Pub Date : 2021-09-11DOI: 10.1177/22840265211045610
A. Kale, G. Basol, Elif Cansu Gündoğdu, E. Mat, G. Yıldız, Betul Kuru, Y. Aboalhasan, N. Uzun, T. Usta, Mehmet Al tıntaş, R. Demirhan
Introduction: Piriformis syndrome is an uncommon disease resulting from the piriformis muscle’s compression of the sciatic nerve. Pain and numbness in the buttocks and down the leg are the most common symptoms. This study analyzes the laparoscopic surgical treatment of piriformis syndrome. Methods: We report three cases of piriformis syndrome diagnosed in our hospital. The first case was a 40 years old woman with a 7-year history of intermittent low back pain and sciatica on her right side. Hyperesthesia and cutaneous allodynia were observed in the right sciatic nerve dermatome. The second case was a 30 years old woman with a 2-year history of sciatica on her left side. The third case was a 30 years old woman with a 2-year history of sciatica on her right side. All the patients underwent laparoscopic decompression surgery, which was performed to release the sciatic nerve or sacral nerve roots. Results: The patients were reexamined at the postoperative 3rd and 6th months. Their visual analog scale (VAS) scores were found to be decreased from 10/10, 9/10, and 7/10 to 0/10, 1/10, and 0/10, respectively. Conclusion: Due to the very few cases in the literature, pelvic piriformis syndrome is an exclusively clinical diagnosis. If the sciatica is refractory to conservative treatments, laparoscopic exploration and decompression surgery of the pelvic nerves and piriformis muscle could be an option.
{"title":"Laparoscopic surgical approach for the treatment of piriformis syndrome: Intrapelvic decompression technique","authors":"A. Kale, G. Basol, Elif Cansu Gündoğdu, E. Mat, G. Yıldız, Betul Kuru, Y. Aboalhasan, N. Uzun, T. Usta, Mehmet Al tıntaş, R. Demirhan","doi":"10.1177/22840265211045610","DOIUrl":"https://doi.org/10.1177/22840265211045610","url":null,"abstract":"Introduction: Piriformis syndrome is an uncommon disease resulting from the piriformis muscle’s compression of the sciatic nerve. Pain and numbness in the buttocks and down the leg are the most common symptoms. This study analyzes the laparoscopic surgical treatment of piriformis syndrome. Methods: We report three cases of piriformis syndrome diagnosed in our hospital. The first case was a 40 years old woman with a 7-year history of intermittent low back pain and sciatica on her right side. Hyperesthesia and cutaneous allodynia were observed in the right sciatic nerve dermatome. The second case was a 30 years old woman with a 2-year history of sciatica on her left side. The third case was a 30 years old woman with a 2-year history of sciatica on her right side. All the patients underwent laparoscopic decompression surgery, which was performed to release the sciatic nerve or sacral nerve roots. Results: The patients were reexamined at the postoperative 3rd and 6th months. Their visual analog scale (VAS) scores were found to be decreased from 10/10, 9/10, and 7/10 to 0/10, 1/10, and 0/10, respectively. Conclusion: Due to the very few cases in the literature, pelvic piriformis syndrome is an exclusively clinical diagnosis. If the sciatica is refractory to conservative treatments, laparoscopic exploration and decompression surgery of the pelvic nerves and piriformis muscle could be an option.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"13 1","pages":"238 - 243"},"PeriodicalIF":0.5,"publicationDate":"2021-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49461550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01Epub Date: 2021-05-28DOI: 10.1177/22840265211018544
Malavika K Adur, Andrea G Braundmeier-Fleming, Bruce A Lessey, Romana A Nowak
Problem: Perturbations in T-helper lymphocyte profiles have previously been associated with endometriosis related subfertility and conception failure. Hence a retrospective in vitro study was conducted to evaluate the relationship between T-regulatory (Treg) and T-helper 17 (Th17) lymphocytes in the eutopic endometrium of women with unexplained subfertility and correlate these profiles to their conception status.
Method of study: Eutopic endometrial biopsies were collected during the mid-secretory phase of the menstrual cycle, from women with unexplained subfertility. These samples were evaluated immunohistochemically for Treg and Th17 lymphocytes as well as the related proinflammatory cytokine, Interleukin-17 (IL-17). These eutopic endometrial T lymphocyte subpopulations were compared to the patients' conception status in subsequent cycles.
Results: Though Treg cells were not indicative of conception success in subsequent cycles, patients who maintained their subfertile (no conception) status were observed to have a higher Th17 cell count in their eutopic endometrium. The ratio of Treg:Th17 cell counts was significantly correlated to patient conception status as well. These trends stayed consistent irrespective of concurrent endometriosis.
Conclusion: Patients with a high proinflammatory Th17 lymphocyte profile and low Treg:Th17 ratio in their eutopic endometrium during the secretory phase of their menstrual cycle are more likely to not conceive in subsequent cycles.
问题：T辅助淋巴细胞谱的紊乱与子宫内膜异位症相关的不孕症和受孕失败有关。因此，我们进行了一项回顾性体外研究，以评估不明原因不孕妇女异位子宫内膜中 T 调节（Treg）和 T 辅助 17（Th17）淋巴细胞之间的关系，并将这些特征与受孕状况联系起来：研究方法：在月经周期中期分泌期收集不明原因不孕妇女的异位子宫内膜活检样本。对这些样本的 Treg 和 Th17 淋巴细胞以及相关的促炎细胞因子白细胞介素-17（IL-17）进行免疫组化评估。将这些异位的子宫内膜 T 淋巴细胞亚群与患者在后续周期的受孕情况进行比较：结果：虽然 Treg 细胞并不代表后续周期的受孕成功率，但观察发现，保持亚受孕（未受孕）状态的患者异位子宫内膜中 Th17 细胞数量较高。Treg:Th17细胞计数比与患者的受孕状态也有显著相关性。无论是否同时患有子宫内膜异位症，这些趋势都是一致的：结论：在月经周期的分泌期，异位子宫内膜中的Th17淋巴细胞具有较高的促炎症特征，且Treg:Th17比率较低的患者更有可能在随后的月经周期中无法受孕。
{"title":"Altered eutopic endometrial T-regulatory and T-helper 17 lymphocyte ratio in women with unexplained subfertility.","authors":"Malavika K Adur, Andrea G Braundmeier-Fleming, Bruce A Lessey, Romana A Nowak","doi":"10.1177/22840265211018544","DOIUrl":"10.1177/22840265211018544","url":null,"abstract":"<p><strong>Problem: </strong>Perturbations in T-helper lymphocyte profiles have previously been associated with endometriosis related subfertility and conception failure. Hence a retrospective in vitro study was conducted to evaluate the relationship between T-regulatory (Treg) and T-helper 17 (Th17) lymphocytes in the eutopic endometrium of women with unexplained subfertility and correlate these profiles to their conception status.</p><p><strong>Method of study: </strong>Eutopic endometrial biopsies were collected during the mid-secretory phase of the menstrual cycle, from women with unexplained subfertility. These samples were evaluated immunohistochemically for Treg and Th17 lymphocytes as well as the related proinflammatory cytokine, Interleukin-17 (IL-17). These eutopic endometrial T lymphocyte subpopulations were compared to the patients' conception status in subsequent cycles.</p><p><strong>Results: </strong>Though Treg cells were not indicative of conception success in subsequent cycles, patients who maintained their subfertile (no conception) status were observed to have a higher Th17 cell count in their eutopic endometrium. The ratio of Treg:Th17 cell counts was significantly correlated to patient conception status as well. These trends stayed consistent irrespective of concurrent endometriosis.</p><p><strong>Conclusion: </strong>Patients with a high proinflammatory Th17 lymphocyte profile and low Treg:Th17 ratio in their eutopic endometrium during the secretory phase of their menstrual cycle are more likely to not conceive in subsequent cycles.</p>","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"13 3","pages":"185-194"},"PeriodicalIF":0.5,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8330881/pdf/nihms-1719513.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39281116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.1177/22840265211011277
I. Marcu, A. Gee, B. Lynn
Chronic pelvic pain in women is common and frequently difficult to treat. Chronic pelvic pain often develops in the setting of endometriosis, interstitial cystitis/bladder pain syndrome, and vulvodynia. Cannabinoids are a promising treatment modality for non-cancer chronic pain, but have not been studied in women with chronic pelvic pain nor in specific chronic pelvic pain conditions. This review focuses on the interaction of the endocannabinoid system with the menstrual cycles, with endometriotic lesions, and within the bladder. Furthermore, it provides a brief overview of existing literature of the effects of endocannabinoids on chronic pain generally, with a focus on neuropathic pain. Finally, it discusses limited data available regarding the use of cannabinoids in women with chronic pelvic pain conditions. In the opinion of the authors, cannabinoids are a reasonable treatment modality for refractory chronic pelvic pain, especially if a neuropathic component is suspected. Practitioners should expect a modest effect on pain levels with an acceptable safety profile.
{"title":"Cannabinoids and chronic pelvic pain in women: Focus on endometriosis","authors":"I. Marcu, A. Gee, B. Lynn","doi":"10.1177/22840265211011277","DOIUrl":"https://doi.org/10.1177/22840265211011277","url":null,"abstract":"Chronic pelvic pain in women is common and frequently difficult to treat. Chronic pelvic pain often develops in the setting of endometriosis, interstitial cystitis/bladder pain syndrome, and vulvodynia. Cannabinoids are a promising treatment modality for non-cancer chronic pain, but have not been studied in women with chronic pelvic pain nor in specific chronic pelvic pain conditions. This review focuses on the interaction of the endocannabinoid system with the menstrual cycles, with endometriotic lesions, and within the bladder. Furthermore, it provides a brief overview of existing literature of the effects of endocannabinoids on chronic pain generally, with a focus on neuropathic pain. Finally, it discusses limited data available regarding the use of cannabinoids in women with chronic pelvic pain conditions. In the opinion of the authors, cannabinoids are a reasonable treatment modality for refractory chronic pelvic pain, especially if a neuropathic component is suspected. Practitioners should expect a modest effect on pain levels with an acceptable safety profile.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"13 1","pages":"155 - 165"},"PeriodicalIF":0.5,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/22840265211011277","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49110604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.1177/22840265211032115
V. Bindra, Mamatha G. S. Reddy, G. Mohanty, N. Agarwal, Aditya D. Kulkarni
Teratomas are most frequent germ cell tumors of ovary with an incidence of 15%–20% of all ovarian neoplasm while endometriomas are present in 25.5%–45% of women with pelvic endometriosis. In spite of their increased individual incidence, association of cystic teratomas and ovarian endometriomas is extremely rare. Our case is that of a 33-year-old nulligravida who presented with heavy menstrual flow and pain during periods for last few months, ultrasonography revealed 74 × 57 mm mass in right adnexa-likely ovarian dermoid, enlarged left ovary with two small cysts of size 33 × 29 mm and 25 × 20 mm likely endometrioma, managed by laparoscopy, found to have left ovarian endometrioma of 6 × 6 cm and right ovarian dermoid cyst of 10 × 8 cm size, histopathology confirmed the same. This association of teratoma in one ovary and endometrioma in other ovary of same patient poses a surgical challenge, when it affects young and nulliparous women. Further follow up is mandatory for this simultaneous finding of ovarian endometriosis with coincidental dermoid cyst to assess ovarian reserve, recurrence of either of the cysts, and it also presents a challenge to clinicians to predict the post-operative course of such cases.
{"title":"Bilateral ovarian cysts of mature cystic teratoma and Endometrioma: Its surgical challenges and review of literature","authors":"V. Bindra, Mamatha G. S. Reddy, G. Mohanty, N. Agarwal, Aditya D. Kulkarni","doi":"10.1177/22840265211032115","DOIUrl":"https://doi.org/10.1177/22840265211032115","url":null,"abstract":"Teratomas are most frequent germ cell tumors of ovary with an incidence of 15%–20% of all ovarian neoplasm while endometriomas are present in 25.5%–45% of women with pelvic endometriosis. In spite of their increased individual incidence, association of cystic teratomas and ovarian endometriomas is extremely rare. Our case is that of a 33-year-old nulligravida who presented with heavy menstrual flow and pain during periods for last few months, ultrasonography revealed 74 × 57 mm mass in right adnexa-likely ovarian dermoid, enlarged left ovary with two small cysts of size 33 × 29 mm and 25 × 20 mm likely endometrioma, managed by laparoscopy, found to have left ovarian endometrioma of 6 × 6 cm and right ovarian dermoid cyst of 10 × 8 cm size, histopathology confirmed the same. This association of teratoma in one ovary and endometrioma in other ovary of same patient poses a surgical challenge, when it affects young and nulliparous women. Further follow up is mandatory for this simultaneous finding of ovarian endometriosis with coincidental dermoid cyst to assess ovarian reserve, recurrence of either of the cysts, and it also presents a challenge to clinicians to predict the post-operative course of such cases.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"13 1","pages":"166 - 171"},"PeriodicalIF":0.5,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/22840265211032115","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48052401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-12DOI: 10.1177/22840265211038197
Francesca Massimello, A. Giannini, L. Tebache, M. Nisolle, T. Simoncini
Introduction: Endometriosis is characterised by the presence of functional endometrial tissue outside the uterus. Salpinges are a common location of endometriotic implants. Endometriosis located into the broad ligament is a rare event. Case description: A 38-year-old infertile woman presented to our attention with moderate left iliac fossa pain after menses and intermenstrual bleeding. Transvaginal ultrasounds and pelvic magnetic resonance evidenced the presence of bilateral haematosalpinges. At the laparoscopic pelvic exploration, fallopian tubes were absent. Opening and dissecting the apical portion of the broad ligaments, we identified bilateral haematosalpinges incarcerated in the homolateral broad ligaments. We performed bilateral salpingectomy. Histological examination confirmed the presence of endometriosis. Conclusion: Care must be taken to the diagnostic assessment, counselling about the surgical programme before the intervention especially in patients during the reproductive period when the possibility of ablative surgery and subsequent need for an assisted reproductive technique exists.
{"title":"Bilateral tubal incarceration into the broad ligaments caused by pelvic endometriosis: A case report","authors":"Francesca Massimello, A. Giannini, L. Tebache, M. Nisolle, T. Simoncini","doi":"10.1177/22840265211038197","DOIUrl":"https://doi.org/10.1177/22840265211038197","url":null,"abstract":"Introduction: Endometriosis is characterised by the presence of functional endometrial tissue outside the uterus. Salpinges are a common location of endometriotic implants. Endometriosis located into the broad ligament is a rare event. Case description: A 38-year-old infertile woman presented to our attention with moderate left iliac fossa pain after menses and intermenstrual bleeding. Transvaginal ultrasounds and pelvic magnetic resonance evidenced the presence of bilateral haematosalpinges. At the laparoscopic pelvic exploration, fallopian tubes were absent. Opening and dissecting the apical portion of the broad ligaments, we identified bilateral haematosalpinges incarcerated in the homolateral broad ligaments. We performed bilateral salpingectomy. Histological examination confirmed the presence of endometriosis. Conclusion: Care must be taken to the diagnostic assessment, counselling about the surgical programme before the intervention especially in patients during the reproductive period when the possibility of ablative surgery and subsequent need for an assisted reproductive technique exists.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"8 2","pages":"266 - 270"},"PeriodicalIF":0.5,"publicationDate":"2021-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41259214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-06DOI: 10.1177/22840265211037235
M. Parillo, C. Altomare, A. Bianchi, B. Beomonte Zobel, C. De Cicco Nardone, C. Quattrocchi
Introduction: Endometriosis is a common and chronic gynaecological condition but the implant in the canal of Nuck constitutes a very unusual state with an estimated prevalence of 0.3%–0.6% of all endometriosis cases. The canal of Nuck is an abnormal patent pouch of parietal peritoneum extending anteriorly from the round ligament of the uterus into the labia majora, thus represents a communication between the peritoneal cavity and the female inguinal canal. This condition may permit the seeding of endometriotic tissue in the inguinal soft tissues, becoming a possible cause of inguinal swelling or pain. Case description: A 43-years-old woman presented with painful swelling in her left groin. Ultrasound and a subsequent pelvic computed tomography showed a cystic lesion as for a Nuck’s canal encysted hydrocele. The patient underwent an anterior open surgery and the histologic examination revealed an endometrium-like tissue in the cystic wall. Conclusion: In women presenting with painful swelling of the groin, despite its rarity, endometriosis of the Nuck’s canal must be differentiated from other more common pathologies like hernias, varicoceles, neoplasms, and lymphadenopathies. Imaging can aid in differential diagnosis, but the final diagnosis is entrusted to histology, which enable to exclude an underlying malignancy.
{"title":"A rare case of left Nuck’s canal cystic endometriosis: Computed Tomography findings","authors":"M. Parillo, C. Altomare, A. Bianchi, B. Beomonte Zobel, C. De Cicco Nardone, C. Quattrocchi","doi":"10.1177/22840265211037235","DOIUrl":"https://doi.org/10.1177/22840265211037235","url":null,"abstract":"Introduction: Endometriosis is a common and chronic gynaecological condition but the implant in the canal of Nuck constitutes a very unusual state with an estimated prevalence of 0.3%–0.6% of all endometriosis cases. The canal of Nuck is an abnormal patent pouch of parietal peritoneum extending anteriorly from the round ligament of the uterus into the labia majora, thus represents a communication between the peritoneal cavity and the female inguinal canal. This condition may permit the seeding of endometriotic tissue in the inguinal soft tissues, becoming a possible cause of inguinal swelling or pain. Case description: A 43-years-old woman presented with painful swelling in her left groin. Ultrasound and a subsequent pelvic computed tomography showed a cystic lesion as for a Nuck’s canal encysted hydrocele. The patient underwent an anterior open surgery and the histologic examination revealed an endometrium-like tissue in the cystic wall. Conclusion: In women presenting with painful swelling of the groin, despite its rarity, endometriosis of the Nuck’s canal must be differentiated from other more common pathologies like hernias, varicoceles, neoplasms, and lymphadenopathies. Imaging can aid in differential diagnosis, but the final diagnosis is entrusted to histology, which enable to exclude an underlying malignancy.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"13 1","pages":"262 - 265"},"PeriodicalIF":0.5,"publicationDate":"2021-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/22840265211037235","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65489448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-03DOI: 10.1177/22840265211035993
K. Becker, K. Heinemann, B. Imthurn, L. Marions, S. Moehner, Sophia von Stockum, C. Gerlinger, M. Serrani, T. Faustmann
Introduction: Women with endometriosis require individualized, long-term treatment. Analyzing prescription choices, medication switches, discontinuations, and breaks can describe real-world treatment patterns and optimize pathways for women. To our knowledge, the Vi sanne P ost-approval O bservational S tudy (VIPOS) is the largest real-world, non-interventional study examining the safety of hormonal treatments for the routine clinical management of endometriosis. We present data from VIPOS on endometriosis drug utilization patterns, including treatment discontinuation due to treatment failure. Methods: VIPOS was a prospective, long-term, controlled, non-interventional cohort study in six European countries (Germany, Switzerland, Russia, Poland, Ukraine, and Hungary) conducted between 2010 and 2018. Women self-reported medical and gynecological history and symptoms and treatment information via comprehensive questionnaires. Results: Overall, 27,840 women were enrolled via gynecologists or specialized centers. Inter-country variance in treatment prescription patterns suggests the influence of differential management strategies and guidelines on prescribing behavior and diagnostic methods. Most enrolled women were receiving combined hormonal contraceptives. Women receiving dienogest 2 mg or gonadotropin-releasing hormone agonists more often had a surgical diagnosis of endometriosis compared to other treatments, while most women receiving combined hormonal contraceptives, other progestins or danazol had a symptom-based diagnosis. Although treatment changes during follow-up were common, only 4733 discontinuations out of 42,342 treatment starts were reported due to side effects or treatment ineffectiveness. Conclusion: VIPOS provides valuable insights into the considerable inter-country variance in endometriosis treatment prescription and potential role of differing management guidelines and practices strategies. Findings presented here suggest the need greater alignment of clinical practice to optimize patient management.
{"title":"Patient-reported utilization patterns of endometriosis medications in Europe: Real-world results from the non-interventional VIPOS study","authors":"K. Becker, K. Heinemann, B. Imthurn, L. Marions, S. Moehner, Sophia von Stockum, C. Gerlinger, M. Serrani, T. Faustmann","doi":"10.1177/22840265211035993","DOIUrl":"https://doi.org/10.1177/22840265211035993","url":null,"abstract":"Introduction: Women with endometriosis require individualized, long-term treatment. Analyzing prescription choices, medication switches, discontinuations, and breaks can describe real-world treatment patterns and optimize pathways for women. To our knowledge, the Vi sanne P ost-approval O bservational S tudy (VIPOS) is the largest real-world, non-interventional study examining the safety of hormonal treatments for the routine clinical management of endometriosis. We present data from VIPOS on endometriosis drug utilization patterns, including treatment discontinuation due to treatment failure. Methods: VIPOS was a prospective, long-term, controlled, non-interventional cohort study in six European countries (Germany, Switzerland, Russia, Poland, Ukraine, and Hungary) conducted between 2010 and 2018. Women self-reported medical and gynecological history and symptoms and treatment information via comprehensive questionnaires. Results: Overall, 27,840 women were enrolled via gynecologists or specialized centers. Inter-country variance in treatment prescription patterns suggests the influence of differential management strategies and guidelines on prescribing behavior and diagnostic methods. Most enrolled women were receiving combined hormonal contraceptives. Women receiving dienogest 2 mg or gonadotropin-releasing hormone agonists more often had a surgical diagnosis of endometriosis compared to other treatments, while most women receiving combined hormonal contraceptives, other progestins or danazol had a symptom-based diagnosis. Although treatment changes during follow-up were common, only 4733 discontinuations out of 42,342 treatment starts were reported due to side effects or treatment ineffectiveness. Conclusion: VIPOS provides valuable insights into the considerable inter-country variance in endometriosis treatment prescription and potential role of differing management guidelines and practices strategies. Findings presented here suggest the need greater alignment of clinical practice to optimize patient management.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"13 1","pages":"229 - 237"},"PeriodicalIF":0.5,"publicationDate":"2021-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46830730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-21DOI: 10.1177/22840265211034092
Nadine Chilton, S. van Oudtshoorn, J. Pontré, K. Karthigasu, B. Mcelhinney
Objective: To gain insight into patients’ understanding of endometriosis, utilised sources of information on endometriosis and perceptions of available treatment options. Design: Observational cross-sectional study. Setting: Data were collected from an outpatient specialist endometriosis clinic within a tertiary hospital. Participants: New patients referred with symptoms suggestive of endometriosis. Methods: A paper based questionnaire was completed by new patients on their first presentation to the clinic. Main outcome measures: Patient understanding of symptoms and causes of endometriosis, types and expectations of treatment, and sources of information utilised by patients in researching endometriosis. Results: Approximately half of all included patients were unsure of the aetiology of endometriosis. Patients who relied on information from specialist gynaecologists were more optimistic about the outcome of surgical treatment, while those who relied on general practitioners were more optimistic about the outcome of medical treatment, when compared to those who sought information from online sources. Conclusions: Endometriosis is a chronic and debilitating condition, yet there is limited data available regarding both the sources of information that patients’ access, and their perceptions of the disease. Given the high proportion of patients in our study who lacked knowledge of endometriosis, and the negative correlation between the use of social media for information and perception of treatment, there is a clear need for improved access to evidence-based resources for patient education.
{"title":"‘My devil womb’: Patients’ perspectives on, and understanding of, endometriosis: An observational cross-sectional study","authors":"Nadine Chilton, S. van Oudtshoorn, J. Pontré, K. Karthigasu, B. Mcelhinney","doi":"10.1177/22840265211034092","DOIUrl":"https://doi.org/10.1177/22840265211034092","url":null,"abstract":"Objective: To gain insight into patients’ understanding of endometriosis, utilised sources of information on endometriosis and perceptions of available treatment options. Design: Observational cross-sectional study. Setting: Data were collected from an outpatient specialist endometriosis clinic within a tertiary hospital. Participants: New patients referred with symptoms suggestive of endometriosis. Methods: A paper based questionnaire was completed by new patients on their first presentation to the clinic. Main outcome measures: Patient understanding of symptoms and causes of endometriosis, types and expectations of treatment, and sources of information utilised by patients in researching endometriosis. Results: Approximately half of all included patients were unsure of the aetiology of endometriosis. Patients who relied on information from specialist gynaecologists were more optimistic about the outcome of surgical treatment, while those who relied on general practitioners were more optimistic about the outcome of medical treatment, when compared to those who sought information from online sources. Conclusions: Endometriosis is a chronic and debilitating condition, yet there is limited data available regarding both the sources of information that patients’ access, and their perceptions of the disease. Given the high proportion of patients in our study who lacked knowledge of endometriosis, and the negative correlation between the use of social media for information and perception of treatment, there is a clear need for improved access to evidence-based resources for patient education.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"13 1","pages":"223 - 228"},"PeriodicalIF":0.5,"publicationDate":"2021-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/22840265211034092","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45287582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-16DOI: 10.1177/22840265211024437
Julia S Mandeville, Damian Best, F. Waterman
Objective: To describe the impact of menstrual and pelvic health disorders on a sample of Barbadian women living with one or more disorders. Design and methods: Responses from a survey taken online by a sample of women living in Barbados (⩾18 years) were assessed. Variables collected included, age, disorder(s) diagnosed, and symptoms. The Work Productivity and Activity Impairment (WPAI) Questionnaire: Specific Health Problem, was administered to measure impact on work and other activities. T-tests, chi- square tests, odds ratios, ANOVA, and multivariate analysis were conducted to estimate the associations between patient characterization, disorder characteristics and outcomes. Results: A total of 247 unique responses were received and after data were reviewed 192 responses (77.7%) from this convenience sample were analyzed. Polycystic Ovary Syndrome was the most frequently reported diagnosis (34.7%). The most frequently reported symptom was fatigue (53%). There was an OR of 2.17 (95% CI 0.54–8.74) of missing work due to menorrhagia and 2.60 (95% CI: 1.31–5.17) of missing work if diagnosed with endometriosis. The WPAI revealed endometriosis to be the condition with the most substantial impact on work in the subgroup of persons with one diagnosis, with presenteeism of 49.2%, absenteeism of 13.3% and an impact on other activities of 56.4%. Conclusion: Pelvic and menstrual disorders have a significant impact on productivity and other activities of Barbadian women. More research is necessary to elucidate the impacts of menstrual and pelvic disorders and treatments on patient outcomes.
目的:描述月经和盆腔健康障碍对患有一种或多种疾病的巴巴多斯妇女样本的影响。设计和方法:对居住在巴巴多斯(大于或等于18岁)的女性样本进行的在线调查的回应进行了评估。收集的变量包括年龄、诊断的疾病和症状。工作效率和活动障碍(WPAI)问卷调查:具体健康问题，用于衡量对工作和其他活动的影响。采用t检验、卡方检验、比值比、方差分析和多变量分析来估计患者特征、疾病特征和结果之间的关系。结果:共收到247份独特回复，经过数据审核后，分析了192份回复(77.7%)。多囊卵巢综合征是最常见的诊断(34.7%)。最常见的症状是疲劳(53%)。因月经过多而缺勤的OR为2.17 (95% CI 0.54-8.74)，诊断为子宫内膜异位症的缺勤OR为2.60 (95% CI: 1.31-5.17)。WPAI显示子宫内膜异位症是对工作影响最大的疾病，出勤率为49.2%，缺勤率为13.3%，对其他活动的影响为56.4%。结论:骨盆和月经紊乱对巴巴多斯妇女的生产力和其他活动有重大影响。需要更多的研究来阐明月经和盆腔疾病及其治疗对患者预后的影响。
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Pub Date : 2021-05-27DOI: 10.1177/22840265211019546
C. Barnett, A. Bauerfeind, Sophia von Stockum, K. Heinemann
Background: Several promising new medications containing low-dose estradiol (E2) in combination with a progestin and an additional component, such as gonadotropin-releasing hormone antagonists, are currently being developed for use in pre-menopausal women. Objective: This pooled analysis was designed to estimate the thromboembolic safety profile of E2 and its ester, estradiol valerate (E2Val), when used in combined hormonal treatments in a pre-menopausal population. Methods: Data regarding users of combined oral contraceptives (COCs) and combined menopausal hormonal therapy (MHT) containing either E2/E2Val or ethinylestradiol (EE) ⩽ 30 µg were retrieved from five large prospective, non-interventional, cohort studies in Europe, US, and Canada with similar study design but differing medication cohorts. Propensity score sub-classification was applied to balance baseline parameters between cohorts and time-to-event analysis of venous thromboembolic events (VTE) was carried out based on the extended Cox model to calculate crude and adjusted hazard ratios (HR). Results: (1) Crude incidence rates of VTE were higher in MHT users compared to pre-menopausal COC users, (2) the VTE risk in menopausal users of E2/E2Val-norethindrone acetate was not higher than that in menopausal users of E2/E2Val-progestin (adjusted HR 0.71; 95% confidence interval, 0.41-1.26) and (3) the VTE risk in pre-menopausal users of E2/E2Val-progestin was similar, or lower, than pre-menopausal users of EE⩽30µg-progestin (adjusted HR 0.49; 95% confidence interval, 0.28–0.84). Conclusion: Our data presents a solid safety assessment of combined hormonal preparations containing E2/E2Val. We conclude that the risk of E2/E2Val-norethindrone acetate in pre-menopausal users is unlikely to be higher than the known risk of COCs containing EE ⩽ 30 µg-progestin.
{"title":"Thromboembolic safety profile of low-dose estradiol (valerate) in combined hormonal preparations: Implications for the development of new hormonal endometriosis and uterine fibroid therapies","authors":"C. Barnett, A. Bauerfeind, Sophia von Stockum, K. Heinemann","doi":"10.1177/22840265211019546","DOIUrl":"https://doi.org/10.1177/22840265211019546","url":null,"abstract":"Background: Several promising new medications containing low-dose estradiol (E2) in combination with a progestin and an additional component, such as gonadotropin-releasing hormone antagonists, are currently being developed for use in pre-menopausal women. Objective: This pooled analysis was designed to estimate the thromboembolic safety profile of E2 and its ester, estradiol valerate (E2Val), when used in combined hormonal treatments in a pre-menopausal population. Methods: Data regarding users of combined oral contraceptives (COCs) and combined menopausal hormonal therapy (MHT) containing either E2/E2Val or ethinylestradiol (EE) ⩽ 30 µg were retrieved from five large prospective, non-interventional, cohort studies in Europe, US, and Canada with similar study design but differing medication cohorts. Propensity score sub-classification was applied to balance baseline parameters between cohorts and time-to-event analysis of venous thromboembolic events (VTE) was carried out based on the extended Cox model to calculate crude and adjusted hazard ratios (HR). Results: (1) Crude incidence rates of VTE were higher in MHT users compared to pre-menopausal COC users, (2) the VTE risk in menopausal users of E2/E2Val-norethindrone acetate was not higher than that in menopausal users of E2/E2Val-progestin (adjusted HR 0.71; 95% confidence interval, 0.41-1.26) and (3) the VTE risk in pre-menopausal users of E2/E2Val-progestin was similar, or lower, than pre-menopausal users of EE⩽30µg-progestin (adjusted HR 0.49; 95% confidence interval, 0.28–0.84). Conclusion: Our data presents a solid safety assessment of combined hormonal preparations containing E2/E2Val. We conclude that the risk of E2/E2Val-norethindrone acetate in pre-menopausal users is unlikely to be higher than the known risk of COCs containing EE ⩽ 30 µg-progestin.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"13 1","pages":"195 - 204"},"PeriodicalIF":0.5,"publicationDate":"2021-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/22840265211019546","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42962133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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