1
|
Mardon AK, Chalmers KJ, Heathcote LC, Curtis LA, Freedman L, Malani R, Parker R, Neumann PB, Moseley GL, Leake HB. "I wish I knew then what I know now" - pain science education concepts important for female persistent pelvic pain: a reflexive thematic analysis. Pain 2024; 165:1990-2001. [PMID: 38452219 DOI: 10.1097/j.pain.0000000000003205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/18/2024] [Indexed: 03/09/2024]
Abstract
ABSTRACT Pain science education (PSE) provides people with an understanding of "how pain works" grounded in the biopsychosocial model of pain; it has been demonstrated to improve outcomes in musculoskeletal pain conditions. Preliminary evidence suggests PSE may be effective for female individuals with persistent pelvic pain, but how the content of PSE needs to be modified for this group remains to be determined. A reflexive thematic analysis of qualitative data was performed to identify PSE concepts that female individuals with persistent pelvic pain consider important and why. Twenty individual, semistructured interviews were conducted with adult females who had engaged with PSE and had self-identified as having "improved" pelvic pain. Most participants had been diagnosed with endometriosis (n = 16). Four themes were generated capturing PSE concepts considered important by female individuals with "improved" pelvic pain: (1) "A sensitised nervous system leads to overprotective pain" validated their pelvic pain as being real; (2) "Pain does not have to mean the body is damaged (although sometimes it does)" provided reassurance that pelvic pain does not mean their condition is worsening; (3) "How I think, feel, and 'see' my pain can make it worse" enabled participants to find optimal ways to manage their pain; and (4) "I can change my pain… slowly" provided hope that pelvic pain can improve and empowered them to pursue pain improvement as a viable goal. This study generated 4 PSE learning concepts that were important to female individuals with improved pelvic pain and may be incorporated into PSE curricula for female individuals with pelvic pain.
Collapse
Affiliation(s)
- Amelia K Mardon
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
| | - K Jane Chalmers
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
| | - Lauren C Heathcote
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
- Health Psychology Section, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Lee-Anne Curtis
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
| | | | - Rinkle Malani
- MGM School of Physiotherapy, Aurangabad, A Constituent Unit of MGMIHS, Maharashtra, India
| | - Romy Parker
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Patricia B Neumann
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
| | - Hayley B Leake
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
| |
Collapse
|
2
|
Choi H, Kim SE, Lee NH, Lee DY, Choi D. Clinical characteristics of endometrioma with and without dysmenorrhea diagnosed by laparoscopy: A retrospective cohort study in a tertiary center. Int J Gynaecol Obstet 2024; 166:1279-1284. [PMID: 38571378 DOI: 10.1002/ijgo.15494] [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: 09/22/2023] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE Clinical characteristics of patients with endometrioma without dysmenorrhea have not been well delineated; our goal was to remedy this issue by performing a retrospective cohort study. METHODS A total of 379 patients who underwent laparoscopic surgery for endometrioma ≥4 cm at a tertiary hospital were included in this retrospective study. Patients were divided into two groups based on the presence of dysmenorrhea at the time of hospital visit; with dysmenorrhea group and without dysmenorrhea group. RESULTS Patients without dysmenorrhea comprised 9.5% of all surgically confirmed endometriomas. Significant differences were found in the revised American Society for Reproductive Medicine (rASRM) stage, age at surgery, and bilaterality. Patients with rASRM stage IV were more likely to have dysmenorrhea than were subjects with rASRM stage III (odds ratio (OR), 10.58; 95% confidence interval (CI), 4.63-24.21; P < 0.001). Older patients were less likely to have dysmenorrhea (OR, 0.94; 95% CI, 0.88-1.00; P = 0.045), as were patients with bilateral rather than unilateral endometrioma (OR, 0.36; 95% CI, 0.15-0.82; P = 0.015). No significant differences in cyst size, age at menarche, body mass index (BMI), parity, or history of previous ovarian surgery were found between the two groups. CONCLUSION Patients without dysmenorrhea comprised 9.5% of endometrioma cases and had less advanced rASRM stage, were older at surgery, and had a higher probability of bilateral than unilateral endometrioma than patients with dysmenorrhea.
Collapse
Affiliation(s)
- Haeryung Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Eun Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Nae Hyun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - DooSeok Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
3
|
Zhu M, Huang F, Xu J, Chen W, Ding B, Shen Y. Risk factors and nomogram construction for predicting women with chronic pelvic pain:a cross-sectional population study. Heliyon 2024; 10:e34534. [PMID: 39156584 PMCID: PMC11330104 DOI: 10.1016/j.heliyon.2024.e34534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/09/2024] [Accepted: 07/11/2024] [Indexed: 08/20/2024] Open
Abstract
Background Chronic pelvic pain (CPP) in women is a critical challenge. Due to the complex etiology and difficulties in diagnosis, it has a greatly negative impact on women's physical and mental health and the healthcare system. At present, there is still a lack of research on the related factors and predictive models of chronic pelvic pain in women. Our study aims to identify risk factors associated with chronic pelvic pain in women and develop a predictive nomogram specifically tailored to high-risk women with CPP. Materials and methods From May to October 2022, trained interviewers conducted face-to-face questionnaire surveys and pelvic floor surface electromyography assessments on women from community hospitals in Nanjing. We constructed a multivariate logistic regression-based predictive model using CPP-related factors to assess the risk of chronic pelvic pain and create a predictive nomogram. Both internal and external validations were conducted, affirming the model's performance through assessments of discrimination, calibration, and practical applicability using area under the curve, calibration plots, and decision curve analysis. Results 1108 women were recruited in total (survey response rate:1108/1200), with 169 (15.3 %) being diagnosed as chronic pelvic pain. Factors contributing to CPP included weight, dysmenorrhea, sexual dysfunction, urinary incontinence, a history of pelvic inflammatory disease, and the surface electromyography value of post-baseline rest. In both the training and validation sets, the nomogram exhibited strong discrimination abilities with areas under the curve of 0.85 (95 % CI: 0.81-0.88) and 0.85 (95 % CI: 0.79-0.92), respectively. The examination of the decision curve and calibration plot showed that this model fit well and would be useful in clinical settings. Conclusions Weight, dysmenorrhea, sexual dysfunction, history of urinary incontinence and pelvic inflammatory disease, and surface electromyography value of post-baseline rest are independent predictors of chronic pelvic pain. The nomogram developed in this study serves as a valuable and straightforward tool for predicting chronic pelvic pain in women.
Collapse
Affiliation(s)
- Mingyue Zhu
- School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China
| | - Fei Huang
- Department of rehabilitation medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China
| | - Jingyun Xu
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China
- School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China
| | - Wanwen Chen
- School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China
| | - Bo Ding
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China
- School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China
| | - Yang Shen
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China
- School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China
| |
Collapse
|
4
|
Pérez-Prieto I, Vargas E, Salas-Espejo E, Lüll K, Canha-Gouveia A, Pérez LA, Fontes J, Salumets A, Andreson R, Aasmets O, Whiteson K, Org E, Altmäe S. Gut microbiome in endometriosis: a cohort study on 1000 individuals. BMC Med 2024; 22:294. [PMID: 39020289 PMCID: PMC11256574 DOI: 10.1186/s12916-024-03503-y] [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] [Received: 01/20/2024] [Accepted: 06/26/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Endometriosis, defined as the presence of endometrial-like tissue outside of the uterus, is one of the most prevalent gynecological disorders. Although different theories have been proposed, its pathogenesis is not clear. Novel studies indicate that the gut microbiome may be involved in the etiology of endometriosis; nevertheless, the connection between microbes, their dysbiosis, and the development of endometriosis is understudied. This case-control study analyzed the gut microbiome in women with and without endometriosis to identify microbial targets involved in the disease. METHODS A subsample of 1000 women from the Estonian Microbiome cohort, including 136 women with endometriosis and 864 control women, was analyzed. Microbial composition was determined by shotgun metagenomics and microbial functional pathways were annotated using the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. Partitioning Around Medoids (PAM) algorithm was performed to cluster the microbial profile of the Estonian population. The alpha- and beta-diversity and differential abundance analyses were performed to assess the gut microbiome (species and KEGG orthologies (KO)) in both groups. Metagenomic reads were mapped to estrobolome-related enzymes' sequences to study potential microbiome-estrogen metabolism axis alterations in endometriosis. RESULTS Diversity analyses did not detect significant differences between women with and without endometriosis (alpha-diversity: all p-values > 0.05; beta-diversity: PERMANOVA, both R 2 < 0.0007, p-values > 0.05). No differential species or pathways were detected after multiple testing adjustment (all FDR p-values > 0.05). Sensitivity analysis excluding women at menopause (> 50 years) confirmed our results. Estrobolome-associated enzymes' sequence reads were not significantly different between groups (all FDR p-values > 0.05). CONCLUSIONS Our findings do not provide enough evidence to support the existence of a gut microbiome-dependent mechanism directly implicated in the pathogenesis of endometriosis. To the best of our knowledge, this is the largest metagenome study on endometriosis conducted to date.
Collapse
Affiliation(s)
- Inmaculada Pérez-Prieto
- Department of Biochemistry and Molecular Biology I, Faculty of Sciences, University of Granada, Granada, Spain.
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain.
| | - Eva Vargas
- Department of Biochemistry and Molecular Biology I, Faculty of Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
- Systems Biology Unit, Department of Experimental Biology, Faculty of Experimental Sciences, University of Jaen, Jaen, Spain
| | - Eduardo Salas-Espejo
- Department of Biochemistry and Molecular Biology I, Faculty of Sciences, University of Granada, Granada, Spain
| | - Kreete Lüll
- Institute of Genomics, Estonian Genome Centre, University of Tartu, Tartu, Estonia
| | - Analuce Canha-Gouveia
- Department of Biochemistry and Molecular Biology I, Faculty of Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
- Department of Physiology, Faculty of Veterinary, University of Murcia, IMIB-Arrixaca, Campus Mare Nostrum, Murcia, Spain
| | - Laura Antequera Pérez
- Department of Biochemistry and Molecular Biology I, Faculty of Sciences, University of Granada, Granada, Spain
- Department of Computer Engineering, Automation and Robotics, University of Granada, Granada, Spain
| | - Juan Fontes
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
- U. Reproducción, UGC Laboratorio Clínico y UGC Obstetricia y Ginecología. HU Virgen de Las Nieves, Granada, Spain
| | - Andres Salumets
- Competence Centre On Health Technologies, Tartu, Estonia
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia
| | - Reidar Andreson
- Institute of Genomics, Estonian Genome Centre, University of Tartu, Tartu, Estonia
- Institute of Genomics, Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Oliver Aasmets
- Institute of Genomics, Estonian Genome Centre, University of Tartu, Tartu, Estonia
| | - Katrine Whiteson
- School of Biological Sciences, University of California, Irvine, CA, USA
| | - Elin Org
- Institute of Genomics, Estonian Genome Centre, University of Tartu, Tartu, Estonia
| | - Signe Altmäe
- Department of Biochemistry and Molecular Biology I, Faculty of Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| |
Collapse
|
5
|
Cano-Herrera G, Salmun Nehmad S, Ruiz de Chávez Gascón J, Méndez Vionet A, van Tienhoven XA, Osorio Martínez MF, Muleiro Alvarez M, Vasco Rivero MX, López Torres MF, Barroso Valverde MJ, Noemi Torres I, Cruz Olascoaga A, Bautista Gonzalez MF, Sarkis Nehme JA, Vélez Rodríguez I, Murguiondo Pérez R, Salazar FE, Sierra Bronzon AG, Rivera Rosas EG, Carbajal Ocampo D, Cabrera Carranco R. Endometriosis: A Comprehensive Analysis of the Pathophysiology, Treatment, and Nutritional Aspects, and Its Repercussions on the Quality of Life of Patients. Biomedicines 2024; 12:1476. [PMID: 39062050 PMCID: PMC11274817 DOI: 10.3390/biomedicines12071476] [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: 03/29/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
Endometriosis is a chronic proinflammatory pathology characterized by the growth of tissue similar to the endometrium outside the uterus, affecting approximately 5 to 15% of women worldwide. Suffering from endometriosis entails a complex pathophysiological process, significantly impacting the quality of life and reproductive function of affected women; therefore, it must be addressed in a personalized and comprehensive manner, as its management requires a multidisciplinary approach. This article aims to conduct a comprehensive literature review of endometriosis, not only as a pathophysiological condition but also as a significant factor impacting the social, nutritional, and mental well-being of those who experience it. Emphasis is placed on the importance of understanding and assessing the impact of the pathology to provide a better and more comprehensive approach, integrating various alternatives and strategic treatments for the factors involved in its development. The aim is to provide a complete overview of endometriosis, from its pathophysiology to its impact on the quality of life of patients, as well as a review of current treatment options, both pharmacological and alternative, in order to broaden the perspective on the pathology to improve the care of patients with this disease.
Collapse
Affiliation(s)
- Gabriela Cano-Herrera
- Escuela de Ciencias de la Salud, Universidad Anáhuac Puebla, 72810 San Andrés Cholula, Mexico;
| | - Sylvia Salmun Nehmad
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
| | - Jimena Ruiz de Chávez Gascón
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
| | - Amairani Méndez Vionet
- Facultad de Ciencias de la Salud, Universidad Panamericana, 03920 Ciudad de México, Mexico
| | - Ximena A. van Tienhoven
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
| | - María Fernanda Osorio Martínez
- División de Ciencias Biológicas y de la Salud, Unidad Xochimilco, Universidad Autónoma Metropolitana, 04960 Ciudad de México, Mexico
| | - Mauricio Muleiro Alvarez
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Mariana Ximena Vasco Rivero
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
| | - María Fernanda López Torres
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
| | - María Jimena Barroso Valverde
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
| | - Isabel Noemi Torres
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
| | - Alexa Cruz Olascoaga
- División de Ciencias Biológicas y de la Salud, Unidad Xochimilco, Universidad Autónoma Metropolitana, 04960 Ciudad de México, Mexico
| | - Maria Fernanda Bautista Gonzalez
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
| | - José Antonio Sarkis Nehme
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
| | | | - Renata Murguiondo Pérez
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
| | - Felipe Esparza Salazar
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Ana Gabriela Sierra Bronzon
- Departamento de Cirugía Ginecológica de Mínima Invasión, Instituto Pélvico Neurovascular, 76807 San Juan del Río, Mexico
| | - Eder Gabriel Rivera Rosas
- Departamento en Cirugía Pélvica, Doyenne High Quality and Multidisciplinary Treatment Center for Endometriosis, 06700 Ciudad de México, Mexico
| | - Dante Carbajal Ocampo
- Departamento en Cirugía Pélvica, Doyenne High Quality and Multidisciplinary Treatment Center for Endometriosis, 06700 Ciudad de México, Mexico
| | - Ramiro Cabrera Carranco
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, 52786 Naucalpan de Juárez, Mexico
- Departamento en Cirugía Pélvica, Doyenne High Quality and Multidisciplinary Treatment Center for Endometriosis, 06700 Ciudad de México, Mexico
| |
Collapse
|
6
|
Özbay K, Semiz A. Assessment of Uterine Blood Flow in Mild Primary Dysmenorrhea. J Pain Res 2024; 17:2071-2077. [PMID: 38887385 PMCID: PMC11182353 DOI: 10.2147/jpr.s456239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 06/05/2024] [Indexed: 06/20/2024] Open
Abstract
Purpose We aimed to assess uterine and arcuate artery Doppler indices in patients with mild primary dysmenorrhea. Patients and Methods A total of 55 patients were included, consisting of women without dysmenorrhea (n=26, group A) and women with mild primary dysmenorrhea (n=29, group B). Doppler measurements of the uterine and arcuate arteries were performed in both groups on the 1st-2nd days and 21st-24th days (midluteal phase) of the menstrual cycle using transvaginal ultrasound and compared between the groups. The severity of dysmenorrhea was assessed using visual analog scale scores. Results Doppler measurements of the uterine and arcuate arteries performed on the 1st-2nd days of the menstrual cycle and the midluteal phase were similar between the groups (p>0.05). There was a significant decrease in the intragroup measurements of uterine and arcuate arteries performed on the first day of menstruation and the luteal phase in both groups (p<0.01). Conclusion Doppler findings of the uterine and arcuate arteries did not differ between patients with and without mild primary dysmenorrhea. The etiology of primary dysmenorrhea mainly involves ischemia and vasoconstriction, but mild primary dysmenorrhea appears to be associated with a different etiology other than decreased tissue perfusion.
Collapse
Affiliation(s)
- Koray Özbay
- Department of Obstetrics and Gynecology, Memorial Şişli Hospital, Istanbul, Turkey
| | - Altuğ Semiz
- Department of Obstetrics and Gynecology, Memorial Şişli Hospital, Istanbul, Turkey
| |
Collapse
|
7
|
Osaki JD, Oliveira MAP. What Is Behind? Impact of Pelvic Pain on Perceived Stress and Inflammatory Markers in Women with Deep Endometriosis. J Clin Med 2024; 13:2927. [PMID: 38792467 PMCID: PMC11122144 DOI: 10.3390/jcm13102927] [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: 04/25/2024] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Introduction/Objectives: Endometriosis affects 10% of women worldwide. It is noteworthy that this condition is often accompanied by pelvic pain and stress. Endometriosis is a debilitating gynecological condition where tissue similar to the uterine lining grows outside the uterus, often causing significant pain and reproductive issues. We aimed to study the relationship between the intensity of pelvic pain, and stress and inflammatory markers in women with deep endometriosis. Methods: This cross-sectional study analyzed women diagnosed with deep endometriosis through imaging, surgery, and/or biopsy. We assessed pain using the Numerical Rating Scale (NRS). Stress was assessed with the Perceived Stress Scale (PSS-10) questionnaire and the serum cortisol levels. Additionally, we analyzed inflammatory markers, including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Results: Fifty-two women, with an average age of 37.8 ± 6.9 years, participated in this study. Forty-four percent of these participants demonstrated high levels of stress, as indicated by scores above 26 on the PSS-10. Those categorized with "high stress" on the PSS-10 questionnaire exhibited significantly higher pain levels compared to those with "low stress" (p < 0.05). Furthermore, patients experiencing more-severe pelvic pain (pain score > 7) had notably higher serum cortisol levels. Women with intense pelvic pain (scores above 7 on the NRS) had significantly elevated serum cortisol levels (Cohen's d = 0.72; p = 0.018). Conclusions: A positive association was found between stress levels and the intensity of pelvic pain in women with deep endometriosis, suggesting an interconnection between emotional aspects and biological responses.
Collapse
Affiliation(s)
- Jordana Diniz Osaki
- Núcleo Avançado de Endometriose e Robótica, Hospital DF Star, Brasília 70390-140, Brazil
| | | |
Collapse
|
8
|
Green R, Mardon AK, Beaumont T, Phillips K, Chalmers KJ. The accessibility of pelvic health physiotherapy for adolescents with persistent pelvic pain: a qualitative framework analysis. Physiother Theory Pract 2024; 40:973-982. [PMID: 36345863 DOI: 10.1080/09593985.2022.2143736] [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: 04/04/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Physiotherapy, with a specific focus on pelvic health, is one service used in the multidisciplinary management of adolescent persistent pelvic pain (PPP). However, there has been little investigations into the accessibility of physiotherapy for adolescents with PPP. OBJECTIVE This qualitative study aimed to detail the experiences of adolescents with PPP accessing a tertiary hospital physiotherapy service. METHODS Two focus groups included six adolescent females diagnosed with PPP that had either a) been referred and attended the physiotherapy clinic (n = 5), or b) been referred to physiotherapy but yet to attend their appointment (n = 1 plus one support person). Focus group transcripts were deductively thematically analyzed according to four domains from the patient-centered healthcare accessibility framework. RESULTS The domain of 'Approachability and ability to perceive' was impacted by limited information and poor patient health literacy. 'Acceptability and ability to seek' was hindered by adolescent mental health struggles and failures of previous PPP management. 'Availability and accommodation, and ability to reach' was influenced by lengthy referral processes, and reliance on familial support for transport. 'Acceptability and ability to engage' was facilitated by engaging clinicians and group environments, however, adolescents became dependent on physiotherapy for pain management. CONCLUSION Physical, social, and environmental factors influence the accessibility of physiotherapy for adolescents with PPP. Healthcare services should consider the specific needs of adolescents with PPP for optimizing accessibility.
Collapse
Affiliation(s)
- Rose Green
- Women's Physiotherapy, Women's and Children's Hospital, Adelaide, Australia
| | - Amelia K Mardon
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - Tara Beaumont
- Women's Physiotherapy, Women's and Children's Hospital, Adelaide, Australia
| | - Kate Phillips
- Women's Physiotherapy, Women's and Children's Hospital, Adelaide, Australia
| | - K Jane Chalmers
- IIMPACT in Health, University of South Australia, Adelaide, Australia
- School of Health Sciences, Western Sydney University, Campbelltown, Australia
| |
Collapse
|
9
|
Vallée A, Saridogan E, Petraglia F, Keckstein J, Polyzos N, Wyns C, Gianaroli L, Tarlatzis B, Ayoubi JM, Feki A. Horizons in Endometriosis: Proceedings of the Montreux Reproductive Summit, 14-15 July 2023. Facts Views Vis Obgyn 2024; 16:1-32. [PMID: 38603778 PMCID: PMC11317919 DOI: 10.52054/fvvo.16.s1.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
Endometriosis is a complex and chronic gynaecological disorder that affects millions of women worldwide, leading to significant morbidity and impacting reproductive health. This condition affects up to 10% of women of reproductive age and is characterised by the presence of endometrial-like tissue outside the uterus, potentially leading to symptoms such as chronic pelvic pain, dysmenorrhoea, dyspareunia, and infertility. The Montreux summit brought a number of experts in this field together to provide a platform for discussion and exchange of ideas. These proceedings summarise the six main topics that were discussed at this summit to shed light on future directions of endometriosis classification, diagnosis, and therapeutical management. The first question addressed the possibility of preventing endometriosis in the future by identifying risk factors, genetic predispositions, and further understanding of the pathophysiology of the condition to develop targeted interventions. The clinical presentation of endometriosis is varied, and the correlation between symptoms severity and disease extent is unclear. While there is currently no universally accepted optimal classification system for endometriosis, several attempts striving towards its optimisation - each with its own advantages and limitations - were discussed. The ideal classification should be able to reconcile disease status based on the various diagnostic tools, and prognosis to guide proper patient tailored management. Regarding diagnosis, we focused on future tools and critically discussed emerging approaches aimed at reducing diagnostic delay. Preserving fertility in endometriosis patients was another debatable aspect of management that was reviewed. Moreover, besides current treatment modalities, potential novel medical therapies that can target underlying mechanisms, provide effective symptom relief, and minimise side effects in endometriotic patients were considered, including hormonal therapies, immunomodulation, and regenerative medicine. Finally, the question of hormonal substitution therapy after radical treatment for endometriosis was debated, weighing the benefits of hormone replacement.
Collapse
|
10
|
Anger JT, Case LK, Baranowski AP, Berger A, Craft RM, Damitz LA, Gabriel R, Harrison T, Kaptein K, Lee S, Murphy AZ, Said E, Smith SA, Thomas DA, Valdés Hernández MDC, Trasvina V, Wesselmann U, Yaksh TL. Pain mechanisms in the transgender individual: a review. FRONTIERS IN PAIN RESEARCH 2024; 5:1241015. [PMID: 38601924 PMCID: PMC11004280 DOI: 10.3389/fpain.2024.1241015] [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: 06/15/2023] [Accepted: 01/25/2024] [Indexed: 04/12/2024] Open
Abstract
Specific Aim Provide an overview of the literature addressing major areas pertinent to pain in transgender persons and to identify areas of primary relevance for future research. Methods A team of scholars that have previously published on different areas of related research met periodically though zoom conferencing between April 2021 and February 2023 to discuss relevant literature with the goal of providing an overview on the incidence, phenotype, and mechanisms of pain in transgender patients. Review sections were written after gathering information from systematic literature searches of published or publicly available electronic literature to be compiled for publication as part of a topical series on gender and pain in the Frontiers in Pain Research. Results While transgender individuals represent a significant and increasingly visible component of the population, many researchers and clinicians are not well informed about the diversity in gender identity, physiology, hormonal status, and gender-affirming medical procedures utilized by transgender and other gender diverse patients. Transgender and cisgender people present with many of the same medical concerns, but research and treatment of these medical needs must reflect an appreciation of how differences in sex, gender, gender-affirming medical procedures, and minoritized status impact pain. Conclusions While significant advances have occurred in our appreciation of pain, the review indicates the need to support more targeted research on treatment and prevention of pain in transgender individuals. This is particularly relevant both for gender-affirming medical interventions and related medical care. Of particular importance is the need for large long-term follow-up studies to ascertain best practices for such procedures. A multi-disciplinary approach with personalized interventions is of particular importance to move forward.
Collapse
Affiliation(s)
- Jennifer T. Anger
- Department of Urology, University of California San Diego, San Diego, CA, United States
| | - Laura K. Case
- Department of Anesthesiology, University of California San Diego, San Diego, CA, United States
| | - Andrew P. Baranowski
- Pelvic Pain Medicine and Neuromodulation, University College Hospital Foundation Trust, University College London, London, United Kingdom
| | - Ardin Berger
- Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, United States
| | - Rebecca M. Craft
- Department of Psychology, Washington State University, Pullman, WA, United States
| | - Lyn Ann Damitz
- Division of Plastic and Reconstructive Surgery, University of North Carolina, Chapel Hill, NC, United States
| | - Rodney Gabriel
- Division of Regional Anesthesia, University of California San Diego, San Diego, CA, United States
| | - Tracy Harrison
- Department of OB/GYN & Reproductive Sciences, University of California San Diego, San Diego, CA, United States
| | - Kirsten Kaptein
- Division of Plastic Surgery, University of California San Diego, San Diego, CA, United States
| | - Sanghee Lee
- Department of Urology, University of California San Diego, San Diego, CA, United States
| | - Anne Z. Murphy
- Neuroscience Institute, Georgia State University, Atlanta, GA, United States
| | - Engy Said
- Division of Regional Anesthesia, University of California San Diego, San Diego, CA, United States
| | - Stacey Abigail Smith
- Division of Infection Disease, The Hope Clinic of Emory University, Atlanta, GA, United States
| | - David A. Thomas
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, United States
| | - Maria del C. Valdés Hernández
- Department of Neuroimaging Sciences, Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Victor Trasvina
- Department of Urology, University of California San Diego, San Diego, CA, United States
| | - Ursula Wesselmann
- Departments of Anesthesiology and Perioperative Medicine/Division of Pain Medicine, Neurology and Psychology, and Consortium for Neuroengineering and Brain-Computer Interfaces, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tony L. Yaksh
- Department of Anesthesiology, University of California San Diego, San Diego, CA, United States
| |
Collapse
|
11
|
Boerner KE, Keogh E, Inkster AM, Nahman-Averbuch H, Oberlander TF. A developmental framework for understanding the influence of sex and gender on health: Pediatric pain as an exemplar. Neurosci Biobehav Rev 2024; 158:105546. [PMID: 38272336 DOI: 10.1016/j.neubiorev.2024.105546] [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: 12/12/2022] [Revised: 07/07/2023] [Accepted: 11/06/2023] [Indexed: 01/27/2024]
Abstract
Sex differences are a robust finding in many areas of adult health, including cardiovascular disease, psychiatric disorders, and chronic pain. However, many sex differences are not consistently observed until after the onset of puberty. This has led to the hypothesis that hormones are primary contributors to sex differences in health outcomes, largely ignoring the relative contributions of early developmental influences, emerging psychosocial factors, gender, and the interaction between these variables. In this paper, we argue that a comprehensive understanding of sex and gender contributions to health outcomes should start as early as conception and take an iterative biopsychosocial-developmental perspective that considers intersecting social positions. We present a conceptual framework, informed by a review of the literature in basic, clinical, and social science that captures how critical developmental stages for both sex and gender can affect children's health and longer-term outcomes. The literature on pediatric chronic pain is used as a worked example of how the framework can be applied to understanding different chronic conditions.
Collapse
Affiliation(s)
- Katelynn E Boerner
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada.
| | - Edmund Keogh
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Amy M Inkster
- Department of Medical Genetics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Hadas Nahman-Averbuch
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
| |
Collapse
|
12
|
Wang TM, Lee YL, Chung CH, Sun CA, Kang CY, Wu GJ, Chien WC. Association Between Endometriosis and Mental Disorders Including Psychiatric Disorders, Suicide, and All-Cause Mortality -A Nationwide Population-Based Cohort Study in Taiwan. Int J Womens Health 2023; 15:1865-1882. [PMID: 38046265 PMCID: PMC10693200 DOI: 10.2147/ijwh.s430252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/08/2023] [Indexed: 12/05/2023] Open
Abstract
Objective A multitude of previous studies has substantiated that endometriosis correlated highly with psychiatric health. This study aims to investigate the association between endometriosis and psychiatric health. Methods Utilizing the National Health Insurance Research Database of Taiwan, 100,770 enrolled participants, including 20,154 patients with endometriosis and 80,616 in the control group (1:4), matched for age, and index date from Taiwan's Longitudinal Health Insurance Database between January 1, 2000, and December 31, 2015. The Cox proportional regression model was used to compare the risk of mental disorders during the 16 years of follow-up after adjusting for confounding factors. Results Of the study patients, 4083 (20.26%) developed mental disorders; 9225 of the 80,616 controls (11.44%) developed mental disorders. The Cox regression demonstrated that, after adjusting for age, monthly income, urbanization level, etc., people with endometriosis are more likely to suffer from mental disorders compared to those without endometriosis (hazard ratio [HR]=2.131; 95% confidence interval [CI]= 1.531-2.788; p<0.001). The result illustrated that women over 40 years old had a more significant risk. Conclusion Compared to people without endometriosis, this study provides evidence that patients with endometriosis are at a 2.131-fold higher risk of developing mental disorders, especially in elder women. Regular psychiatric follow-up might be needed for those patients.
Collapse
Affiliation(s)
- Tsan-Min Wang
- Department of Medical Research, Tri-Service General Hospital, Taipei, 11490, Taiwan
| | - Yi-Liang Lee
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Department of Obstetrics and Gynecology, Kang Ning Hospital, Taipei, Taiwan, Republic of China
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, Taipei, 11490, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, 11490, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, 11490, Taiwan
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, Republic of China
- Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, Republic of China
| | - Chieh-Yi Kang
- Department of Obstetrics & Gynecology, Chi Mei Medical Center Gynecologic Oncologist Division, Tainan City, Taiwan, Republic of China
| | - Gwo-Jang Wu
- Department of Medical Research, Tri-Service General Hospital, Taipei, 11490, Taiwan
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, 11490, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, Taipei, 11490, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, 11490, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, 11490, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, 11490,Taiwan
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Komatsu H, Sunada H, Endo Y, Noma H, Taniguchi F, Harada T. Evaluation of the Characteristics of Ovarian Endometriomas in Patients with Endometriosis: Efficacy of a Low-Dose Estrogen/Progestogen Combination. Gynecol Obstet Invest 2023; 88:375-383. [PMID: 37952524 PMCID: PMC10794979 DOI: 10.1159/000534666] [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: 06/04/2023] [Accepted: 10/08/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Approximately 17-44% of women diagnosed with endometriosis have ovarian endometriomas (cysts). Although ovarian endometriomas may adversely affect quality of life and work performance, the associations among patient characteristics, cyst size, and pain in women with endometriosis have not yet been reported. Thus, the objective of this study was to assess the association among age, cyst size, and pain in women with ovarian endometriomas. DESIGN This was a retrospective secondary analysis of pooled data from six randomized clinical trials on the use of low-dose estrogen/progestogen drugs for endometriosis. PARTICIPANTS/MATERIALS, SETTING, AND METHODS Data on 491 patients enrolled in four randomized and two nonrandomized trials between 2003 and 2017 were pooled. None of the participants had undergone surgical treatment before trial participation. We examined differences in dysmenorrhea score, menstrual pain score, analgesic score, and pelvic pain, as measured using a visual analog scale (VAS), by age and endometrioma size. RESULTS The mean dysmenorrhea, menstrual pain, and analgesic scores were 4.2, 2.2, and 2.0, respectively. The mean VAS for pelvic pain was 55, which decreased significantly with an increase in age. Age was not associated with endometrioma size, including volume and maximum diameter, or dysmenorrhea score. Additionally, endometrioma volume and maximum diameter were not associated with menstrual pain, analgesic score, or pelvic pain. LIMITATIONS The details of past treatment history were not available; therefore, these could not be considered in the analysis. Additionally, the assessment of pain is heavily influenced by psychological factors, making it difficult to assess the true extent of pain. CONCLUSIONS Endometrioma size was not associated with dysmenorrhea or pelvic pain measured using the VAS.
Collapse
Affiliation(s)
- Hiroaki Komatsu
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Tottori, Japan
| | - Hiroshi Sunada
- Advanced Medicine, Innovation and Clinical Research Center, Tottori University Hospital, Tottori, Japan
| | - Yusuke Endo
- Advanced Medicine, Innovation and Clinical Research Center, Tottori University Hospital, Tottori, Japan
| | - Hisashi Noma
- Department of Data Science, Institute of Statistical Mathematics, Tokyo, Japan
| | - Fuminori Taniguchi
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Tottori, Japan
| | | |
Collapse
|
15
|
Gete DG, Doust J, Mortlock S, Montgomery G, Mishra GD. Associations between endometriosis and common symptoms: findings from the Australian Longitudinal Study on Women's Health. Am J Obstet Gynecol 2023; 229:536.e1-536.e20. [PMID: 37499990 DOI: 10.1016/j.ajog.2023.07.033] [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: 03/08/2023] [Revised: 06/28/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Endometriosis has been linked to higher rates of a variety of symptoms; however, the findings from longitudinal studies are scarce and inconsistent. OBJECTIVE This study aimed to examine the association between endometriosis and common symptoms in a prospective cohort study. STUDY DESIGN This study included 7606 women born from 1973 to 1978 using data from the Australian Longitudinal Study on Women's Health that were collected every 3 years from 2009 to 2018. We identified women with endometriosis based on self-reported incidence from each survey and linked administrative health data. At each survey, women also completed a checklist on the presence of 24 symptoms. Generalized estimating equations for multinomial responses were used for analyses. RESULTS Women with endometriosis had significantly more menstrual symptoms than those without endometriosis with an adjusted odds ratio (95% confidence interval) of 3.61 (3.11-4.19) for severe period pain, 2.40 (2.10-2.74) for heavy menstrual bleeding, 1.76 (1.52-2.03) for irregular bleeding, and 1.52 (1.32-1.76) for premenstrual tension. They also had higher odds of mental health problems with adjusted odds ratios of 1.67 (1.39-2.01) for depression and 1.59 (1.24-2.03) for anxiety and higher odds of allergies and nonspecific symptoms with adjusted odds of 1.62 (1.40-1.89) for allergies or hay fever or sinusitis, 1.79 (1.56-2.05) for severe tiredness, 1.56 (1.35-1.81) for sleep difficulty, and 1.77 (1.37-2.18) for palpitations. There was also a strong association with other forms of pain with an adjusted odds ratio of 1.76 (1.53-2.04) for backpain, 1.50 (1.29-1.74) for headaches or migraines, and 1.65 (1.41-1.93) for stiff or painful joints. Women with endometriosis also had increased odds of developing bowel and urinary symptoms with an adjusted odds ratio (95% confidence interval) of 1.67 (1.35-2.08) for constipation, 1.46 (1.12-1.90) for hemorrhoids or piles, 1.25 (1.03-1.52) for indigestion or heartburn, 2.80 (1.71-4.58) for urine burn or stings, and 1.37 (1.03-1.82) for vaginal discharge or irritation. The association between each symptom and endometriosis was similar whether endometriosis was surgically confirmed or clinically suspected. No association was found between endometriosis and the risk for skin problems, leaking urine, or breathing difficulty. CONCLUSION This study suggests that women with endometriosis are more likely to report not only menstrual symptoms but are also at an increased risk for mental health problems, other pain symptoms, bowel and urinary symptoms, and nonspecific symptoms, such as severe tiredness and difficulty sleeping.
Collapse
Affiliation(s)
- Dereje G Gete
- Australian Woman and Girls' Health Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jenny Doust
- Australian Woman and Girls' Health Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Sally Mortlock
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Grant Montgomery
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Gita D Mishra
- Australian Woman and Girls' Health Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
| |
Collapse
|
16
|
Pašalić E, Tambuwala MM, Hromić-Jahjefendić A. Endometriosis: Classification, pathophysiology, and treatment options. Pathol Res Pract 2023; 251:154847. [PMID: 37844487 DOI: 10.1016/j.prp.2023.154847] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023]
Abstract
The human endometrium is a complex hormone-target tissue consisting of two layers: the lower basalis, and the upper functionalis. The latter of the two goes through a cycle of thickening and shedding without residual scarring or loss of function. This cycle, known as the menstrual cycle, occurs on a monthly basis in most of healthy reproductive-age women. It is, however, associated with a number of reproductive diseases, endometriosis being one of them. Endometriosis is defined as the presence of endometrium at ectopic sites within the peritoneum or, more rarely, other locations outside the abdominal area. It affects around 6-10% of reproductive-age women in the world and causes debilitating pain, heavy menstrual bleeding, pain during penetrative sex, and infertility. The etiology of the disease is not yet fully understood but the generally accepted theory is that the endometriotic lesions originate from viable eutopic endometrial cells that flow back into the peritoneum through the process of retrograde menstruation. Endometriosis is usually classified into four stages: minimal, mild, moderate, and severe, though it is important to note that the presentation of symptoms does not necessarily correspond to the disease progression. The immune system plays an important role in supporting the viability and growth of ectopic endometriotic tissue, all the while promoting chronic inflammation at the lesion sites, which causes prolonged pain. There is no definitive cure for endometriosis, but there are several options for symptom management, including laparoscopy, hormonal therapy, the use of NSAIDs, dietary changes, exercise, and, in cases when all conservative treatments fail, hysterectomy.
Collapse
Affiliation(s)
- Elma Pašalić
- Faculty of Engineering and Natural Sciences, Genetics and Bioengineering Department, Faculty of Engineering and Natural Sciences, International University of Sarajevo, Bosnia and Herzegovina
| | - Murtaza M Tambuwala
- Lincoln Medical School, University of Lincoln, Brayford Pool Campus, Lincoln LN6 7TS, UK.
| | - Altijana Hromić-Jahjefendić
- Faculty of Engineering and Natural Sciences, Genetics and Bioengineering Department, Faculty of Engineering and Natural Sciences, International University of Sarajevo, Bosnia and Herzegovina.
| |
Collapse
|
17
|
Dong Y, Li MJ, Hong YZ, Li WJ. Insight into Dysmenorrhea Research from 1992 to 2022: A Bibliometric Analysis. J Pain Res 2023; 16:3591-3611. [PMID: 37915864 PMCID: PMC10617534 DOI: 10.2147/jpr.s430233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/29/2023] [Indexed: 11/03/2023] Open
Abstract
Dysmenorrhea, classified as primary dysmenorrhea and secondary dysmenorrhea, is a common gynecological symptom that seriously affects female daily life. At present, studies on dysmenorrhea are numerous and complex. To better reflect the trend and innovative progress of dysmenorrhea-related research, this study screened papers on the Web of Science from January 1, 1992, to December 31, 2022. A total of 1012 papers were selected and analyzed for their affiliated countries, institutions, authors, keywords, etc. China is the country with the most academic output, Beijing University of Traditional Chinese Medicine is the most influential institution, and Yang Jie, from Chengdu University of Traditional Chinese Medicine, China, is the scholar with the most papers. We consider that the current research focus is on pathogenesis, treatment, epidemiology, and self-management. With increasing research on functional connectivity between dysmenorrhea and various brain regions, functional connectivity has gradually become the forefront of research. We hope our study can promote the further study of dysmenorrhea.
Collapse
Affiliation(s)
- Yin Dong
- Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Ming-Jing Li
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Yan-Zhu Hong
- School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Wen-Jie Li
- Shanghai Innovation Center of TCM Health Service, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| |
Collapse
|
18
|
Xue HL, Hao WJ, Wang B. A comparative study between Dydrogesterone alone and combined with Non-Steroidal Anti-Inflammatory Drugs in the treatment of Mild Endometriosis. Pak J Med Sci 2023; 39:1406-1410. [PMID: 37680832 PMCID: PMC10480722 DOI: 10.12669/pjms.39.5.7138] [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: 09/16/2022] [Revised: 05/27/2023] [Accepted: 06/03/2023] [Indexed: 09/09/2023] Open
Abstract
Objective To evaluate the clinical efficacy of dydrogesterone combined with non-steroidal anti-inflammatory drugs(NSAIDs) in the treatment of patients with mild endometriosis. Methods This was a clinical comparative study. Eighty patients with mild endometriosis were recruited at Affiliated Hospital of Hebei University, randomly divided experimental group (n=40) and control group (n=40) from March 2022 to March 2023. Both groups started treatment with dydrogesterone on the 5th day of menstruation. Patients in the control group were treated with dydrogesterone monotherapy, while those in the experimental group were treated with mefenamic acid the basis of the therapy of the control group. The clinical efficacy, differences in the levels of humoral immune indexes, the levels of inflammatory factor and the incidence of adverse drug reactions of the two groups was compared and analyzed. Results The efficacy of the experimental group was significantly higher than the control group, with a statistically significant difference(P=0.02). The levels of C3 and C4 in the experimental group after treatment were significantly lower than those in the control group, with a statistically significant difference(P=0.00). After treatment, TNF-a, CRP, IL-6 and other indexes in the experimental group were significantly lower than those in the control group, with statistically significant differences(P=0.00). The incidence of adverse reactions after treatment had no statistically significant difference(P=0.45). Conclusion Dydrogesterone combined with non-steroidal anti-inflammatory drugs is a safe and effective treatment for patients with endometriosis. It can improve various obvious curative effects, such as marked relief of pain symptoms, reduction of complement and inflammatory factor levels without a significant increase in adverse reactions.
Collapse
Affiliation(s)
- Hui-ling Xue
- Hui-ling Xue, Department of Obstetrics and Gynecology, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, P. R. China
| | - Wan-jiao Hao
- Wan-jiao Hao, Department of Obstetrics and Gynecology, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, P. R. China
| | - Bing Wang
- Bing Wang, Department of Obstetrics and Gynecology, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, P. R. China
| |
Collapse
|
19
|
Pant A, Moar K, K Arora T, Maurya PK. Biomarkers of endometriosis. Clin Chim Acta 2023; 549:117563. [PMID: 37739024 DOI: 10.1016/j.cca.2023.117563] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023]
Abstract
Endometriosis is one of the most severe female reproductive disorders, affecting 6-10% of women between 18 and 35. It is a gynaecological condition where endometrial tissue develops and settles outside the uterus. The aetiology of endometriosis is primarily influenced by genetic, epigenetic, and non-genetic variables, making it highly challenging to create a therapeutic therapy explicitly targeting the ectopic tissue. The delay in the treatment is due to the limitations in the diagnostic approaches, which are restricted to invasive techniques such as laparoscopy or laparotomy. This accords to 70% of the women being diagnosed at later stages. By understanding the subject, several treatment medications have been produced to lessen the disease's symptoms. Nevertheless, endometriosis cannot be permanently cured. A viable or persuasive standard screening test for endometriosis must be utilized in a clinical context. A helpful assessment method for the early identification of endometriosis could be biomarkers. A major research priority is the identification of a biomarker that is sensitive and specific enough for detecting endometriosis. The present article has reviewed studies published on the expression of biomarkers of endometriosis. It outlines various biomarkers from different sample types, such as serum/plasma and urine, in addition to tissue. This would provide a non-invasive approach to diagnosing the disease at the initial stages without any harmful repercussions. Future high-throughput advances in science and technology are anticipated to result in the creation of a potent remedy for endometriosis. To achieve successful outcomes, it is necessary to research the discussed biomarkers that demonstrate substantial results extensively.
Collapse
Affiliation(s)
- Anuja Pant
- Department of Biochemistry, Central University of Haryana, Mahendergarh 123031, India
| | - Kareena Moar
- Department of Biochemistry, Central University of Haryana, Mahendergarh 123031, India
| | - Taruna K Arora
- Reproductive Biology and Maternal Child Health Division, Indian Council of Medical Research, New Delhi 110029, India
| | - Pawan Kumar Maurya
- Department of Biochemistry, Central University of Haryana, Mahendergarh 123031, India.
| |
Collapse
|
20
|
Yagci N, Senel A, Atalay OT, Akman TC, Can OK. Long-Term Follow-Up Result of Connective Tissue Manipulation in Young Women with Primary Dysmenorrhea: Different Intervention Durations. Reprod Sci 2023; 30:2198-2209. [PMID: 36717461 DOI: 10.1007/s43032-023-01172-5] [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: 07/11/2022] [Accepted: 01/11/2023] [Indexed: 02/01/2023]
Abstract
The purpose of this study was to reveal the effect of connective tissue manipulation (CTM) on long-term pain severity, fatigue, sleep quality, premenstrual symptom severity, general health status, anxiety, and depression in women with primary dysmenorrhea (PD). Thirty-five women with PD were divided into two groups. CTM was applied to the participants in each group on the days when they were not on menstruation between two menstrual cycles for the group 1 (n=18) and between three menstrual cycles for the group 2 (n=17). Intensity of menstrual pain, the sleep quality, and fatigue status of the participants during dysmenorrhea were evaluated by the Visual Analog Scale (VAS). Depressive symptoms and anxiety were evaluated using the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI), respectively. Also, the Premenstrual Syndrome Scale (PMSS) and the General Health Questionnaire (GHQ) were used to investigate the severity of premenstrual symptoms and mental health status during menstrual period. A significant decrease in the pain severity and fatigue of the participants was observed in both group 1 and group 2 after treatment, after 3rd, and 6th month follow-up (p=0.001). Also, this decrease lasted for 12th month follow-up after treatment in group 2 (p=0.0001). There was no statistically significant improvement in sleep quality within each group (p>0.05). Moreover, none of the parameters were significantly different between two groups (p>0.05). We can suggest that 2-cycle CTM treatment should be preferred in clinical settings to obtain long-lasting effects for decreasing pain, fatigue, and premenstrual symptoms in women with PD. CLINICAL TRIAL NUMBER: NCT04509934. Registration date: 8 November 2020.
Collapse
Affiliation(s)
- Nesrin Yagci
- Faculty of Physiotherapy and Rehabilitation, Pamukkale University, Denizli, Turkey.
| | - Aybike Senel
- Division of Physiotherapy and Rehabilitation, İstanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Orcin Telli Atalay
- Faculty of Physiotherapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Tuba Can Akman
- Faculty of Physiotherapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Ozlem Kosar Can
- Department of Obstetrics and Gynecology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| |
Collapse
|
21
|
Gete DG, Doust J, Mortlock S, Montgomery G, Mishra GD. Impact of endometriosis on women's health-related quality of life: A national prospective cohort study. Maturitas 2023; 174:1-7. [PMID: 37182389 DOI: 10.1016/j.maturitas.2023.04.272] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 04/14/2023] [Accepted: 04/30/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To examine the association between endometriosis and women's health-related quality of life (HRQoL). STUDY DESIGN This study included 3728 women born in 1973-78 using data from the Australian Longitudinal Study on Women's Health. Women with endometriosis were identified using self-reported longitudinal surveys linked to administrative health records. A mixed effect model with only random intercept and generalised estimating equations with binary logistic regressions were used to examine the association between endometriosis and health-related quality of life over eight time points. Each HRQoL scale was analysed in terms of binary outcomes by comparing women who had a lower HRQoL (scoring below the 25th percentile) with those who had a higher HRQoL (scoring above the 25th percentile). MAIN OUTCOME MEASURES Women's HRQoL was assessed using the 36-item Short Form Survey every 3 years from 1996 to 2018. RESULTS Endometriosis was associated with significantly worse reports of HRQoL over time. In the comparison against women without endometriosis, the following adjusted odds ratios (95 % confidence intervals) were calculated for women with endometriosis having worse scores on the eight domains of the Short Form Survey: physical functioning 1.33 (1.19, 1.50), role physical 1.57 (1.41, 1.74), bodily pain 1.65 (1.48, 1.82), general health 1.61 (1.42, 1.81), vitality 1.38 (1.23, 1.55), social functioning 1.38 (1.25, 1.53), role emotion 1.19 (1.06, 1.33), mental health 1.32 (1.18, 1.48). Women with endometriosis also had significantly lower physical health 1.68 (1.51, 1.88) and mental health components scores 1.28 (1.14, 1.44). CONCLUSIONS Endometriosis is associated with worse physical, mental, and social functioning and well-being. Bodily pain was the most affected HRQoL domain.
Collapse
Affiliation(s)
- Dereje G Gete
- Australian Women and Girls' Health Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, 266 Herston Road, Brisbane, Queensland 4006, Australia.
| | - Jenny Doust
- Australian Women and Girls' Health Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, 266 Herston Road, Brisbane, Queensland 4006, Australia.
| | - Sally Mortlock
- Institute for Molecular Bioscience, The University of Queensland, 306 Carmody Road, Brisbane, Queensland 4072, Australia.
| | - Grant Montgomery
- Institute for Molecular Bioscience, The University of Queensland, 306 Carmody Road, Brisbane, Queensland 4072, Australia.
| | - Gita D Mishra
- Australian Women and Girls' Health Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, 266 Herston Road, Brisbane, Queensland 4006, Australia.
| |
Collapse
|
22
|
Tuo L, Tang S, Li S, Gu S, Xie Z. Murine Models and Research Progress on Dysmenorrhea. Reprod Sci 2023:10.1007/s43032-023-01220-0. [PMID: 37010703 DOI: 10.1007/s43032-023-01220-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 03/15/2023] [Indexed: 04/04/2023]
Abstract
Dysmenorrhea is a prevalent gynecological disease among women at reproductive age. It is classified as the primary dysmenorrhea and the secondary dysmenorrhea according to the etiology. The primary dysmenorrhea is caused by uterine hypercontraction without any identifiable pelvic lesions, while the secondary dysmenorrhea is incurred by gynecological disorder with pelvic organic lesions. However, the underlying mechanism of dysmenorrhea is not completely clear. Animal models of dysmenorrhea, especially mouse and rat model, are helpful to explore the pathophysiological mechanism of dysmenorrhea, clarify the therapeutic effect of compounds, and guide clinical treatment. The murine model of primary dysmenorrhea is commonly induced by oxytocin or prostaglandin F2α, while the secondary dysmenorrhea murine model was further created by injecting oxytocin on the basis of the established primary disease model. This review summarizes the current progress of dysmenorrhea models in rodent, including experimental methods, corresponding evaluation indexes, and the advantages and disadvantages of various murine dysmenorrhea models, in order to provide a reference for the selection of murine dysmenorrhea models and the further study of the pathophysiological mechanism of dysmenorrhea.
Collapse
Affiliation(s)
- Lu Tuo
- Institute of Pharmacy and Pharmacology, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hunan Provincial Key Laboratory of Tumor Microenvironment Responsive Drug Research, University of South China, Hengyang, 421001, Hunan Province, China
| | - Simiao Tang
- Institute of Pharmacy and Pharmacology, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hunan Provincial Key Laboratory of Tumor Microenvironment Responsive Drug Research, University of South China, Hengyang, 421001, Hunan Province, China
| | - Shiyan Li
- Institute of Pharmacy and Pharmacology, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hunan Provincial Key Laboratory of Tumor Microenvironment Responsive Drug Research, University of South China, Hengyang, 421001, Hunan Province, China
| | - Shuyi Gu
- Institute of Pharmacy and Pharmacology, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hunan Provincial Key Laboratory of Tumor Microenvironment Responsive Drug Research, University of South China, Hengyang, 421001, Hunan Province, China
| | - Zhizhong Xie
- Institute of Pharmacy and Pharmacology, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hunan Provincial Key Laboratory of Tumor Microenvironment Responsive Drug Research, University of South China, Hengyang, 421001, Hunan Province, China.
| |
Collapse
|
23
|
Tayade S, Rai S, Pai H, Patel M, Makhija N. Efficacy of Dienogest in Adolescent Endometriosis: A Narrative Review. Cureus 2023; 15:e36729. [PMID: 37123753 PMCID: PMC10139672 DOI: 10.7759/cureus.36729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
Teenage endometriosis is seen as a chronic condition that can worsen if untreated. Treatment objectives include relief of symptoms, prevention of disease development, and preservation of future fertility. In many regions, dienogest (DNG), an oral progestin, has emerged as a key treatment in suppressing endometriosis. The usage of DNG for endometriosis in adolescents was researched in papers published between 2015 and 2022 using PubMed and Google Scholar. A thorough search of all identified studies' reference lists and previously published literature reviews was carried out. The study's nature and geographic scope were not restricted. After reviewing these publications, the authors decided on which ones were the most pertinent in light of their personal experiences. The final study consisted of 14 studies that satisfied inclusion requirements. The trials showed that taking DNG 2 mg daily efficiently lowers endometriotic lesions, eases painful endometriosis symptoms, and improves quality-of-life indicators. In most of these investigations, DNG was shown to be safe and tolerated, with predictable and moderate side effects, good patient compliance rates, and low withdrawal rates. Although endometrioma did not enlarge while receiving treatment, significant regression was not typical. Overall, the studies found that DNG is safe and effective in reducing symptoms of endometriosis in adolescents.
Collapse
|
24
|
Khashchenko EP, Uvarova EV, Chuprynin VD, Pustynnikova MY, Fatkhudinov TK, Elchaninov AV, Gardanova ZR, Ivanets TY, Vysokikh MY, Sukhikh GT. Pelvic Pain, Mental Health and Quality of Life in Adolescents with Endometriosis after Surgery and Dienogest Treatment. J Clin Med 2023; 12:jcm12062400. [PMID: 36983400 PMCID: PMC10052887 DOI: 10.3390/jcm12062400] [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: 02/26/2023] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Diagnostic and treatment delays have caused significant impacts on the physical and emotional well-being of adolescents with endometriosis, though such research is limited. This study aimed to assess the effects of one-year dienogest therapy on the clinical picture, pain patterns, psycho-emotional status, and quality-of-life indicators in adolescents with endometriosis after surgical treatment. METHODS The study enrolled 32 girls aged 13-17 with peritoneal endometriosis to analyze one-year dynamics of the Visual Analog Scale (VAS), McGill Pain Questionnaire, Beck Depression Scale (BDI), Hospital Anxiety and Depression Scale (HADS), Spielberger State-Trait Anxiety Inventory (STAI) and SF-36 quality-of-life survey scores along with clinical and laboratory indicators before surgery and after one-year dienogest therapy. RESULTS The therapy provided a significant alleviation of endometriosis-associated clinical symptoms, including dysmenorrhea, pelvic pain, gastrointestinal/dysuria symptoms, decreased everyday activity (<0.001), a decrease in anxiety/depression scores (BDI, HADS, STAI), and quality-of-life improvement (<0.001). These effects were accompanied by beneficial dynamics in hormone and inflammatory markers (prolactin, cortisol, testosterone, estradiol, CA-125, neutrophil/lymphocyte ratio; <0.005) within reference ranges. A low body mass index and high C-reactive protein levels were associated with higher VAS scores; a high estradiol level was a factor for anxiety/depression aggravation (<0.05). CONCLUSIONS Dienogest, after surgical treatment, significantly improved quality of life and reduced pain symptoms while showing good tolerability and compliance, and reasoning with timely hormonal therapy in adolescents with endometriosis.
Collapse
Affiliation(s)
- Elena P Khashchenko
- FSBI "National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov" Ministry of Healthcare of the Russian Federation, 4, Oparina Street, 117997 Moscow, Russia
| | - Elena V Uvarova
- FSBI "National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov" Ministry of Healthcare of the Russian Federation, 4, Oparina Street, 117997 Moscow, Russia
- Department for Obstetrics, Gynecology, Perinatology and Reproduction, Sechenov First Moscow State Medical University, Trubetskaya Str. 8, Bld. 2, 119991 Moscow, Russia
| | - Vladimir D Chuprynin
- FSBI "National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov" Ministry of Healthcare of the Russian Federation, 4, Oparina Street, 117997 Moscow, Russia
| | - Margarita Yu Pustynnikova
- Faculty of Fundamental Medicine, Moscow State University Named after M.V. Lomonosov, 119991 Moscow, Russia
| | - Timur Kh Fatkhudinov
- FSBI "National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov" Ministry of Healthcare of the Russian Federation, 4, Oparina Street, 117997 Moscow, Russia
- Department of Histology, Cytology and Embryology, Peoples' Friendship University of Russia (RUDN), Miklukho-Maklaya Str. 6, 117997 Moscow, Russia
| | - Andrey V Elchaninov
- FSBI "National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov" Ministry of Healthcare of the Russian Federation, 4, Oparina Street, 117997 Moscow, Russia
- Department of Histology, Cytology and Embryology, Peoples' Friendship University of Russia (RUDN), Miklukho-Maklaya Str. 6, 117997 Moscow, Russia
| | - Zhanna R Gardanova
- FSBI "National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov" Ministry of Healthcare of the Russian Federation, 4, Oparina Street, 117997 Moscow, Russia
| | - Tatyana Yu Ivanets
- FSBI "National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov" Ministry of Healthcare of the Russian Federation, 4, Oparina Street, 117997 Moscow, Russia
| | - Mikhail Yu Vysokikh
- FSBI "National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov" Ministry of Healthcare of the Russian Federation, 4, Oparina Street, 117997 Moscow, Russia
- A.N. Belozersky Research Institute of Physico-Chemical Biology MSU, Leninskye Gory, House 1, Building 40, 119992 Moscow, Russia
| | - Gennady T Sukhikh
- FSBI "National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov" Ministry of Healthcare of the Russian Federation, 4, Oparina Street, 117997 Moscow, Russia
- Department for Obstetrics, Gynecology, Perinatology and Reproduction, Sechenov First Moscow State Medical University, Trubetskaya Str. 8, Bld. 2, 119991 Moscow, Russia
| |
Collapse
|
25
|
Saad M, Rafiq A, Jamil A, Sarfraz Z, Sarfraz A, Robles-Velasco K, Cherrez-Ojeda I. Addressing the Endometriosis Knowledge Gap for Improved Clinical Care—A Cross-Sectional Pre- and Post-Educational-Intervention Study among Pakistani Women. Healthcare (Basel) 2023; 11:healthcare11060809. [PMID: 36981467 PMCID: PMC10048359 DOI: 10.3390/healthcare11060809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/23/2023] [Accepted: 03/08/2023] [Indexed: 03/11/2023] Open
Abstract
This study explored the baseline knowledge and symptoms associated with endometriosis, educated women about endometriosis, and documented the improvement in endometriosis knowledge. A brief intervention with an educational brochure on endometriosis was administered among 303 female participants. A paired-sample t-test and one-way ANOVA were run to compute endometriosis knowledge scores. In total, 49.5% of the participants had consistent access to annual healthcare, 25.1% were healthcare workers, and 45.2% had an undergraduate education. The entire sample had a pre-test endometriosis knowledge score of 4.2 (SD = 2.48), and the score was 6.3 (SD = 2.3) on the post-test. One-way ANOVA yielded no significant improvement in knowledge scores across the groups with consistent and inconsistent access to annual healthcare, despite a significant overall increase in scores (t = 16.63, df = 302, p < 0.001). We identified a significant improvement in the knowledge concerning endometriosis. Educational strategies among women who are menstruating are essential for addressing diagnostic delays and bridging the endometriosis knowledge gap.
Collapse
Affiliation(s)
- Muhammad Saad
- Department of Research, Services Institute of Medical Sciences, Lahore 54000, Pakistan
| | - Aiman Rafiq
- Department of Research, Nishtar Medical University, Multan 66000, Pakistan
| | - Anam Jamil
- Department of Research, Continental Medical College, Lahore 54000, Pakistan
| | - Zouina Sarfraz
- Department of Research and Publications, Fatima Jinnah Medical University, Lahore 54000, Pakistan
| | - Azza Sarfraz
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi 74800, Pakistan
- Correspondence: (A.S.); (I.C.-O.)
| | - Karla Robles-Velasco
- Department of Allergy and Pulmonology, Universidad Espíritu Santo, Samborondón 092301, Ecuador
| | - Ivan Cherrez-Ojeda
- Department of Allergy and Pulmonology, Universidad Espíritu Santo, Samborondón 092301, Ecuador
- Correspondence: (A.S.); (I.C.-O.)
| |
Collapse
|
26
|
How to Improve Non-Invasive Diagnosis of Endometriosis with Advanced Statistical Methods. Medicina (B Aires) 2023; 59:medicina59030499. [PMID: 36984500 PMCID: PMC10059817 DOI: 10.3390/medicina59030499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Background and Objectives: Endometriosis is one of the most common gynecological disorders in women of reproductive age. Causing pelvic pain and infertility, it is considered one of the most serious health problems, being responsible for work absences or productivity loss. Its diagnosis is often delayed because of the need for an invasive laparoscopic approach. Despite years of studies, no single marker for endometriosis has been discovered. The aim of this research was to find an algorithm based on symptoms and laboratory tests that could diagnose endometriosis in a non-invasive way. Materials and Methods: The research group consisted of 101 women hospitalized for diagnostic laparoscopy, among which 71 had confirmed endometriosis. Data on reproductive history were collected in detail. CA125 (cancer antigen-125) level and VEGF1(vascular endothelial growth factor 1) were tested in blood samples. Among the used statistical methods, the LASSO regression—a new important statistical tool eliminating the least useful features—was the only method to have significant results. Results: Out of 19 features based on results of LASSO, 7 variables were chosen: body mass index, age of menarche, cycle length, painful periods, information about using contraception, CA125, and VEGF1. After multivariate logistic regression with a backward strategy, the three most significant features were evaluated. The strongest impact on endometriosis prediction had information about painful periods, CA125 over 15 u/mL, and the lowest BMI, with a sensitivity of 0.8800 and a specificity of 0.8000, respectively. Conclusions: Advanced statistical methods are crucial when creating non-invasive tests for endometriosis. An algorithm based on three easy features, including painful menses, BMI level, and CA125 concentration could have an important place in the non-invasive diagnosis of endometriosis. If confirmed in a prospective study, implementing such an algorithm in populations with a high risk of endometriosis will allow us to cover patients suspected of endometriosis with proper treatment.
Collapse
|
27
|
Wang Y, Yang L, Zhang X, Sun Y, Sun H, Yan G, Zhao Q, Han Y, Wang X. Quality marker discovery of Danggui Jianzhong decoction for treating primary dysmenorrhoea based on chinmedomics strategy. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2023; 115:154724. [PMID: 37087788 DOI: 10.1016/j.phymed.2023.154724] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/31/2023] [Accepted: 02/20/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Danggui Jianzhong Decoction (DGJZD) has been proven as an effective classical prescription for clinically treating primary dysmenorrhoea (PD). However, the industrialisation development and drug innovation of DGJZD remain limited due to its undefined effective constituents and quality markers (Q-markers). PURPOSE Elucidating the Q-markers of DGJZD, which is related to clinical efficacy. METHODS In accordance with chinmedomics strategy, we evaluated the therapeutic efficacy of DGJZD on the basis of the metabolomic profile and biomarker of a PD rat model to further identify the constituents of DGJZD in vivo that originated from the formula under the acting condition of DGJZD. The potential effective constituents and Q-markers were identified by mining the dynamic relation between the constituents in vivo and the biomarkers. RESULTS Subsequently, 29 serum metabolites were characterized as biomarkers for PD, and DGJZD adjusted the levels of the primary biomarkers involved in arachidonic acid metabolism, glycerophospholipid metabolism, tryptophan metabolism as well as the synthesis of steroid hormones. Under the active condition of DGJZD, 20 prototype ingredients and 4 metabolites of DGJZD were found in vivo, five of which were mostly related with the efficacy of PD, namely, ferulic acid, zizyphusin, cinnamic acid, protocatechuic acid-3-glucoside, and azelaic acid. They were the potential pharmacodynamic constituents for treating PD, and they could be regarded as the Q-markers of DGJZD. CONCLUSION Taken together, the Q-markers of DGJZD identified in this research are credible and assist in solving problems related to quality control and drug innovation, accelerating industrialisation development. Besides, the efficacy, mechanism and active ingredients of DGJZD for the treatment of PD were innovatively elucidated for the first time on the basis of the chinmedomics strategy for uncovering the Q-markers of drugs from the system perspective.
Collapse
Affiliation(s)
- Ying Wang
- National Chinmedomics Research Center, National TCM Key Laboratory of Serum Pharmacochemistry, Metabolomics Laboratory, Department of Pharmaceutical Analysis, Heilongjiang University of Chinese Medicine, Heping Road 24, Harbin 150040, China
| | - Le Yang
- State Key Laboratory of Dampness Syndrome, The Second Affiliated Hospital Guangzhou University of Chinese Medicine, Dade Road 111, Guangzhou, China
| | - Xiwu Zhang
- National Chinmedomics Research Center, National TCM Key Laboratory of Serum Pharmacochemistry, Metabolomics Laboratory, Department of Pharmaceutical Analysis, Heilongjiang University of Chinese Medicine, Heping Road 24, Harbin 150040, China
| | - Ye Sun
- State Key Laboratory of Dampness Syndrome, The Second Affiliated Hospital Guangzhou University of Chinese Medicine, Dade Road 111, Guangzhou, China
| | - Hui Sun
- National Chinmedomics Research Center, National TCM Key Laboratory of Serum Pharmacochemistry, Metabolomics Laboratory, Department of Pharmaceutical Analysis, Heilongjiang University of Chinese Medicine, Heping Road 24, Harbin 150040, China.
| | - Guangli Yan
- National Chinmedomics Research Center, National TCM Key Laboratory of Serum Pharmacochemistry, Metabolomics Laboratory, Department of Pharmaceutical Analysis, Heilongjiang University of Chinese Medicine, Heping Road 24, Harbin 150040, China
| | - Qiqi Zhao
- National Chinmedomics Research Center, National TCM Key Laboratory of Serum Pharmacochemistry, Metabolomics Laboratory, Department of Pharmaceutical Analysis, Heilongjiang University of Chinese Medicine, Heping Road 24, Harbin 150040, China
| | - Ying Han
- National Chinmedomics Research Center, National TCM Key Laboratory of Serum Pharmacochemistry, Metabolomics Laboratory, Department of Pharmaceutical Analysis, Heilongjiang University of Chinese Medicine, Heping Road 24, Harbin 150040, China
| | - Xijun Wang
- National Chinmedomics Research Center, National TCM Key Laboratory of Serum Pharmacochemistry, Metabolomics Laboratory, Department of Pharmaceutical Analysis, Heilongjiang University of Chinese Medicine, Heping Road 24, Harbin 150040, China; State Key Laboratory of Dampness Syndrome, The Second Affiliated Hospital Guangzhou University of Chinese Medicine, Dade Road 111, Guangzhou, China; State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macao.
| |
Collapse
|
28
|
Mackenzie M, Cohn S. You Can Change a Girl's Life Today: The Truth About Periods and Endometriosis. NASN Sch Nurse 2023; 38:85-90. [PMID: 36250309 DOI: 10.1177/1942602x221127247] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
While endometriosis, a condition where tissue growing outside the uterus causes pain and infertility, is generally widespread among teenage girls and women, it is often misdiagnosed leading to a delay in treatment while the symptoms and damage from the disease increase. This article uses a case study to illustrate the signs and symptoms of endometriosis in a teenage girl, while also discussing many factors surrounding the issue such as the incidence, disease burden, medical research and women, reasons for diagnostic delay, and the current recommended treatments. School nurses are in the unique position to identify young girls and adolescents who are presenting with painful periods or other symptoms possibly associated with endometriosis and can become advocates for the next generation of patients.
Collapse
|
29
|
Endometriosis in Adolescents: Diagnostics, Clinical and Laparoscopic Features. J Clin Med 2023; 12:jcm12041678. [PMID: 36836214 PMCID: PMC9962715 DOI: 10.3390/jcm12041678] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND The early diagnosis of endometriosis in adolescents is not developed. OBJECTIVE We aim to conduct clinical, imaging, laparoscopic and histological analyses of peritoneal endometriosis (PE) in adolescents in order to improve early diagnosis. METHODS In total, 134 girls (from menarche to 17 years old) were included in a case-control study: 90 with laparoscopically (LS) confirmed PE, 44 healthy controls underwent full examination and LS was analyzed in the PE group. RESULTS Patients with PE were characterized with heredity for endometriosis, persistent dysmenorrhea, decreased daily activity, gastrointestinal symptoms, higher LH, estradiol, prolactin and Ca-125 (<0.05 for each). Ultrasound detected PE in 3.3% and MRI in 78.9%. The most essential MRI signs are as follows: hypointense foci, the heterogeneity of the pelvic tissue (paraovarian, parametrial and rectouterine pouch) and sacro-uterine ligaments lesions (<0.05 for each). Adolescents with PE mostly exhibit initial rASRM stages. Red implants correlated with the rASRM score, and sheer implants correlated with pain (VAS score) (<0.05). In 32.2%, foci consisted of fibrous, adipose and muscle tissue; black lesions were more likely to be histologically verified (0.001). CONCLUSION Adolescents exhibit mostly initial PE stages, which are associated with greater pain. Persistent dysmenorrhea and detected MRI parameters predict the laparoscopic confirmation of initial PE in adolescents in 84.3% (OR 15.4; <0.01), justifying the early surgical diagnostics and shortening the time delay and suffering of the young patients.
Collapse
|
30
|
Aubry G, Bencharif C, Vesale E, Oueld E, Dietrich G, Collinet P, Azais H, Canlorbe G. [Delays and pathways for patients with endometriosis in France: A multicenter study]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:117-122. [PMID: 36423880 DOI: 10.1016/j.gofs.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 10/02/2022] [Accepted: 11/10/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The diagnosis of endometriosis is often difficult to make, generating a median diagnostic delay ranging from 2 to 10.7years. A study of the care pathway of these patients seems essential in order to evaluate the diagnostic delay of endometriosis in France and the factors related to the diagnostic delay. METHODS This is a prospective multicenter study, conducted between 2017 and 2019. A questionnaire concerning their care pathway and their feelings about the diagnosis was distributed to all patients consulting for endometriosis. Statistical analyses were performed using the Kruskal-Wallis, Chi2 and Student's t tests. RESULTS Fifity-seven of the 84 patients (67.8%) who completed the questionnaire were included in the evaluation of diagnostic delays. The total diagnostic delay was 12years (min 0; max 33) and was comparable between all inclusion cities (P=0.68). Regarding the care pathway according to specialties, the diagnosis of endometriosis was made by gynecologists in 81% of patients versus 19% by general practitioners. The time between the onset of symptoms and the first consultation was significantly shorter in favor of the general practitioner (2years versus 4years, P=0.012). 60% of the patients reported that their symptoms were labelled as "normal" by the physicians and 35% of them considered them normal themselves. CONCLUSION Our study showed that the delay in diagnosis in France was still very long and that the mechanisms of the delay in management were multifactorial. Awareness raising and training of health care providers remains one of the major areas to be optimized.
Collapse
Affiliation(s)
- G Aubry
- Assistance Publique des Hôpitaux de Paris (APHP), Service de chirurgie et oncologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - C Bencharif
- Assistance Publique des Hôpitaux de Paris (APHP), Service de chirurgie et oncologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - E Vesale
- Assistance Publique des Hôpitaux de Paris (APHP), Service de chirurgie et oncologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - E Oueld
- Assistance Publique des Hôpitaux de Paris (APHP), Service de chirurgie et oncologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - G Dietrich
- Department of Gynecological and Mammary Surgery, Paris Saint-Joseph Hospital Group, Paris, France
| | - P Collinet
- Gynaecological Surgery Unit, Jeanne de Flandre Hospital, University Hospital of Lille, Lille, France
| | - H Azais
- Assistance Publique des Hôpitaux de Paris (APHP), Service de chirurgie et oncologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - G Canlorbe
- Assistance Publique des Hôpitaux de Paris (APHP), Service de chirurgie et oncologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne University, Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA),INSERM UMR_S_938, 75012 Paris, France..
| |
Collapse
|
31
|
Tajik M, Shahali S, Shadjoo K. The co-effect of sensate focus technique and sexual position changing on sexual function of women who use medical treatment for endometriosis. J OBSTET GYNAECOL 2022; 42:3706-3711. [PMID: 36541405 DOI: 10.1080/01443615.2022.2158316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Endometriosis is one of the most common chronic diseases of women. This study aimed to investigate the effect of sensate focus technique and sexual position changing on sexual function of women who used medical treatment for endometriosis. This clinical trial study was performed on 80 women who used medical treatment for endometriosis. Women were randomly assigned to two groups: in the intervention group, 2 h of verbal educational session were held and at the end of the session, an instruction booklet about sensate focus technique was given to them, the control group received routine treatment. The sexual function and the dyspareunia of the participants were evaluated after 4 and 8 weeks. Eight weeks after the intervention, the mean total score of sexual function in the intervention group was significantly improved compared to before the intervention (p < 0.001). The mean score of sexual pain in the follow-up periods in the intervention group was significantly different compared to before the intervention and control groups (p < 0.001). The sensate focus technique and sexual position change simultaneously improve sexual function in women with endometriosis who used medication.Trial registration: Approval number from Iranian Registry of Clinical Trials: IRCT2200617047812N1 (Registration date: 2020-11-05).Impact StatementWhat is already known on this subject? The role of endometriosis in the genesis of sexual dysfunction in women has been mentioned in several articles. Researches have shown that some sexual positions put less pressure on parts of the pelvis that contain endometrial tissue. The sensate focus technique can improve sexual dysfunction, including hypoactive sexual desire disorder (HSDD) and female sexual arousal disorder (FSAD), orgasm, dyspareunia, and vaginismus.What do the results of this study add? Have a positive effect on sexual function and dyspareunia in women with endometriosis undergoing medical treatment and improve their sexual function.What are the implications of these findings for clinical practice and/or further research? Medical staff recommended becoming familiar with these techniques to teach sensate focus and sexual position changing to women with endometriosis to improve their sexual function.
Collapse
Affiliation(s)
- Maryam Tajik
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Shadab Shahali
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Khadijeh Shadjoo
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| |
Collapse
|
32
|
Mansfield C, Lenobel D, McCracken K, Hewitt G, Appiah LC. Impact of Pelvic Floor Physical Therapy on Function in Adolescents and Young Adults with Biopsy-Confirmed Endometriosis at a Tertiary Children's Hospital: A Case Series. J Pediatr Adolesc Gynecol 2022; 35:722-727. [PMID: 35830927 DOI: 10.1016/j.jpag.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/17/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
STUDY OBJECTIVE The purpose of this case series is to describe the change in capability to perform self-selected activities in adolescent and young adult patients with chronic pelvic pain and surgically proven endometriosis following pelvic floor physical therapy as part of multidisciplinary treatment. DESIGN Retrospective case series SETTING: Tertiary care pediatric hospital PARTICIPANTS: Twenty patients with ages ranging from 14 to 22 years and a median age of 16.5 years with biopsy-confirmed endometriosis INTERVENTION: Pelvic floor physical therapy MAIN OUTCOME MEASURE(S): Patient-Specific Functional Scale (PSFS) outcome measure RESULTS: Patients had a clinically significant functional improvement (median score of 6.0 points on the PSFS outcome measure; interquartile range, 3.8-13.5) over the course of care (median number of 12 visits; range 4-48 visits) (P < .001). CONCLUSIONS Patients with chronic pelvic pain and surgically proven endometriosis experienced significant functional improvement after physical therapy treatment. The results of this case series suggest that physical therapy is a viable additional intervention for adolescents and young adults with chronic pelvic pain and endometriosis and warrants further research.
Collapse
Affiliation(s)
- Christine Mansfield
- Sports and Orthopedic Therapies, Nationwide Children's Hospital, Columbus, OH, United States
| | - Dana Lenobel
- Pediatric and Adolescent Gynecology, Outpatient Care Center, Nationwide Children's Hospital, 555 S 18th St #5, Columbus, OH 43205, United States.
| | - Kate McCracken
- Pediatric and Adolescent Gynecology, Outpatient Care Center, Nationwide Children's Hospital, 555 S 18th St #5, Columbus, OH 43205, United States
| | - Geri Hewitt
- Pediatric and Adolescent Gynecology, Outpatient Care Center, Nationwide Children's Hospital, 555 S 18th St #5, Columbus, OH 43205, United States
| | - Leslie C Appiah
- Obsetrics and Gynecology, University of Colorado Hospital, Aurora, CO, United States
| |
Collapse
|
33
|
Myofascial Pain Syndrome in Women with Primary Dysmenorrhea: A Case-Control Study. Diagnostics (Basel) 2022; 12:diagnostics12112723. [PMID: 36359567 PMCID: PMC9689409 DOI: 10.3390/diagnostics12112723] [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: 09/20/2022] [Revised: 10/22/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
There is limited information on myofascial trigger points (MTrPs) and specific symptoms of chronic pelvic pain and, more specifically, dysmenorrhea. The objective of this study was to determine whether patients suffering from primary dysmenorrhea present alterations in mechanosensitivity and pain patterns, and greater presence of MTrPs in the abdominal and pelvic floor muscles. A case-control study was carried out with a total sample of 84 participants distributed based on primary dysmenorrhea and contraceptive treatment. The sample was divided into four groups each comprising 21 women. Data on pain, quality of life, and productivity and work absenteeism were collected; three assessments were made in different phases of the menstrual cycle, to report data on pressure pain threshold, MTrP presence, and referred pain areas. One-way ANOVA tests showed statistically significant differences (p < 0.01) between the groups, for the Physical Health domain and the total score of the SF-12 questionnaire, and for all the domains of the McGill questionnaire; but no significant differences were found in the data from the WPAI-GH questionnaire. Statistically significant data (p < 0.01) were found for mechanosensitivity in the abdominal area and limbs, but not for the lumbar assessment, within the group, with very few significant intergroup differences. The frequency of active MTrPs is higher in the groups of women with primary dysmenorrhea and during the menstrual phase, with the prevalence of myofascial trigger points of the iliococcygeus muscle being especially high in all examination groups (>50%) and higher than 70% in women with primary dysmenorrhea, in the menstrual phase, and the internal obturator muscle (100%) in the menstrual phase. Referred pain areas of the pelvic floor muscles increase in women with primary dysmenorrhea.
Collapse
|
34
|
Supporting young women with menstrual pain – Experiences of midwives working at youth clinics. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 34:100795. [DOI: 10.1016/j.srhc.2022.100795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/26/2022] [Accepted: 11/08/2022] [Indexed: 11/14/2022]
|
35
|
Veena KV, Siddamalla S, Deenadayal M, Sisinthy S, Bhanoori M. Histone deacetylase 1, Sirtuin 1, and Sirtuin 3 single-nucleotide polymorphisms and the risk of endometriosis in South Indian women. J OBSTET GYNAECOL 2022; 42:3230-3235. [PMID: 35980861 DOI: 10.1080/01443615.2022.2109955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The aim of the study was to investigate the association between Histone deacetylase 1 (HDAC1), Sirtuin1 (SIRT1), and Sirtuin3 (SIRT3) single-nucleotide polymorphisms (SNPs) and risk of endometriosis in South Indian women. A total of 300 subjects were recruited in this case-control study comprising 150 affected women and 150 women with no evidence of disease. All the subjects were of South Indian origin. The genotyping of HDAC1, SIRT1, and SIRT3 SNPs (rs1741981T/C, rs144124002A/G, and rs536715G/A) was carried out on DNA from subjects by PCR-RFLP and sequencing analysis. The genotype (p = .00782) and allele (p = .02561) frequencies of the HDAC1 rs1741981 polymorphism showed significant difference between cases and controls. In contrast, SIRT1 (rs144124002) and SIRT3 (rs536715) SNPs did not show significant association with the disease. The HDAC1 polymorphism may constitute a heritable risk factor for endometriosis in South Indian women. To date, there is no reported study on the association of polymorphisms in HDAC1, SIRT1, and SIRT3 with endometriosis risk. Impact StatementWhat is already known on this subject? Endometriosis is a benign gynaecological disease characterised by the implantation of functional endometrial tissue at ectopic positions, associated with an increased risk of malignant transformation. Epigenetic mechanisms are essential for normal development and maintenance of tissue-specific gene expression patterns. Histone modification, including deacetylation of lysine residues by HDACs, is a key epigenetic mechanism of gene expression regulation in endometriosis, therefore genetic variation in HDACs causing epigenetic control defects might lead to disease susceptibility.What do the results of this study add? Our study shows that the HDAC1 SNP is significantly associated with endometriosis in South Indian women, whereas the SNPs of SIRT1 and SIRT3 could not show any association with the disease.What are the implications of these findings for clinical practice and/or further research? The polymorphism of HDAC1 rs1741981 could be used as an important marker of genetic susceptibility to endometriosis development. Analysis of this SNP might help to identify patients at high risk for disease outcome.
Collapse
Affiliation(s)
- K V Veena
- Department of Biochemistry, Osmania University, Hyderabad, India
| | | | - Mamata Deenadayal
- Infertility Institute and Research Centre (IIRC), Secundrabad, India
| | - Shivaji Sisinthy
- Centre for Cellular and Molecular Biology (CCMB), Hyderabad, India
| | - Manjula Bhanoori
- Department of Biochemistry, Osmania University, Hyderabad, India
| |
Collapse
|
36
|
Brown J, Weikel K. An Approach to Common Causes of Nonobstetric Gynecologic Pelvic Pain. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
37
|
Bäumler M, Heiss N, Druckmann R. Endometriosis at all ages: diagnostic ultrasound. Horm Mol Biol Clin Investig 2022; 43:151-157. [PMID: 35654472 DOI: 10.1515/hmbci-2021-0082] [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: 09/24/2021] [Accepted: 03/13/2022] [Indexed: 11/15/2022]
Abstract
Endometriosis is a gynecological disease affecting about 10% of the female population. The multifactorial hormonal, inflammatory, genetic, mental and behavior pathogenesis can result in chronic pelvic pain, blooding disorders and infertility causing disruption of quality of life. Correct diagnosis of the extension and topography is substantial in defining the adequate therapeutic strategy. In an increasing proportion of the cases, endometriosis is being managed medically and para-medically; diagnostic or therapeutic surgery can often be avoided or delayed. Transvaginal sonography is considered being the first-line imaging method in the diagnosis of pelvic endometriosis. The paradigm shift from the belief that endometriosis only affects women of reproductive age has drawn attention to endometriosis in both premenarchal and postmenopausal patients. This review resumes the actually recommended ultrasound signs in the case of patients in menstrual age. Specific diagnostic approaches in adolescent and menopausal patients are highlighted.
Collapse
Affiliation(s)
- Marcel Bäumler
- Department of Gynécologie-Obstétrique, CHU Nimes, Nimes, France
| | - Niko Heiss
- Department of Gynécologie-Obstétrique, CHU Nimes, Nimes, France
| | | |
Collapse
|
38
|
Abstract
The normal ovulatory menstrual cycle requires the presence of a mature hypothalamic-pituitary-ovarian axis and highly coordinated hormonal feedback loops. Consisting of three phases (follicular, ovulatory, and luteal), the normal menstrual cycle results in the formation of a mature follicle and release of an oocyte during each cycle, with menses occurring in the absence of fertilization. While adolescents may initially experience anovulatory cycles following menarche, the vast majority of cycles will be fairly regular, lasting 21 to 45 days in length with an average of three to seven days of bleeding. Absence of menarche by age 15, absence of menses for three consecutive months, and menses lasting eight days or longer with or without associated heavy bleeding are among the menstrual abnormalities that warrant further evaluation. Obtaining the menstrual history in adolescents with the knowledge of expected menstrual patterns allows the pediatric practitioner to provide appropriate counseling and education to adolescents and their families, and to identify menstrual abnormalities when they arise. Treating the menstrual cycle as a "vital sign" highlights the importance of normal menses as an indicator of an individual's overall health and enables timely identification of any concerning findings.
Collapse
Affiliation(s)
- Khalida Itriyeva
- Division of Adolescent Medicine, Cohen Children's Medical Center, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 410 Lakeville Road, Suite 108, New Hyde Park, Hempstead, NY 11042, USA.
| |
Collapse
|
39
|
Wu Y, Zhang J, Wang T, Lou K. Clinical efficacy of turtle shell decocted pills for endometriosis and their influence on cellular immunity. Am J Transl Res 2022; 14:1901-1908. [PMID: 35422950 PMCID: PMC8991112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/20/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore the therapeutic efficacy of the levonorgestrel-releasing intrauterine system combined with turtle shell decocted pills for endometriosis and their effect on cellular immune function. METHODS Clinical data of 118 patients with endometriosis admitted to Taizhou First People's Hospital from January 2019 to January 2020 were retrospectively analyzed. The patients were assigned into a single-drug group (n=68) and a combined traditional Chinese medicine group (n=50) according to treatment methods. The single-drug group was treated with the levonorgestrel-releasing intrauterine system, and the combined traditional Chinese medicine group was treated with additional turtle shell decocted pills for three cycles for a total of 12 weeks. Enzyme-linked immunosorbent assay was adopted to measure the concentration of Th1 cytokines (tumor necrosis factor (TNF)-α and interferon (IFN)-γ) and Th2 cytokines (interleukin (IL)-6 and IL-10), and the protein level of programmed cell death 1 (PD-1) and programmed cell death ligand 1 (PD-L1). The levels of serum luteinizing hormone (LH), follicle stimulating hormone (FSH), and estradiol (E2) were compared between the two groups. The response rate of treatment, the control rate of blood pressure and the incidence of adverse reactions were recorded in both groups. RESULTS The response rate of treatment in the combined traditional Chinese medicine group was higher than that in the single-drug group (P<0.05). Compared to before treatment, the TNF-α and IFN-γ increased in both groups after treatment, and the expressions were higher in the combined traditional Chinese medicine group than in the single-drug group (all P<0.05). After treatment, the levels of IL-6, IL-10, PD-1, and PD-L1 decreased, and the decreases in the combined traditional Chinese medicine group were greater than those in the single-drug group (all P<0.05). Serum LH, FSH and E2 levels before and after the treatment in the two groups were not statistically different (all P>0.05). The incidence of treatment-related adverse reactions between the two groups of patients was also not statistically different (P>0.05). CONCLUSION Turtle shell decocted pills can increase the clinical efficacy of levonorgestrel-releasing intrauterine system in the treatment of endometriosis, reduce levels of PD-1, and PD-L1 and improve cellular immune function. The pills do not affect the secretion of ovarian hormones or increase adverse reactions.
Collapse
Affiliation(s)
- Yunfang Wu
- Department of Gynecology, Shandong Provincial Hospital, Shandong UniversityJinan 250021, Shandong Province, China
- Department of Gynecology, Zibo Hospital of Traditional Chinese MedicineZibo 255200, Shandong Province, China
| | - Jichen Zhang
- Department of Cardiothoracic Surgery, Taizhou First People’s HospitalTaizhou 318020, Zhejiang Province, China
| | - Ting Wang
- Department of Clinical Laboratory, Zibo Hospital of Traditional Chinese MedicineZibo 255200, Shandong Province, China
| | - Kai Lou
- Department of Emergency, Taizhou First People’s HospitalTaizhou 318020, Zhejiang Province, China
| |
Collapse
|
40
|
Burden of Endometriosis: Infertility, Comorbidities, and Healthcare Resource Utilization. J Clin Med 2022; 11:jcm11041133. [PMID: 35207404 PMCID: PMC8880408 DOI: 10.3390/jcm11041133] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/16/2022] [Indexed: 12/11/2022] Open
Abstract
The goal of our study was to evaluate the burden of endometriosis in the community by comparing healthcare resource utilization, total direct medical costs, infertility, and comorbidity rates of women with and without a diagnosis of endometriosis. A retrospective case–control study was performed using the databases of a 2.1 million-member nationwide healthcare plan. The study population included women aged 15–55 years enrolled in the healthcare plan. Women with a diagnosis (ICD-9) of endometriosis were compared to controls without diagnosed endometriosis. Women were individually matched (1:4) on age and residence area. Patient characteristics were described, including infertility, comorbidities, and annual healthcare resource utilization. Total direct medical costs were analyzed in a generalized linear model adjusting for age. Women with endometriosis (n = 6146, mean age ± SD: 40.4 ± 8.0 y) were significantly more likely than controls (n = 24,572) to have a lower BMI and a higher socioeconomic status. After adjusting for BMI and socioeconomic status, endometriosis was significantly associated with infertility (OR = 3.3; 95% CI 3.1–3.5), chronic comorbidities, higher utilization of healthcare services (hospitalization: OR = 2.3; 95% CI 2.1–2.5), pain medications, and antidepressants. Women aged 15–19 y with endometriosis had substantially higher utilization of primary care visits (57.7% vs. 14.4%) and oral contraceptive use (76.9% vs. 9.6%). Direct medical costs associated with endometriosis were higher than those for controls (OR = 1.75; 95% CI 1.69–1.85). Endometriosis is associated with a high burden of comorbidities, increased healthcare resource utilization, and excess costs, particularly for younger patients whose healthcare needs may differ widely from the older population.
Collapse
|
41
|
Techatraisak K, Hestiantoro A, Soon R, Banal-Silao MJ, Kim MR, Seong SJ, Hidayat ST, Cai L, Shin S, Lee BS. Impact of Long-Term Dienogest Therapy on Quality of Life in Asian Women with Endometriosis: the Prospective Non-Interventional Study ENVISIOeN. Reprod Sci 2022; 29:1157-1169. [PMID: 35112299 PMCID: PMC8907083 DOI: 10.1007/s43032-021-00787-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/24/2021] [Indexed: 11/25/2022]
Abstract
Several clinical trials in women with endometriosis demonstrated that dienogest reduces endometrial lesions and improves health-related quality of life (HRQoL). To assess HRQoL in dienogest-treated patients in real-world setting, we conducted a prospective, non-interventional study in 6 Asian countries. Women aged ≥18 years with clinical or surgical diagnosis of endometriosis, presence of endometriosis-associated pelvic pain (EAPP) and initiating dienogest therapy were enrolled. The primary objective was to evaluate HRQoL using the Endometriosis Health Profile-30 (EHP-30) questionnaire. The secondary objectives included analysis of EAPP, satisfaction with dienogest, endometriosis symptoms and bleeding patterns. 887 patients started dienogest therapy. Scores for all EHP-30 scales improved with the largest mean changes at month 6 and 24 in scale pain (−28.9 ± 27.5 and − 34 ± 28.4) and control and powerlessness (−23.7 ± 28.2 and − 28.5 ± 26.2). Mean EAPP score change was −4.6 ± 3.0 for both month 6 and 24 assessments. EAPP decrease was similar in surgically and only clinically diagnosed patients. From baseline to month 24, rates of normal bleeding decreased (from 85.8% to 17.5%) while rates of amenorrhea increased (from 3.5% to 70.8%). Majority of patients and physicians were satisfied with dienogest. Over 80% of patients reported symptoms improvement. 39.9% of patients had drug-related treatment-emergent adverse events, including vaginal hemorrhage (10.4%), metrorrhagia (7.3%) and amenorrhea (6.4%). In conclusion, dienogest improves HRQoL and EAPP in the real-world setting in women with either clinical or surgical diagnosis of endometriosis. Dienogest might be a promising first-line treatment option for the long-term management of debilitating endometriosis-associated symptoms. NCT02425462, 24 April 2015.
Collapse
Affiliation(s)
- Kitirat Techatraisak
- Department of Obstetrics and Gynecology, Gynecologic Endocrinology Unit, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Andon Hestiantoro
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Ruey Soon
- Department of Obstetrics and Gynecology, Sabah Women's and Children's Hospital, Kota Kinabalu, Malaysia
| | - Maria Jesusa Banal-Silao
- Department of Obstetrics and Gynecology, St. Luke's Medical Center Global City, University of the Philippines College of Medicine, Philippine General Hospital, Manila, Philippines
| | - Mee-Ran Kim
- Department of Obstetrics & Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok Ju Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea
| | | | - Ling Cai
- Bayer Pharma AG, Wuppertal, Germany
| | - SoYoung Shin
- Former employee of Bayer AG, Seoul, Republic of Korea
| | - Byung Seok Lee
- Division of Gynecologic Endocrinology and Infertility, Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University, Seoul, Republic of Korea.
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea.
| |
Collapse
|
42
|
Veena KV, Siddamalla S, Deenadayal M, Shivaji S, Bhanoori M. DNMT1 and DNMT3B gene variants and their association with endometriosis in South Indian women. Mol Biol Rep 2022; 49:321-329. [PMID: 34697715 DOI: 10.1007/s11033-021-06877-x] [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: 07/31/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Endometriosis is a multifactorial estrogen dependent gynecological disease characterized by implantation of functional endometrial tissue at ectopic positions. Though this disease is benign, it is associated with an increased risk of malignant transformation. Epigenetic disruptions like aberrant DNA methylation, resulting changes in gene expression capacity, are important in tumor progression and malignant cellular transformation. Therefore, variation in genes involved in DNA methylation might lead to disease susceptibility. PURPOSE To investigate the association between DNA methyl transferases (DNMT1 and DNMT3B) single nucleotide polymorphisms (SNPs) and the risk of endometriosis in South Indian women. METHODS In the present study, we examined the genotypic and allele distribution of DNMT1 (rs10423341C/A, rs2228611G/Aandrs4804490C/A) and DNMT3B (rs1569686G/T) among the endometriosis patients (n = 150) and controls (n = 150). The genotypes were analyzed by polymerase chain reaction (PCR) and sequencing methods. Haplotype frequencies for multiple loci and the standardized disequilibrium coefficient (D') for pairwise linkage disequilibrium (LD) were surveyed by Haploview Software. RESULT Significant increase in the frequencies of DNMT1 rs10423341 (P = 0.04601), rs2228611 (P = 0.00175) and DNMT3B rs1569686 (P = 0.033) genotypes and alleles was observed in patients compared to controls. In addition, the frequency of A/A/C (P = 0.0065) haplotype was significantly high in patients. But the DNMT1 (rs4804490) SNP did not show significant association with the disease. CONCLUSION The DNMT1 and DNMT3B polymorphism may constitute an inheritable risk factor for endometriosis in South Indian women. To the best of our knowledge there is no reported study on the association of polymorphisms in DNMT1 and DNMT3B with endometriosis risk.
Collapse
Affiliation(s)
- K V Veena
- Department of Biochemistry, Osmania University, Hyderabad, 500 007, India
| | - Swapna Siddamalla
- Department of Biochemistry, Osmania University, Hyderabad, 500 007, India
| | - Mamata Deenadayal
- Infertility Institute and Research Centre (IIRC), Secunderabad, India
| | - Sisinthy Shivaji
- Centre for Cellular and Molecular Biology (CCMB), Hyderabad, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Manjula Bhanoori
- Department of Biochemistry, Osmania University, Hyderabad, 500 007, India.
| |
Collapse
|
43
|
Szymańska J, Dąbrowska-Galas M. An assessment of Polish women’s level of knowledge about endometriosis: a pilot study. BMC Womens Health 2021; 21:404. [PMID: 34876118 PMCID: PMC8650458 DOI: 10.1186/s12905-021-01556-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Insufficient knowledge about endometriosis among women is one of the causes of its delayed diagnoses. Due to the elusiveness of symptoms, the most important component of early detection is proper and exhaustive knowledge. The objective of the study was to assess Polish women's awareness of endometriosis.
Methods
The pilot studies were performed with the participation of 200 women, in an average age of 33.65 years (SD = 11.45), who completed the authors’ questionnaire related to self-assessment of the level of knowledge about the disease, its symptoms, late effects and directions of a remediation procedure. The statistical analysis was performed using the IBM SPSS Statistics 25 suite. It included a frequency analysis, a one-way analysis of variance ANOVA, a single variable regression analysis and Student’s t-test for independent samples.
Results
Almost 84% of women had heard about endometriosis, while only 1/3 of them considered their knowledge sufficient or good. Very good knowledge was declared by 4.5% of women, while 16.1% of participants had never heard about it. The level of knowledge was significantly higher (p = 0.001) among women with medical education. Polish women acquired their knowledge mainly from the Internet and the experience of other women. The reasons identified by women were the still existing ‘taboo’ related to menstruation, the absence of information in the media and education in schools, which is critical according to 92.4% of women.
Conclusions
Polish women’s level of knowledge about endometriosis is insufficient, which we should strive to improve. Higher awareness is presented by women with medical education, and the higher the level of knowledge, the larger a woman’s interest in healthy behaviour.
Collapse
|
44
|
Alborzi S, Poordast T, Askary E, Chamanara K, Sorouri ZZ, Kellaii EHN, Nahooji SP. The effect of vasopressin injection on ovarian reserve in patients who had cystectomy for ovarian endometrioma; a randomized controlled trial. Reprod Biomed Online 2021; 44:651-658. [DOI: 10.1016/j.rbmo.2021.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/20/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
|
45
|
Lahoti A, Yu C, Brar PC, Dalgo A, Gourgari E, Harris R, Kamboj MK, Marks S, Nandagopal R, Page L, Raman V, Reynolds DG, Sarafoglou K, Terrell C, Stanley TL. An endocrine perspective on menstrual suppression for adolescents: achieving good suppression while optimizing bone health. J Pediatr Endocrinol Metab 2021; 34:1355-1369. [PMID: 34388330 DOI: 10.1515/jpem-2020-0539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 07/19/2021] [Indexed: 11/15/2022]
Abstract
Suppression of menstruation and/or ovarian function in adolescent girls may be desired for a variety of reasons. Numerous medical options exist. The choice of the appropriate modality for an individual patient depends on several factors based on differences in the efficacy of achieving menstrual suppression as well as in their side effect profiles. Adolescence is also a period of bone mass accrual in girls, and several of these modalities may negatively influence peak bone mass. This review focuses on the efficacy of achieving menstrual suppression and the effect on bone health of the various options through an overview of the current literature and also highlights areas in need of further research.
Collapse
Affiliation(s)
- Amit Lahoti
- Pediatric Endocrine Division, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, TN, USA
| | - Christine Yu
- Section of Adult and Pediatric Endocrinology, Diabetes, & Metabolism, University of Chicago, Chicago, IL, USA
| | - Preneet Cheema Brar
- Division of Pediatric Endocrinology and Diabetes, NYU Grossman School of Medicine, New York, NY, USA
| | - Austin Dalgo
- Center for Bioethics and Health Equity, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, TN, USA
| | - Evgenia Gourgari
- Pediatric Endocrinology Division, Department of Pediatrics, Georgetown University, Washington, DC, USA
| | - Rebecca Harris
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
| | - Manmohan K Kamboj
- Section of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital at The Ohio State University, Columbus, OH, USA
| | - Seth Marks
- Section of Pediatric Endocrinology and Metabolism, Department of Pediatrics and Child Health, Children's Hospital HSC Winnipeg, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Radha Nandagopal
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Laura Page
- Division of Endocrinology, Department of Pediatrics, Duke University, Durham, NC, USA
| | | | - Danielle G Reynolds
- Diabetes and Endocrinology Center, University of South Florida, Tampa, FL, USA
| | - Kyriakie Sarafoglou
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA.,Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN, USA
| | - Carrie Terrell
- Division of General Obstetrics, Gynecology, Midwifery and Family Planning at the University of Minnesota Medical School, Minneapolis, MN, USA
| | - Takara L Stanley
- Pediatric Endocrine Unit and Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
46
|
Salliss ME, Farland LV, Mahnert ND, Herbst-Kralovetz MM. The role of gut and genital microbiota and the estrobolome in endometriosis, infertility and chronic pelvic pain. Hum Reprod Update 2021; 28:92-131. [PMID: 34718567 DOI: 10.1093/humupd/dmab035] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 08/25/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Endometriosis is a chronic, burdensome condition that is historically understudied. Consequently, there is a lack of understanding of the etiology of the disease and its associated symptoms, including infertility and chronic pelvic pain (CPP). Endometriosis development is influenced by estrogen metabolism and inflammation, which are modulated by several factors including the microbiome and the estrobolome (the collection of genes encoding estrogen-metabolizing enzymes in the gut microbiome). Therefore, there is increasing interest in understanding the role of microbiota in endometriosis etiology. OBJECTIVE AND RATIONALE To date, there is no cure for endometriosis and treatment options often are ineffective. This manuscript will review the potential relationship between the microbiome and endometriosis, infertility and CPP and highlight the available data on the microbiome in relation to endometriosis and its related symptoms. The overarching goal of this manuscript is to inform future microbiome research that will lead to a deeper understanding of the etiology of the disease and possible diagnostic modalities and treatments. The potential impact of the microbiome on estrogen regulation modulated by the estrobolome, as well as inflammation and other endometriosis-promoting mechanisms within the genital tract, will be reviewed. The methodological limitations of microbiome-related studies will be critically assessed to provide improved guidelines for future microbiome and clinical studies. SEARCH METHODS PubMed databases were searched using the following keywords: endometriosis AND microbiome, infertility AND microbiome, pelvic pain AND microbiome, IVF (in-vitro fertilization) AND microbiome, endometriosis AND infertility. Clinical and preclinical animal trials that were eligible for review, and related to microbiome and endometriosis, infertility or CPP were included. All available manuscripts were published in 2002-2021. OUTCOMES In total, 28 clinical and 6 animal studies were included in the review. In both human and animal studies, bacteria were enriched in endometriosis groups, although there was no clear consensus on specific microbiota compositions that were associated with endometriosis, and no studies included infertility or CPP with endometriosis. However, bacterial vaginosis-associated bacteria and Lactobacillus depletion in the cervicovaginal microbiome were associated with endometriosis and infertility in the majority (23/28) of studies. Interpretation of endometrial studies is limited owing to a variety of methodological factors, discussed in this review. In addition, metadata outlining antibiotic usage, age, race/ethnicity, menopausal status and timing of sample collection in relation to diagnosis of endometriosis was not consistently reported. Animal studies (6/6) support a bidirectional relationship between the gut microbiota and endometriosis onset and progression. WIDER IMPLICATIONS There is evidence that a dysbiotic gut or genital microbiota is associated with multiple gynecologic conditions, with mounting data supporting an association between the microbiome and endometriosis and infertility. These microbiomes likely play a role in the gut-brain axis, which further supports a putative association with the spectrum of symptoms associated with endometriosis, including infertility and CPP. Collectively, this review highlights the demand for more rigorous and transparent methodology and controls, consistency across the field, and inclusion of key demographic and clinical characteristics of disease and comparison participants. Rigorous study designs will allow for a better understanding of the potential role of the microbiome in endometriosis etiology and the relationship to other disorders of the female reproductive tract.
Collapse
Affiliation(s)
- Mary E Salliss
- Department of Obstetrics and Gynecology, University of Arizona-College of Medicine, Phoenix, AZ, USA.,Department of Biology and Biochemistry, Bath University, Bath, UK
| | - Leslie V Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.,Department of Obstetrics and Gynecology, University of Arizona-College of Medicine Tucson, Tucson, AZ, USA
| | - Nichole D Mahnert
- Department of Obstetrics and Gynecology, University of Arizona-College of Medicine, Phoenix, AZ, USA.,Department of Obstetrics and Gynecology, Banner-University Medical Center Phoenix, Phoenix, AZ, USA
| | - Melissa M Herbst-Kralovetz
- Department of Obstetrics and Gynecology, University of Arizona-College of Medicine, Phoenix, AZ, USA.,Department of Basic Medical Sciences, University of Arizona-College of Medicine, Phoenix, AZ, USA
| |
Collapse
|
47
|
Greydanus DE, Cabral MD, Patel DR. Pelvic inflammatory disease in the adolescent and young adult: An update. Dis Mon 2021; 68:101287. [PMID: 34521505 DOI: 10.1016/j.disamonth.2021.101287] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that is typically polymicrobial with classic core involvement of Neisseria gonorrhoeae and/or Chlamydia trachomatis, though other endogenous flora from the vagino-cervical areas can be involved as well. It is often a sexually transmitted disease but other etiologic routes are also noted. A variety of risk factors have been identified including adolescence, young adulthood, adolescent cervical ectropion, multiple sexual partners, immature immune system, history of previous PID, risky contraceptive practices and others. An early diagnosis and prompt treatment are necessary to reduce risks of PID complications such as chronic pelvic pain, ectopic pregnancy and infertility. Current management principles of PID are also reviewed. It is important for clinicians to screen sexually active females for common sexually transmitted infections such as Chlamydia trachomatis and provide safer sex education to their adolescent and young adult patients. Clinicians should provide comprehensive management to persons with PID and utilize established guidelines such as those from the US Centers for Disease Control and Prevention (CDC).
Collapse
Affiliation(s)
- Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
| | - Maria Demma Cabral
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
| | - Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
| |
Collapse
|
48
|
Endometriosis-A Multifaceted Problem of a Modern Woman. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158177. [PMID: 34360470 PMCID: PMC8346111 DOI: 10.3390/ijerph18158177] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/23/2021] [Accepted: 07/30/2021] [Indexed: 11/17/2022]
Abstract
Endometriosis is a chronic disease of unclear aetiology that affects millions of women around the world. It causes chronic pain, dysmenorrhea, and infertility, which significantly reduces the quality of daily life. The aim of the following study was a multivariate analysis of the functioning of women diagnosed with endometriosis, and the identification of the relationship between the level of physical activity and sexual functioning, ability to cope with stress, and the degree of anxiety and mood disorders. The prospective survey was conducted of 957 women. The research was carried out using standardised IPAQ, FSFI, HADS, and Mini-Cope questionnaires. The study showed that patients with endometriosis exhibit a higher level of depression and anxiety disorders (p = 0.01) and a lower level of sexual functions (p < 0.001). The influence of physical activity on the functioning of patients with endometriosis was demonstrated. Depending on the clinical stage of endometriosis, the influence of physical activity on individual aspects of life differed. Physical activity was shown, inter alia, to reduce anxiety (p = 0.015), and influence stress-coping strategies. Endometriosis affects the mental and physical health of women. Physical activity can reduce the severity of endometriosis symptoms and improve the daily functioning of patients.
Collapse
|
49
|
Natarajan J, Ahmed T, Patil S, Mamsaang M, Kapadia R, Tailor Y, Shrikhande A. Pain and functionality improved when underlying neuromuscular dysfunction addressed in chronic pelvic pain patients. Neurourol Urodyn 2021; 40:1609-1615. [PMID: 34082473 DOI: 10.1002/nau.24726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/12/2021] [Accepted: 05/22/2021] [Indexed: 12/14/2022]
Abstract
AIM Examine the effects of treating underlying neuromuscular dysfunction in chronic pelvic pain (CPP) patients. METHODS A retrospective longitudinal study of 200 female and male patients with CPP was performed upon an Institutional Review Board (IRB) approval (IRB# 17-0761). The outpatient protocol consisted of ultrasound-guided trigger point injections to the pelvic floor musculature with peripheral nerve blocks once a week for 6 weeks in an outpatient setting. Pelvic pain and functionality were measured before and after treatment using the Visual Analogue Scale and the Functional Pelvic Pain Scale. Functionality categories assessed were intercourse, bladder, bowel, working, walking, running, lifting, and sleeping. RESULTS Pretreatment, mean VAS score was 6.44 (standard deviation [SD] = 2.50; p < 0.05, 95% confidence interval [CI] = 6.09-6.79). Posttreatment mean VAS score was 4.25 (SD = 2.63; p < 0.05, 95% CI = 3.88-4.61). The mean FPPS score before treatment was 10.77 (SD = 6.39; p < 0.05, 95% CI = 9.88-11.65). Posttreatment mean FPPS score was 7.42 (SD = 5.87; p < 0.05, 95% CI = 6.61-8.23). Analysis of subcategories within FPPS indicated statistically significant improvement in the categories of intercourse, working, and sleeping. CONCLUSION Findings show the treatment was efficient at decreasing pain in CPP patients. Results show promise for improving overall pelvic functionality, particularly within the categories of intercourse, sleeping, and working.
Collapse
Affiliation(s)
- Janaki Natarajan
- Department of Physical Medicine and Rehabilitation, Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, Florida, USA.,Department of Physical Medicine and Rehabilitation, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Tayyaba Ahmed
- Department of Physical Medicine and Rehabilitation, Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, Florida, USA.,Department of Physical Medicine and Rehabilitation, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Soha Patil
- Department of Physical Medicine and Rehabilitation, Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, Florida, USA.,Department of Physical Medicine and Rehabilitation, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Marjorie Mamsaang
- Department of Physical Medicine and Rehabilitation, Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, Florida, USA.,Department of Physical Medicine and Rehabilitation, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Rucha Kapadia
- Department of Physical Medicine and Rehabilitation, Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, Florida, USA.,Department of Physical Medicine and Rehabilitation, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Yogita Tailor
- Department of Physical Medicine and Rehabilitation, Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, Florida, USA.,Department of Physical Medicine and Rehabilitation, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Allyson Shrikhande
- Department of Physical Medicine and Rehabilitation, Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, Florida, USA.,Department of Physical Medicine and Rehabilitation, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York, USA
| |
Collapse
|
50
|
Simpson CN, Lomiguen CM, Chin J. Combating Diagnostic Delay of Endometriosis in Adolescents via Educational Awareness: A Systematic Review. Cureus 2021; 13:e15143. [PMID: 34164243 PMCID: PMC8214575 DOI: 10.7759/cureus.15143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/20/2021] [Indexed: 11/05/2022] Open
Abstract
Endometriosis occurs in approximately 10% of adult women worldwide; however, it is commonly under- or misdiagnosed in adolescents. The purpose of this study was to analyze existing scientific literature for reasons for diagnostic delay of endometriosis and to determine how education regarding endometriosis could be improved. An integrative review was conducted based on articles published between December 1980 and December 2020. Suitable articles were identified from the MEDLINE/PubMed databases, using relevant terms. Eligible studies included discussion on potential causes of diagnostic delay of endometriosis in the adolescent population. Data were extracted from eligible publications and qualitative synthesis was used. The 27 articles included in the study revealed several primary reasons for the delay, such as a physician and/or patient knowledge gap, normalization by physician and patient, lack of research, and physician resistance. Strategies to lessen diagnostic delay of endometriosis in adolescents must include integrated actions by educators and healthcare providers to improve health literacy and awareness of common causes of pelvic pain in this age group.
Collapse
Affiliation(s)
- Cassandra N Simpson
- Obstetrics and Gynecology, Lake Erie College of Osteopathic Medicine, Erie, USA
| | - Christine M Lomiguen
- Pathology, Lake Erie College of Osteopathic Medicine, Erie, USA
- Family Medicine, Millcreek Community Hospital, Erie, USA
| | - Justin Chin
- Medical Education, Lake Erie College of Osteopathic Medicine, Erie, USA
- Family Medicine, LifeLong Medical Care, Richmond, USA
| |
Collapse
|