reprod Biomed Online 2023; 46:729-738. [PMID: 36792417 DOI: 10.1016/j.rbmo.2023.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/12/2022] [Accepted: 01/03/2023] [Indexed: 01/10/2023]
Abstract
RESEARCH QUESTION Are M2 macrophages implicated in endometrial invasiveness in adenomyosis? DESIGN Seventeen formalin-fixed paraffin-embedded uterine samples and 16 fresh endometrial biopsies were collected from women with or without adenomyosis. Double immunofluorescence was performed to determine the predominant macrophage population in adenomyosis between M1 and M2 phenotypes. The invasion capacity of endometrial cells was assessed by invasion assays and quantitative polymerase chain reaction for genes involved in cell motility and epithelial-mesenchymal transition (EMT). Specific mechanisms of invasion were investigated by immunohistochemistry for E-cadherin, N-cadherin and matrix metalloproteinase 9 (MMP9). RESULTS Only M2 macrophages were found to accumulate in adenomyosis, in higher numbers in both eutopic endometrium (P = 0.0109) and lesions (P = 0.0267) than healthy tissue. Co-culture with M2 macrophages significantly boosted invasion capacity in endometrial epithelial (P = 0.0002; P = 0.002) and stromal cells (P = 0.0469; P = 0.0047) from both adenomyosis patients and healthy controls. No gene expression differences indicating EMT were noted, either between co-cultured and control cells, or between healthy and adenomyotic cells. E- and N-cadherin protein expression did not differ significantly between endometrium from adenomyosis subjects and healthy tissue but MMP9 expression was increased in eutopic stroma from adenomyosis patients (P = 0.0492). In adenomyosis, both E-cadherin (P = 0.0379) and N-cadherin (P = 0.0196) were more extensively expressed in basal glands than functional glands. CONCLUSIONS M2 macrophages accumulate in adenomyosis and enhance invasion capacity of adenomyotic and even healthy endometrial cells, implying that macrophage infiltration alone may be sufficient to promote the disease. This study failed to detect any changes pointing to EMT, suggesting an alternative mode of invasion. Strong E- and N-cadherin-positive intercellular junctions in basal (invasive) glands suggest the involvement of collective cell migration in the invasion process of endometrium.
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Affiliation(s)
- Christina Anna Stratopoulou
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Sophie Cussac
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Marie d'Argent
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Jacques Donnez
- Société de Recherche pour l'Infertilité, Brussels, Belgium; Université Catholique de Louvain, Brussels, Belgium
| | - Marie-Madeleine Dolmans
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Gynecology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
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Chen P, Wang K, Zhuang M, Fu X, Liu S, Chen M, Lei Y. An insight into gut microbiota and metabolites in the mice with adenomyosis. Front Cell Infect Microbiol 2023; 13:1075387. [PMID: 36923594 PMCID: PMC10008959 DOI: 10.3389/fcimb.2023.1075387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/07/2023] [Indexed: 03/02/2023] Open
Abstract
Background Adenomyosis (AM) is a benign uterine disease characterized pathologically by the invasion of endometrial tissue into the myometrium. The pathogenesis of AM is still far from clear. Although the gut microbiome and metabolomics are thought to contribute to a variety of diseases, the role of them in AM has not been revealed. Objective To investigate changes in the gut microbiota and derived metabolites in AM mice. Method Female ICR mice were randomly assigned to AM and control groups, and pituitary transplantation was employed to perform AM modeling. Then, the fecal samples were obtained for microbial (16S rRNA gene sequencing) and metabolomic (liquid chromatography mass spectrometry, LC-MS) analysis. Result The results of gut microbiota analysis showed that the intestinal microbiota composition of AM mice was altered. The ratio of Firmicutes/Bacteroidetes and the relative abundance of Lactobacillus in AM group increased compared with the control group. Sixty differential expressed metabolites were identified in intestinal metabolites, mainly involved in steroid hormone biosynthesis, cysteine and methionine metabolism, and alanine, aspartate, and glutamate metabolism. Further, correlation analysis verified that L-methionine and L-cystine were negatively correlated with Bacteroides and positively correlated with Desulfovibrio. The Pregnenolone, Androsterone glucuronide, and Testosterone glucuronide were negatively correlated with Unidentified_Ruminococcaceae and Alistipes, whereas they positively correlated with Bacteroides. Conclusion AM mice have a unique gut microbiome and intestinal metabolites.
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Affiliation(s)
- Peipei Chen
- Third-Grade Pharmacological Laboratory on Chinese Medicine Approved by State Administration of Traditional Chinese Medicine, Medical College of China Three Gorges University, Yichang, Hubei, China
| | - Kun Wang
- Third-Grade Pharmacological Laboratory on Chinese Medicine Approved by State Administration of Traditional Chinese Medicine, Medical College of China Three Gorges University, Yichang, Hubei, China
| | - Mingyan Zhuang
- Obstetrics and Gynecology Department of Maternity and Child Health Care Hospital, Three Gorges University, Yichang, Hubei, China
- *Correspondence: Mingyan Zhuang, ; Xianyun Fu,
| | - Xianyun Fu
- Third-Grade Pharmacological Laboratory on Chinese Medicine Approved by State Administration of Traditional Chinese Medicine, Medical College of China Three Gorges University, Yichang, Hubei, China
- *Correspondence: Mingyan Zhuang, ; Xianyun Fu,
| | - Shidan Liu
- Third-Grade Pharmacological Laboratory on Chinese Medicine Approved by State Administration of Traditional Chinese Medicine, Medical College of China Three Gorges University, Yichang, Hubei, China
| | - Minmin Chen
- Third-Grade Pharmacological Laboratory on Chinese Medicine Approved by State Administration of Traditional Chinese Medicine, Medical College of China Three Gorges University, Yichang, Hubei, China
| | - Ya Lei
- Third-Grade Pharmacological Laboratory on Chinese Medicine Approved by State Administration of Traditional Chinese Medicine, Medical College of China Three Gorges University, Yichang, Hubei, China
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18
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Shen Z, He Y, Shen Z, Wang X, Wang Y, Hua Z, Jiang N, Song Z, Li R, Xiao Z. Novel exploration of Raman microscopy and non-linear optical imaging in adenomyosis. Front Med (Lausanne) 2022; 9:969724. [PMID: 36341264 PMCID: PMC9630647 DOI: 10.3389/fmed.2022.969724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background Adenomyosis is a common gynecological disease in women. A relevant literature search found that approximately 82% of patients with adenomyosis chose to undergo hysterectomy. However, women of childbearing age are more likely to undergo surgery to preserve the uterus. Because it is difficult to determine the extent of adenomyosis, it is almost impossible to resect adenomyotic tissue and retain the uterus at the same time. Materials and methods Following ethics approval and patient consent, tissue samples were resected and prepared to create frozen slices for analysis. One slice was subjected to H&E staining while the remaining slices were photographed with Coherent Anti-Stokes Raman Scattering (CARS), Second-Harmonic Generation (SHG) microscopy, and Raman spectroscopy. Comparative observations and analyses at the same positions were carried out to explore the diagnostic ability of CARS, SHG, and Raman spectroscopy for adenomyosis. Results In adenomyotic tissue, we found two characteristic peaks at 1,155 and 1,519 cm–1 in the Raman spectrum, which were significantly different from normal tissue. The substances shown in the CARS spectrum were represented by peaks of 1,519 cm–1. SHG microscopy showed a distribution of collagen at the focus of the adenomyosis. Conclusion This study represents a novel analysis of Raman microscopy, CARS, and SHG in the analysis of adenomyotic lesions. We found the diffraction spectrum useful in determining the focal boundary and the diagnosis of adenomyosis in the tested samples.
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Affiliation(s)
- Zhuowei Shen
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yingying He
- Department of Pathology, Dalian Medical Center for Women and Children, Dalian, China
| | - Zhuoyi Shen
- Department of Information Science and Technology, Wenhua University, Wuhan, China
| | - Xuefei Wang
- Department of Pathology, Dalian Medical Center for Women and Children, Dalian, China
| | - Yang Wang
- Department of Physics, Dalian University of Technology, Dalian, China
| | - Zhengyu Hua
- Department of Pathology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Nan Jiang
- Department of Pathology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zejiang Song
- Department of Physics, Dalian University of Technology, Dalian, China
| | - Rui Li
- Department of Physics, Dalian University of Technology, Dalian, China
- Rui Li,
| | - Zhen Xiao
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- *Correspondence: Zhen Xiao,
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19
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Lin J, Liu L, Zheng F, Chen S, Yang W, Li J, Mo S, Zeng DY. Exploration the global single-cell ecological landscape of adenomyosis-related cell clusters by single-cell RNA sequencing. Front Genet 2022; 13:1020757. [DOI: 10.3389/fgene.2022.1020757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Adenomyosis (AM) is a common benign uterine disease that threatens the normal life of patients. Cells associated with microenvironmental immune ecology are crucial in AM, although they are not as well understood at the cellular level.Methods: Single-cell sequencing (scRNA-seq) data were used to construct an AM global single-cell map, to further identify relevant cell clusters and infer chromosomal copy number variation (CNV) in AM samples. The biological functions of cell clusters were explored and cellular evolutionary processes were inferred by enrichment analysis and pseudotime analysis. In addition, a gene regulatory network (GRN) analysis was constructed to explore the regulatory role of transcription factors in AM progression.Results: We obtained the expression profiles of 42260 cells and identified 10 cell clusters. By comparing the differences in cell components between AM patients and controls, we found that significant abundance of endometrial cells (EC), epithelial cells (Ep), endothelial cells (En), and smooth muscle cells (SMC) in AM patients. Cell clusters with high CNV levels possessing tumour-like features existed in the ectopic endometrium samples. Moreover, the Ep clusters were significantly involved in leukocyte transendothelial cell migration and apoptosis, suggesting an association with cell apoptosis and migration. En clusters were mainly involved in pathways in cancer and apoptosis, indicating that En has certain malignant features.Conclusion: This study identified cell clusters with immune-related features, investigated the changes in the immune ecology of the microenvironment of these cells during AM, and provided a new strategy for the treatment of AM.
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Lazaridis A, Grammatis AL, Spencer S, Hirsch M. Nonsurgical management of adenomyosis: an overview of current evidence. Curr Opin Obstet Gynecol 2022; 34:315-323. [PMID: 35895912 DOI: 10.1097/gco.0000000000000810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Adenomyosis is a condition where endometrium-like tissue spreads within the myometrium. Although its prevalence in the general population is not exactly known, its clinical manifestations are well established and include pelvic pain, dysmenorrhea (painful periods), heavy menstrual bleeding and subfertility [1] . Adenomyosis often coexists with other gynaecological conditions, such as endometriosis or fibroids, and may cloud the clinical presentation [2] . The aim of this article is to review current noninterventional, nonsurgical management modalities and wherever possible offer information that allows women to make safe and informed choices regarding their treatment options. RECENT FINDINGS Recent studies support that medical strategies, including the Mirena coil, Dienogest and GnRH antagonists, are efficient in improving adenomyosis-associated symptoms. High-quality evidence is scarce and is needed to properly counsel women with this condition. Future research should prioritize overall pain, menstrual bleeding, quality of life and live birth as primary outcomes and assess women with different grades of adenomyosis. SUMMARY This review provides the most current evidence with regards to the nonsurgical management of adenomyosis. In light of the paucity and low quality of existing data, high-quality trials are needed to definitely determine the impact of conservative and medical treatment on the clinical management of adenomyosis.
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Affiliation(s)
- Alexandros Lazaridis
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford
| | | | - Stuart Spencer
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford
| | - Martin Hirsch
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford
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Miao J, Lu J, Tang J, Lu P. Long-term treatment of dienogest with symptomatic adenomyosis: retrospective analysis of efficacy and safety in clinical practice. Gynecol Endocrinol 2022; 38:656-660. [PMID: 35850637 DOI: 10.1080/09513590.2022.2098948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Objective: To evaluate the efficacy and safety of dienogest (DNG) in women with symptomatic adenomyosis.Methods: Women with symptomatic adenomyosis were included in this retrospective observation study. Group 1 (maximum uterine dimension ≥ 100.0 mm) began DNG after 4 months of GnRH-a administration, Group 2 (maximum uterine dimension < 100.0 mm) received DNG with no prior GnRH-a treatment. All women were assessed for their pain symptoms, uterine size, adverse effects and laboratory hematology at baseline and every 6 months during the treatment.Results: 123 women were enrolled in this study, in Group 1 (71 women) with severe uterine enlargement, the median VAS score was 80 mm prior to GnRH-a administration and 10, 10, 10, 20, and 20 mm, respectively, after 0, 6,12,18, and 24 months of DNG treatment. The mean uterine volume decreased from 262.9 ml to 104.7 ml after GnRH-a therapy, and slowly increased from 104.7 ml to 139.5 ml after 24 month-treatment of DNG. Another 52 women with mild uterine enlargement received DNG without prior GnRH-a administration, median VAS score was 70 mm at baseline and decreased to 20, 20, 10, and 10 mm at 6,12,18, and 24 months. The mean uterine volume slightly decreased from 157.9 ml to 153.3 ml after 24 months of DNG treatment (p > 0.05). All laboratory parameters were in the normal range.Conclusions: DNG is effective and well tolerated as a long-term treatment for symptomatic adenomyosis, and it can be used as maintenance therapy after discontinuation of GnRH-a administration.
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Affiliation(s)
- Juan Miao
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Lu
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Juanjuan Tang
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pinhong Lu
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Functional Implications of Estrogen and Progesterone Receptors Expression in Adenomyosis, Potential Targets for Endocrinological Therapy. J Clin Med 2022; 11:jcm11154407. [PMID: 35956024 PMCID: PMC9369051 DOI: 10.3390/jcm11154407] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 02/04/2023] Open
Abstract
Adenomyosis is a common gynaecological disease associated with the presence of endometrial lesions in the uterine myometrium. Estrogens have been proven to be the crucial hormones driving the growth of adenomyosis. Little is known about the distinct mechanisms of progesterone action in adenomyosis. Hence, in this study, we decided to characterize the expression of all nuclear and membrane estrogen and progesterone receptors. Additionally, as a functional investigation, we monitored prolactin production and cell proliferation after estradiol and progesterone treatments. We confirmed the presence of all nuclear and membrane estrogen and progesterone receptors in adenomyotic lesions at gene and protein levels. The expression of membrane progesterone receptors α and β (mPRα, mPRβ) as well as estrogen receptor β (ERβ) was upregulated in adenomyosis compared to normal myometrium. Estradiol significantly increased adenomyotic cell proliferation. Progesterone and cAMP upregulated prolactin secretion in adenomyosis in the same pattern as in the normal endometrium. In the present study, we showed the functional link between estradiol action and adenomyotic cell proliferation, as well as progesterone and prolactin production. Our findings provide novel insights into the sex steroid receptor expression pattern and potential regulated pathways in adenomyosis, suggesting that all receptors play an important role in adenomyosis pathophysiology.
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Li YT, Seow KM, Wang PH. Adenomyomectomy: A complicated surgery. Taiwan J Obstet Gynecol 2022; 61:407-408. [PMID: 35595427 DOI: 10.1016/j.tjog.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Yiu-Tai Li
- Department of Obstetrics and Gynecology, Kuo General Hospital, Tainan, Taiwan
| | - Kok-Min Seow
- Department of Obstetrics and Gynecology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Peng-Hui Wang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Female Cancer Foundation, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
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Mitteilungen der DGGEF. GYNAKOLOGISCHE ENDOKRINOLOGIE 2022. [DOI: 10.1007/s10304-022-00446-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Miyagawa C, Murakami K, Tobiume T, Nonogaki T, Matsumura N. Characterization of patients that can continue conservative treatment for adenomyosis. BMC Womens Health 2021; 21:431. [PMID: 34961515 PMCID: PMC8714452 DOI: 10.1186/s12905-021-01577-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background Historically, hysterectomy has been the radical treatment for adenomyosis. Although, some patients may not want to have their uterus removed, patients often have to no choice but to request hysterectomy during conservative treatment. The factors necessitating these hysterectomies remain unknown. The purpose of this study was to determine which patients can continue conservative treatment for adenomyosis. Methods We selected women diagnosed with adenomyosis and provided with conservative treatment at the Kindai University Hospital and Osaka Red Cross Hospital in Osaka Japan from 2008 to 2017. Age at diagnosis, parity, uterine size, subtype of adenomyosis, type of conservative treatment, and timing of hysterectomy for cases with difficulty continuing conservative treatment were examined retrospectively. Results A total of 885 patients were diagnosed with adenomyosis, and 124 started conservative treatment. Conservative treatment was continued in 96 patients (77.4%) and hysterectomy was required in 28 patients (22.6%). The cumulative hysterectomy rate was 32.4%, and all women had hysterectomy within 63 months. In the classification tree, 82% (23/28) of women aged 46 years or younger were able to continue conservative treatment when parity was zero or one. In those with parity two and over, 95% (20/21) of those aged 39 years and older had hysterectomy. Conclusions Patients who continue conservative treatment for approximately 5 years are more likely to have successful preservation of the uterus. Multiparity and higher age at diagnosis are factors that contribute to hysterectomy after conservative treatment. Parity and age at diagnosis may be stratifying factors in future clinical trials of hormone therapy.
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