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Bourdon M, Maignien C, Giraudet G, Estrade JP, Indersie E, Solignac C, Arbo E, Roman H, Chapron C, Santulli P. Investigating the medical journey of endometriosis-affected women: Results from a cross-sectional web-based survey (EndoVie) on 1,557 French women. J Gynecol Obstet Hum Reprod 2024; 53:102708. [PMID: 38097043 DOI: 10.1016/j.jogoh.2023.102708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE To investigate the medical journey and the quality of life of French endometriosis-affected women, from the onset of the symptoms to the therapeutic management. STUDY DESIGN Between January 15th 2020 and February 3rd 2020, a prospective cross-sectional web-based survey was conducted among women diagnosed with endometriosis. The questionnaire included 52 questions distributed in five sections (screening, sociodemographic characteristics, impacts on quality of life, SF36 questionnaire, management of endometriosis and proposals for care improvement). RESULTS One thousand five hundred fifty-seven endometriosis-affected women aged of 42±12.8 years answered the questionnaire. On average, 7 years elapsed between the first symptoms (at 23.8 ± 10.2 years) and the diagnosis (31.0 ± 8.9 years). The mean number of symptoms was 4.6 ± 2.3, with 82 % of women experiencing pain scores between 7 and 10/10. Following diagnosis, 66 % women received a medical treatment, mostly hormonal treatments (45 %), with a significant decrease in pain intensity (VAS scores after treatment = 4.9 ± 2.7, p < 0.001). Most women (62 %) had already been operated, among whom 22 % by laparotomy. Finally, patients reported numerous impacts on their daily lives, particularly on the sexual, psychological, and physical fields. The overall mean score of quality of life was 4.3 ± 2.6 /10. CONCLUSION This large prospective web-based survey underlines that the journey of women with endometriosis is long and difficult until diagnosis and efficient treatment. It emphasizes the urgent need to reduce the diagnostic delay and thereby the burden of endometriosis on women's lives. Moreover, the creation of referral multidisciplinary centers appears to be crucial to improve the management of the disease.
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Affiliation(s)
- Mathilde Bourdon
- Université de Paris-Cité, Faculté de Santé, Faculté de Médecine Paris Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, Paris, France; Université de Paris, Department of Infection, Immunity, Inflammation, INSERM U1016, Institut Cochin, Paris, France
| | - Chloé Maignien
- Université de Paris-Cité, Faculté de Santé, Faculté de Médecine Paris Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, Paris, France
| | | | - Jean-Philippe Estrade
- Department of Gynecological Surgery, Hôpital Privé de Provence, Aix-en-Provence, France
| | - Emilie Indersie
- French Association for Endometriosis EndoFrance, Gaillac, France
| | | | | | - Horace Roman
- Endometriosis Center, Clinique Tivoli-Ducos, IFEMEndo, Bordeaux, France
| | - Charles Chapron
- Université de Paris-Cité, Faculté de Santé, Faculté de Médecine Paris Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, Paris, France
| | - Pietro Santulli
- Université de Paris-Cité, Faculté de Santé, Faculté de Médecine Paris Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, Paris, France; Université de Paris, Department of Infection, Immunity, Inflammation, INSERM U1016, Institut Cochin, Paris, France.
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Fernandez H, Agostini A, Baffet H, Chabbert-Buffet N, Descamps P, Estrade JP, Giraudet G, Hocke C, Salle B, Tremollieres F, Chapron C. Update on the management of endometriosis-associated pain in France. J Gynecol Obstet Hum Reprod 2023; 52:102664. [PMID: 37669732 DOI: 10.1016/j.jogoh.2023.102664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/02/2023] [Indexed: 09/07/2023]
Abstract
The French National College of Obstetricians and Gynecologists (CNGOF) published guidelines for managing endometriosis-associated pain in 2018. Given the development of new pharmacological therapies and a review that was published in 2021, most national and international guidelines now suggest a new therapeutic approach. In addition, a novel validated screening method based on patient questionnaires and analysis of 109-miRNA saliva signatures, which combines biomarkers and artificial intelligence, opens up new avenues for overcoming diagnostic challenges in patients with pelvic pain and for avoiding laparoscopic surgery when sonography and MRI are not conclusive. Dienogest (DNG) 2 mg has been a reimbursable healthcare expense in France since 2020, and, according to recent studies, it is at least as effective as combined hormonal contraception (CHC) and can be used as an alternative to CHC for first-line treatment of endometriosis-associated pain. Since 2018, the literature concerning the use of DNG has grown considerably, and the French guidelines should be modified accordingly. The levonorgestrel intrauterine system (LNG IUS) and other available progestins per os, including DNG, or the subcutaneous implant, can be offered as first-line therapy, gonadotropin-releasing hormone (GnRH) agonists with add-back therapy (ABT) as second-line therapy. Oral GnRH antagonists are promising new medical treatments for women with endometriosis-associated pain. They competitively bind to GnRH receptors in the anterior pituitary, preventing native GnRH from binding to GnRH receptors and from stimulating the secretion of luteinizing hormone and follicle-stimulating hormone. Consequently, estradiol and progesterone production is reduced. Oral GnRH antagonists will soon be on the market in France. Given their mode of action, their efficacy is comparable to that of GnRH agonists, with the advantage of oral administration and rapid action with no flare-up effect. Combination therapy with ABT is likely to allow long-term treatment with minimal impact on bone mass. GnRH antagonists with ABT may thus be offered as second-line treatment as an alternative to GnRH agonists with ABT. This article presents an update on the management of endometriosis-associated pain in women who do not have an immediate desire for pregnancy.
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Affiliation(s)
- Hervé Fernandez
- AP-HP, Gynecology and Obstetrics Department, Bicetre Hospital, GHU Sud, 78 avenue du Général Leclerc, Le Kremlin Bicetre F-94276, France; Paris Saclay University, 63 rue Gabriel Péri, Le Kremlin Bicetre F-94276, France; Centre of research in epidemiology and population health (CESP), UMR1018, Inserm, Paris Saclay University, Hôpital Paul Brousse, 16 avenue Paul Vaillant Couturier, Villejuif F-94816, France.
| | - Aubert Agostini
- A Agostini, Service de Gynécologie Obstétrique, AP-HM, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Hortense Baffet
- H Baffet, Service de Gynécologie Médicale, Orthogénie et Sexologie, CHU de Lille, université de Lille, Lille, France
| | - Nathalie Chabbert-Buffet
- N Chabbert-Buffet, Service de Gynécologie Obstétrique Médecine de la Reproduction, Centre expert en Endométriose C3E, Hôpital Tenon APHP Sorbonne Université, Paris, France
| | - Philippe Descamps
- P Descamps, Service de Gynécologie Obstétrique et Médecine de la Reproduction, CHU Angers, Centre expert en Endométriose Pays de Loire, Angers, France
| | | | | | - Claude Hocke
- C Hocké, Service de Chirurgie Gynécologique et Médecine de la Reproduction, Centre expert régional Nouvelle Aquitaine, Centre Aliénor d'Aquitaine, Université Bordeaux, Bordeaux, France
| | - Bruno Salle
- B Salle, Service de Médecine de la Reproduction, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, Bron, France
| | - Florence Tremollieres
- F Trémollieres, Centre de Ménopause, Hôpital Paule de Viguier, CHU Toulouse, Université Toulouse III, Toulouse, France
| | - Charles Chapron
- C Chapron, Service de Chirurgie Gynécologique II et Médecine de la Reproduction, AP-HP, Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Université Paris-Cité, Faculté de Médecine Paris-Centre, Paris, France
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Silva Filho AL, Catherino WH, Estrade JP, Koga K, Singh SS, Vannuccini S, Yang X, Lahav A, Caetano C, Calaf J. The HOPE study: evaluating the impact of an online educational resource for heavy menstrual bleeding on the patient-physician dynamic. Women Health 2023:1-13. [PMID: 37291687 DOI: 10.1080/03630242.2023.2220806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The Heavy menstrual bleeding: Evidence-based Learning for best Practice (HELP) Group developed an educational website about heavy menstrual bleeding (HMB). The "HMB improving Outcomes with Patient counseling and Education" (HOPE) project examined the website's impact on women's knowledge, confidence, and consultations with healthcare providers (HCPs). HOPE was a quantitative online survey of gynecologists and women with HMB in Brazil. After an initial consultation, patients had unlimited access to the website and completed a survey. HCPs also completed a survey about the sconsultation. After a second consultation, HCPs and patients completed another survey. HCP surveys assessed their perception of patients' awareness, understanding, and willingness to discuss HMB. Patient surveys assessed their knowledge, experience, and confidence in discussing HMB. Forty HCPs recruited 400 women with HMB. Based on HCP perceptions at the first consultation, 18 percent of patients had "good knowledge" or "very good knowledge" of HMB, increasing to 69 percent after patients had visited the website. Before and after visiting the website, 34 percent and 69 percent of patients, respectively, regarded their HMB knowledge as "goo.d" Additionally, 17 percent of women reported their anxiety as "highest" during the first consultation; this decreased to 7 percent during the second consultation. After visiting the HELP website, patients' knowledge of HMB improved and they were less anxious.
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Affiliation(s)
| | - William H Catherino
- Research Division, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | | | - Kaori Koga
- Department of Obstetrics and Gynecology, Chiba University and University of Tokyo, Tokyo, Japan
| | - Sukhbir S Singh
- Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada
| | - Silvia Vannuccini
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Xin Yang
- Gynecology, Peking University People's Hospital, Beijing, China
| | | | | | - Joaquim Calaf
- Hospital Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
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Singh SS, Calaf Alsina J, Vannuccini S, Koga K, Lopes Silva-Filho A, Yang X, Estrade JP, Catherino W. Clinical perspectives on the menstrual pictogram for the assessment of heavy menstrual bleeding. Hum Reprod Open 2022; 2022:hoac048. [PMID: 36382010 PMCID: PMC9651972 DOI: 10.1093/hropen/hoac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 09/20/2022] [Indexed: 11/23/2022] Open
Abstract
Heavy menstrual bleeding (HMB) has an estimated prevalence of 18–32% but is known to be under-reported due to poor recognition and estimation of menstrual blood loss (MBL). HMB can negatively impact quality of life, affecting social interactions, work productivity and sexual life. Abnormal menstrual bleeding may have an underlying structural or systemic cause, such as endometrial and myometrial disorders; however, for some, there is no identified pathological cause. Several methods are available for assessing MBL, including the alkaline hematin (AH) method and the menstrual pictogram (MP). The AH method is considered to be the most accurate way to monitor MBL; however, it is associated with inconvenience and expense, therefore limiting its value outside of research. The MP requires the user to select an icon from a chart that reflects the appearance of a used sanitary product; the icon is associated with a blood volume that can be used to determine MBL. Validation studies have demonstrated that the results of the MP and AH method are well correlated, showing that the MP can measure MBL with sufficient accuracy. Additionally, the MP is more convenient for users, less expensive than the AH method, may be used in regions where the AH method is unavailable and may also be used as part of a digital application. Overall, the MP offers a convenient approach to monitor MBL both in research and clinical practice settings.
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Affiliation(s)
- Sukhbir S Singh
- University of Ottawa & Ottawa Hospital Research Institute , Ottawa, Ontario, Canada
| | | | | | | | | | - Xin Yang
- Peking University People’s Hospital , Beijing, China
| | | | - William Catherino
- Uniformed Services University of the Health Sciences , Bethesda, Maryland, USA
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Rebahi C, Cardaillac C, Cosson M, Fernandez H, Hermieu JF, Estrade JP, Winer N, Dochez V, Thubert T. National survey of surgical practices: Sacropexy in France in 2019. Int Urogynecol J 2020; 32:975-991. [PMID: 32918592 DOI: 10.1007/s00192-020-04526-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Sacropexy is a reference surgical treatment for pelvic organ prolapse in women. The great variability in surgical techniques for this procedure is a source of bias that complicates analysis of the results of trials assessing it. Using the French guidelines issued in 2016 by the SCGP, AFU, SIFUD-PP, and CNGOF as a reference, we sought to inventory the surgical practices of the surgeons who perform these procedures. METHODS In November 2018, a questionnaire about the technical aspects of this procedure was distributed by email to the French physicians performing it. It was distributed to members of several professional societies (CNGOF, SCGP, and SIFUD) and to gynecologists practicing in clinics owned by the ELSAN group. RESULTS Of the 273 responders, 92% reported that they perform most operations laparoscopically. Overall, 83% of gynecologic surgeons used polypropylene prostheses (mesh); 38% routinely placed a posterior mesh, while the rest did so only in cases of clinical rectocele with anorectal symptoms. A concomitant hysterectomy was performed by 51% of respondents when the uterus was bulky and/or associated with substantial uterine prolapse. Finally, half the surgeons suggested the placement of a suburethral sling for women with stress urinary incontinence. CONCLUSIONS Although practices are largely consistent with the most recent guidelines, surgical techniques vary widely between surgeons, both in France and internationally.
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Affiliation(s)
- Christie Rebahi
- Service de gynécologie et d'obstétrique, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Claire Cardaillac
- Service de gynécologie obstétrique, Centre Hospitalier Universitaire de Nantes, Hotel Dieu, 38, boulevard Jean-Monnet, 44093, Nantes, France
| | - Michel Cosson
- Service de chirurgie gynécologique de Lille, Hopital Jeanne De Flandre, Lille, France
| | - Hervé Fernandez
- Département de gynécologie et d'obstétrique, AP-HP, GHU-Sud, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Jean-Francois Hermieu
- Service d'urologie, Hôpital Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, Université Paris-Diderot, 46, rue Henri Huchard, 75018, Paris, France
| | - Jean-Philippe Estrade
- Service de gynécologie obstétrique, Gyneco Marseille Saint-Giniez, Marseille, France
| | - Norbert Winer
- Service de gynécologie obstétrique, Centre Hospitalier Universitaire de Nantes, Hotel Dieu, 38, boulevard Jean-Monnet, 44093, Nantes, France
| | - Vincent Dochez
- Service de gynécologie obstétrique, Centre Hospitalier Universitaire de Nantes, Hotel Dieu, 38, boulevard Jean-Monnet, 44093, Nantes, France
| | - Thibault Thubert
- Service de gynécologie obstétrique, Centre Hospitalier Universitaire de Nantes, Hotel Dieu, 38, boulevard Jean-Monnet, 44093, Nantes, France.
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Santulli P, Giraudet G, Estrade JP, Indersie E, Solignac C, Roman H. IMPACT OF ENDOMETRIOSIS ON PARTNER'S DAILY LIFE : RESULTS FROM THE ENDOVIE SURVEY. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Santulli P, Giraudet G, Estrade JP, Indersie E, Solignac C, Roman H. IMPACT OF ENDOMETRIOSIS ON SEXUAL LIFE OF WOMEN AND PARTNERS: RESULTS FROM THE ENDOVIE SURVEY. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Estrade JP. Laparoscopic Sacrocolpopexy with Vaginal Prosthetic Adhesive: Multicenter Prospective Study of 45 Patients. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Blanc B, Lazard A, Estrade JP, Agostini A, Gurriet B. [Contraceptive methods after gynecological and breast cancer]. Bull Acad Natl Med 2010; 194:521-530. [PMID: 21171246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
With earlier diagnosis and more effective treatments, more and more women are receiving fertility-preserving cancer therapy. Approximately 10% of breast and gynecological cancers occur in women under 40, and more than 5 000 French women under 45 develop breast cancer each year. While hormonal contraception is contra-indicated for women with a history of breast or endometrial cancer, it seems to have a protective effective in ovarian cancer. Although pregnancy is not contra-indicated after cancer, it must be planned in a timely manner, meaning that appropriate contraception is necessary in the meantime.
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