Pub Date : 2021-05-26DOI: 10.1177/22840265211018310
Parviz Ranjbarvan, F. Khazaei, Farzaneh Chobsaz, M. Khazaei
Introduction: Raloxifene (Ral) is the oldest SERM (selective oestrogen receptor modulators) for treatment of breast cancer and osteoporosis. Its oestrogen-modulating effects have been shown in breast and uterus. Since there is little available data on direct Ral effect on the human endometrium, the aim of present study was to investigate the Ral effect on the growth and angiogenesis of the human endometrium of healthy and endometriosis subjects in an in vitro three-dimensional (3D) tissue culture model. Material and methods: Endometrial biopsies from healthy (n = 9) and endometriosis (n = 7) patients (endometriotic) were taken and were cut into 1 × 1 mm fragments and implanted between two layers of fibrin jell made by fibrinogen solution (3 mg/ml in medium 199+thrombin). Tissue cultures were performed in 24-wel culture plates. Each biopsy was divided into control wells which received M199 supplemented with FBS (5%) and experimental wells which received same media containing one of raloxifene doses (0.1, 1 and 10 μM). Endometrial tissues were photographed at the beginning and the end of the study period (21 days). Tissue growth and angiogenesis were determined by a scoring system. Results: In control (0), 0.1, 1 and 10 μM Ral, the growth score of normal human endometrial tissues were 1.99, 1.72, 1.53 and 1.12 (p = 0.02) and angiogenesis percent were 29.6%, 31.28%, 33% and 11.5%. The Growth scores of the endometriotic endometrium were 1.92, 1.82, 1.92 and 1.1 (p = 0.008) and angiogenesis percent were 36.6%, 16.6%, 44% and 12.5% respectively. Conclusion: Raloxifene showed a different dose dependent effect on endometrial and endometriotic tissue.
{"title":"Comparison of raloxifene effect on the growth and angiogenesis of human endometrium of healthy and endometriosis subjects: An in vitro three-dimensional tissue culture model","authors":"Parviz Ranjbarvan, F. Khazaei, Farzaneh Chobsaz, M. Khazaei","doi":"10.1177/22840265211018310","DOIUrl":"https://doi.org/10.1177/22840265211018310","url":null,"abstract":"Introduction: Raloxifene (Ral) is the oldest SERM (selective oestrogen receptor modulators) for treatment of breast cancer and osteoporosis. Its oestrogen-modulating effects have been shown in breast and uterus. Since there is little available data on direct Ral effect on the human endometrium, the aim of present study was to investigate the Ral effect on the growth and angiogenesis of the human endometrium of healthy and endometriosis subjects in an in vitro three-dimensional (3D) tissue culture model. Material and methods: Endometrial biopsies from healthy (n = 9) and endometriosis (n = 7) patients (endometriotic) were taken and were cut into 1 × 1 mm fragments and implanted between two layers of fibrin jell made by fibrinogen solution (3 mg/ml in medium 199+thrombin). Tissue cultures were performed in 24-wel culture plates. Each biopsy was divided into control wells which received M199 supplemented with FBS (5%) and experimental wells which received same media containing one of raloxifene doses (0.1, 1 and 10 μM). Endometrial tissues were photographed at the beginning and the end of the study period (21 days). Tissue growth and angiogenesis were determined by a scoring system. Results: In control (0), 0.1, 1 and 10 μM Ral, the growth score of normal human endometrial tissues were 1.99, 1.72, 1.53 and 1.12 (p = 0.02) and angiogenesis percent were 29.6%, 31.28%, 33% and 11.5%. The Growth scores of the endometriotic endometrium were 1.92, 1.82, 1.92 and 1.1 (p = 0.008) and angiogenesis percent were 36.6%, 16.6%, 44% and 12.5% respectively. Conclusion: Raloxifene showed a different dose dependent effect on endometrial and endometriotic tissue.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"13 1","pages":"178 - 184"},"PeriodicalIF":0.5,"publicationDate":"2021-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/22840265211018310","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44044895","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 : 2021-05-12DOI: 10.1177/22840265211009643
Claire Figuier, P. Montoriol, B. Pereira, P. Chauvet, N. Bourdel, M. Canis
Objective: Investigate the relationship between the structure of abdominal wall endometriotic nodules in MRI and their localisation in abdominal wall layers in order to better understand nodule origins. Design: Women who had an MRI prior to surgical treatment of an abdominal wall endometriotic nodule between 2005 and 2016. Population: Thirty-six patients including four patients with two nodules. Methods: MRI images were reviewed. Each nodule was analysed according to its structure (fibrous, cystic, mixed), localisation (subcutaneous fat, intra muscular, intermediary position), and size. Results: Forty nodules were analysed in MRI with no relationship found between localisation and nodule structure (p = 0.48). 87.5% of mixed nodules were revealed to have a cystic superficial rim extending towards the subcutaneous fat layer. This finding suggests that the glandular part of the nodule is the active part of the disease from which nodule progression occurs. Intermediary and intramuscular nodules were respectively statistically larger than subcutaneous fat nodules indicating a relationship between nodule size and localisation (35 mm (22–53) vs 17 mm (17–23)) (p = 0.03). Conclusion: Despite differences in environments surrounding the nodules, no significant relationship between nodule structure in imaging and abdominal wall localisation was found. Data from mixed nodules indicate however the possible role of nodule environment on structure and that the mechanism of nodule growth may be linked to development of cystic superficial rims, at the forefront of disease progression, abdominal wall nodules growing from deep to superficial. Studies are required to further investigate our findings and enable greater understanding of the origins of AWE.
目的:探讨腹壁子宫内膜异位结节的MRI结构与腹壁层定位的关系，以便更好地了解结节的起源。设计:2005年至2016年间，在腹壁子宫内膜异位结节手术治疗前接受MRI检查的女性。人群:36例，其中4例伴2个结节。方法:回顾MRI影像。每个结节根据其结构(纤维性、囊性、混合性)、定位(皮下脂肪、肌肉内、中间位置)和大小进行分析。结果:MRI分析40例结节，定位与结节结构无相关性(p = 0.48)。87.5%的混合性结节表现为囊性浅缘向皮下脂肪层延伸。这一发现提示，结节的腺体部分是疾病的活跃部分，结节从这里开始进展。中间结节和肌肉内结节分别大于皮下脂肪结节，这表明结节大小与定位有关(35 mm (22-53) vs 17 mm (17 - 23)) (p = 0.03)。结论:尽管结节周围环境不同，但影像学上结节结构与腹壁定位无明显关系。然而，来自混合结节的数据表明，结节环境对结构的可能作用以及结节生长的机制可能与囊性浅缘的发展有关，在疾病进展的最前沿，腹壁结节从深部向浅表生长。需要进一步研究我们的发现，并更好地了解AWE的起源。
{"title":"Abdominal wall endometriosis: Is structure in imaging related to nodule localisation? A retrospective study","authors":"Claire Figuier, P. Montoriol, B. Pereira, P. Chauvet, N. Bourdel, M. Canis","doi":"10.1177/22840265211009643","DOIUrl":"https://doi.org/10.1177/22840265211009643","url":null,"abstract":"Objective: Investigate the relationship between the structure of abdominal wall endometriotic nodules in MRI and their localisation in abdominal wall layers in order to better understand nodule origins. Design: Women who had an MRI prior to surgical treatment of an abdominal wall endometriotic nodule between 2005 and 2016. Population: Thirty-six patients including four patients with two nodules. Methods: MRI images were reviewed. Each nodule was analysed according to its structure (fibrous, cystic, mixed), localisation (subcutaneous fat, intra muscular, intermediary position), and size. Results: Forty nodules were analysed in MRI with no relationship found between localisation and nodule structure (p = 0.48). 87.5% of mixed nodules were revealed to have a cystic superficial rim extending towards the subcutaneous fat layer. This finding suggests that the glandular part of the nodule is the active part of the disease from which nodule progression occurs. Intermediary and intramuscular nodules were respectively statistically larger than subcutaneous fat nodules indicating a relationship between nodule size and localisation (35 mm (22–53) vs 17 mm (17–23)) (p = 0.03). Conclusion: Despite differences in environments surrounding the nodules, no significant relationship between nodule structure in imaging and abdominal wall localisation was found. Data from mixed nodules indicate however the possible role of nodule environment on structure and that the mechanism of nodule growth may be linked to development of cystic superficial rims, at the forefront of disease progression, abdominal wall nodules growing from deep to superficial. Studies are required to further investigate our findings and enable greater understanding of the origins of AWE.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"13 1","pages":"205 - 210"},"PeriodicalIF":0.5,"publicationDate":"2021-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/22840265211009643","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45834241","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 : 2021-04-25DOI: 10.1177/22840265211012119
I. Kahyaoğlu, C. Gülerman, N. Yılmaz, M. U. Ceran, A. Ozgu-Erdinc, S. Kahyaoglu, Y. Bardakci, Yaprak Engin Üstün
Objectives: Data regarding whether the assisted reproductive technologies (ART) outcome of patients with decreased ovarian reserve (DOR) secondary to an endometrioma surgery differs from that of patients with DOR secondary to other etiologies is limited. The aim of this study was to compare the ART outcomes of DOR patients diagnosed by Bologna criteria secondary to a previous endometrioma surgery with DOR patients without a history of an endometrioma surgery. Methods: This retrospective cohort study was conducted in the assisted reproduction unit of a tertiary research and education hospital. Medical records of the patients with DOR were reviewed retrospectively. Group I included 23 cycles of DOR patients secondary to a previous endometrioma surgery and Group II consisted of 260 cycles of DOR patients without a history of endometrioma surgery. Results: No significant difference was demonstrated between groups regarding demographic features except for the age (32 (24–41) in Group I vs 35 (23–47) in Group II, p = 0.031). The data comparing the controlled ovarian stimulation parameters and ART outcomes showed similar results in both groups. No statistically significant difference was found between groups regarding pregnancy rates per transfer (23% vs 22.2 %) and per cycle (13% vs 15.4%) (p > 0.05). Conclusion: Cycle outcomes of DOR patients secondary to an endometrioma surgery did not differ from that of DOR without an endometrioma surgery history.
{"title":"Does endometrioma surgery affect assisted reproductive technologies cycle outcome in patients with decreased ovarian reserve diagnosed by Bologna criteria?","authors":"I. Kahyaoğlu, C. Gülerman, N. Yılmaz, M. U. Ceran, A. Ozgu-Erdinc, S. Kahyaoglu, Y. Bardakci, Yaprak Engin Üstün","doi":"10.1177/22840265211012119","DOIUrl":"https://doi.org/10.1177/22840265211012119","url":null,"abstract":"Objectives: Data regarding whether the assisted reproductive technologies (ART) outcome of patients with decreased ovarian reserve (DOR) secondary to an endometrioma surgery differs from that of patients with DOR secondary to other etiologies is limited. The aim of this study was to compare the ART outcomes of DOR patients diagnosed by Bologna criteria secondary to a previous endometrioma surgery with DOR patients without a history of an endometrioma surgery. Methods: This retrospective cohort study was conducted in the assisted reproduction unit of a tertiary research and education hospital. Medical records of the patients with DOR were reviewed retrospectively. Group I included 23 cycles of DOR patients secondary to a previous endometrioma surgery and Group II consisted of 260 cycles of DOR patients without a history of endometrioma surgery. Results: No significant difference was demonstrated between groups regarding demographic features except for the age (32 (24–41) in Group I vs 35 (23–47) in Group II, p = 0.031). The data comparing the controlled ovarian stimulation parameters and ART outcomes showed similar results in both groups. No statistically significant difference was found between groups regarding pregnancy rates per transfer (23% vs 22.2 %) and per cycle (13% vs 15.4%) (p > 0.05). Conclusion: Cycle outcomes of DOR patients secondary to an endometrioma surgery did not differ from that of DOR without an endometrioma surgery history.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"13 1","pages":"172 - 177"},"PeriodicalIF":0.5,"publicationDate":"2021-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/22840265211012119","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48324071","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 : 2021-04-15DOI: 10.1177/22840265211009634
Paola M. Ramos-Echevarría, D. M. Soto-Soto, A. Torres-Reverón, C. Appleyard, Tala Akkawi, Bárbara D Barros-Cartagena, Verónica López-Rodríguez, Eida M Castro-Figueroa, Idhaliz Flores-Caldera
Introduction: Monitoring the impact of natural disasters such as pandemics on health and wellbeing is a public health priority. Stress is proven to affect pain intensity and quality of life of endometriosis patients. A cross-sectional study was conducted to determine whether the measures implemented to mitigate COVID-19 infections had a substantial impact on risk behaviors, endometriosis symptoms, stress, and access to healthcare. Methods: Electronic questionnaires that measured COVID-19 impact and peri-traumatic stress were disseminated through social media over June–September 2020 and completed by 82 adult patients with endometriosis living in Puerto Rico. Descriptive data analysis and correlations were done in quantitative data and systematic analysis of free text was done on qualitative responses. Results: Participants self-reported worsening of endometriosis symptoms and high levels of peri-traumatic stress, as well as changes in risk behaviors (exercise, nutrition, sedentarism, sleep) during the pandemic in comparison to the previous months. They also reported substantial barriers in access to medical appointments, scheduled procedures, and prescriptions. Electronic health modalities (telemedicine, mobile apps) were considered acceptable alternatives for gynecologic care during natural disasters. Conclusion: The COVID-19 pandemic negatively impacts the health and wellbeing of endometriosis patients while imposing substantial restrictions on access to health care. These timely insights will guide the development and implementation of plans to address barriers to health care and minimize long-term detrimental effects of natural disasters on the health of those living with stress-related disorders such as endometriosis.
{"title":"Impact of the early COVID-19 era on endometriosis patients: Symptoms, stress, and access to care","authors":"Paola M. Ramos-Echevarría, D. M. Soto-Soto, A. Torres-Reverón, C. Appleyard, Tala Akkawi, Bárbara D Barros-Cartagena, Verónica López-Rodríguez, Eida M Castro-Figueroa, Idhaliz Flores-Caldera","doi":"10.1177/22840265211009634","DOIUrl":"https://doi.org/10.1177/22840265211009634","url":null,"abstract":"Introduction: Monitoring the impact of natural disasters such as pandemics on health and wellbeing is a public health priority. Stress is proven to affect pain intensity and quality of life of endometriosis patients. A cross-sectional study was conducted to determine whether the measures implemented to mitigate COVID-19 infections had a substantial impact on risk behaviors, endometriosis symptoms, stress, and access to healthcare. Methods: Electronic questionnaires that measured COVID-19 impact and peri-traumatic stress were disseminated through social media over June–September 2020 and completed by 82 adult patients with endometriosis living in Puerto Rico. Descriptive data analysis and correlations were done in quantitative data and systematic analysis of free text was done on qualitative responses. Results: Participants self-reported worsening of endometriosis symptoms and high levels of peri-traumatic stress, as well as changes in risk behaviors (exercise, nutrition, sedentarism, sleep) during the pandemic in comparison to the previous months. They also reported substantial barriers in access to medical appointments, scheduled procedures, and prescriptions. Electronic health modalities (telemedicine, mobile apps) were considered acceptable alternatives for gynecologic care during natural disasters. Conclusion: The COVID-19 pandemic negatively impacts the health and wellbeing of endometriosis patients while imposing substantial restrictions on access to health care. These timely insights will guide the development and implementation of plans to address barriers to health care and minimize long-term detrimental effects of natural disasters on the health of those living with stress-related disorders such as endometriosis.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"13 1","pages":"111 - 121"},"PeriodicalIF":0.5,"publicationDate":"2021-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/22840265211009634","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41795925","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 : 2021-03-01DOI: 10.1177/2284026520954068
Alexon M Racilan, Wiviane A Assis, Maíra Casalechi, Ananda Spagnolo-Souza, Marcelo A Pascoal-Xavier, Ana C Simões-E-Silva, Helen L Del Puerto, Fernando M Reis
Objective: Angiotensin-converting-enzyme 2 (ACE2), the cell surface receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is found in a variety of reproductive tissues. The present study evaluated whether uterine fibroids and normal myometrium express ACE2 and, if so, at which tissue compartments.
Methods: We included 13 premenopausal women (age range 33-50 years, median 40 years) with uterine fibroids undergoing elective hysterectomy or myomectomy. Samples of leiomyoma (n = 12) and normal myometrial tissue (n = 8) were analyzed by immunohistochemistry for protein localization or by real time PCR for mRNA detection.
Results: In normal myometrium, ACE2 immunoreactivity was localized in smooth muscle fibers, arteriolar walls, and endothelial cells. In uterine leiomyoma, ACE2 staining was more intense in smooth muscle cells than in the extracellular matrix, and was also present in vascular endothelium. ACE2 mRNA was detected in myometrium as well as in fibroid samples.
Conclusion: Human myometrium and uterine leiomyoma express ACE2 mRNA and have abundant distribution of ACE2 protein in their smooth muscle cells and microvasculature.
{"title":"Angiotensin-converting enzyme 2, the SARS-CoV-2 cellular receptor, is widely expressed in human myometrium and uterine leiomyoma.","authors":"Alexon M Racilan, Wiviane A Assis, Maíra Casalechi, Ananda Spagnolo-Souza, Marcelo A Pascoal-Xavier, Ana C Simões-E-Silva, Helen L Del Puerto, Fernando M Reis","doi":"10.1177/2284026520954068","DOIUrl":"https://doi.org/10.1177/2284026520954068","url":null,"abstract":"<p><strong>Objective: </strong>Angiotensin-converting-enzyme 2 (ACE2), the cell surface receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is found in a variety of reproductive tissues. The present study evaluated whether uterine fibroids and normal myometrium express ACE2 and, if so, at which tissue compartments.</p><p><strong>Methods: </strong>We included 13 premenopausal women (age range 33-50 years, median 40 years) with uterine fibroids undergoing elective hysterectomy or myomectomy. Samples of leiomyoma (<i>n</i> = 12) and normal myometrial tissue (<i>n</i> = 8) were analyzed by immunohistochemistry for protein localization or by real time PCR for mRNA detection.</p><p><strong>Results: </strong>In normal myometrium, ACE2 immunoreactivity was localized in smooth muscle fibers, arteriolar walls, and endothelial cells. In uterine leiomyoma, ACE2 staining was more intense in smooth muscle cells than in the extracellular matrix, and was also present in vascular endothelium. ACE2 mRNA was detected in myometrium as well as in fibroid samples.</p><p><strong>Conclusion: </strong>Human myometrium and uterine leiomyoma express ACE2 mRNA and have abundant distribution of ACE2 protein in their smooth muscle cells and microvasculature.</p>","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"13 1","pages":"20-24"},"PeriodicalIF":0.5,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2284026520954068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39225011","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 : 2021-03-01DOI: 10.1177/2284026520960649
F. Gkrozou, O. Tsonis, A. Daniilidis, I. Navrozoglou, M. Paschopoulos
Purpose: Tubo-ovarian abscess (TOA) and pelvic abscess are characterized by an inflammatory pelvic mass. In the majority of cases, this condition involves the ovaries, the fallopian tubes and/or any other adjacent tissue. TOA is considered a severe complication of PID and can cause severe sepsis. The main risk factors for women’s health are the size of the abscess, the initial amount of white blood cells (WBC), patients’ age as well as, any co-existing comorbidities. Methods: This study provides a review of the current literature regarding the management of TOA and the different criteria used in order to establish the optimal therapeutic approach or to predict outcome by individualizing cases. Four major search engines, MEDLINE, Google Scholar, PubMed and EMBASE, up to February 2020 were explored, focusing in epidemiology and risk factors, pathogenesis, diagnosis and treatment. Results: Our review suggests that there are no clear guidelines for best practice, in case of TOA, but it appears that intravenous antibiotics combined with interventional radiology have good results for TOA <5 cm. When TOA is >5 cm, laparoscopic approach is indicated. Further studies are needed in order to evaluate the best treatment for women with TOA. Conclusions: More prospective studies on large-series of patients are in need, in order to determine a clear pathway and to suggest specific criteria, which can guide clinicians to choose optimal approach in a timely manner.
{"title":"Tubo-ovarian abscess: Exploring optimal treatment options based on current evidence","authors":"F. Gkrozou, O. Tsonis, A. Daniilidis, I. Navrozoglou, M. Paschopoulos","doi":"10.1177/2284026520960649","DOIUrl":"https://doi.org/10.1177/2284026520960649","url":null,"abstract":"Purpose: Tubo-ovarian abscess (TOA) and pelvic abscess are characterized by an inflammatory pelvic mass. In the majority of cases, this condition involves the ovaries, the fallopian tubes and/or any other adjacent tissue. TOA is considered a severe complication of PID and can cause severe sepsis. The main risk factors for women’s health are the size of the abscess, the initial amount of white blood cells (WBC), patients’ age as well as, any co-existing comorbidities. Methods: This study provides a review of the current literature regarding the management of TOA and the different criteria used in order to establish the optimal therapeutic approach or to predict outcome by individualizing cases. Four major search engines, MEDLINE, Google Scholar, PubMed and EMBASE, up to February 2020 were explored, focusing in epidemiology and risk factors, pathogenesis, diagnosis and treatment. Results: Our review suggests that there are no clear guidelines for best practice, in case of TOA, but it appears that intravenous antibiotics combined with interventional radiology have good results for TOA <5 cm. When TOA is >5 cm, laparoscopic approach is indicated. Further studies are needed in order to evaluate the best treatment for women with TOA. Conclusions: More prospective studies on large-series of patients are in need, in order to determine a clear pathway and to suggest specific criteria, which can guide clinicians to choose optimal approach in a timely manner.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"13 1","pages":"10 - 19"},"PeriodicalIF":0.5,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2284026520960649","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47566071","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 : 2021-03-01DOI: 10.1177/2284026520984366
N. Fernley
Introduction: One in nine women experience endometriosis, a common gynaecological disease, yet time to diagnosis averages 7 years. People are sharing their endometriosis experiences online. This research’s aim was to expose and synthesise the collective themes of diagnostic experience. Method: A qualitative thematic analysis of publicly accessible online autobiographical accounts of women and their endometriosis diagnosis. Themes were coded within NVIVO and thematic maps and tables created. Eighty-nine original accounts were identified, 26 were excluded. Saturation point was 49. Results: Women communicated long, painful and emotional journeys to diagnosis. Forty women experienced endometriosis symptoms before the age of 20, 33 before 15 years. Despite repeated GP presentation, 36 women had never heard of endometriosis before diagnosis. Women highlighted the positive impact of ‘that one doctor’ who said the word ‘endometriosis’ who listened, believed, investigated and provided prompt referral to specialists. Diagnosis gave relief and answers to the long journey, provided women a sense of community, hope and personal visibility after feeling alone. While this common disease is undiagnosed women suffer. Conclusion: ‘That one doctor’ can transform a patient’s experience and create a positive diagnosis pathway towards endometriosis. The doctor patient alliance is vital for prompt diagnosis. Symptom dismissal with long diagnosis delays are having negative, physical and psychological consequences for women. Early detection, GP education and community awareness campaigns are imperative to reduce further delayed diagnosis and long-term negative impacts of undiagnosed endometriosis.
{"title":"That one doctor. . . Qualitative thematic analysis of 49 women’s written accounts of their endometriosis diagnosis","authors":"N. Fernley","doi":"10.1177/2284026520984366","DOIUrl":"https://doi.org/10.1177/2284026520984366","url":null,"abstract":"Introduction: One in nine women experience endometriosis, a common gynaecological disease, yet time to diagnosis averages 7 years. People are sharing their endometriosis experiences online. This research’s aim was to expose and synthesise the collective themes of diagnostic experience. Method: A qualitative thematic analysis of publicly accessible online autobiographical accounts of women and their endometriosis diagnosis. Themes were coded within NVIVO and thematic maps and tables created. Eighty-nine original accounts were identified, 26 were excluded. Saturation point was 49. Results: Women communicated long, painful and emotional journeys to diagnosis. Forty women experienced endometriosis symptoms before the age of 20, 33 before 15 years. Despite repeated GP presentation, 36 women had never heard of endometriosis before diagnosis. Women highlighted the positive impact of ‘that one doctor’ who said the word ‘endometriosis’ who listened, believed, investigated and provided prompt referral to specialists. Diagnosis gave relief and answers to the long journey, provided women a sense of community, hope and personal visibility after feeling alone. While this common disease is undiagnosed women suffer. Conclusion: ‘That one doctor’ can transform a patient’s experience and create a positive diagnosis pathway towards endometriosis. The doctor patient alliance is vital for prompt diagnosis. Symptom dismissal with long diagnosis delays are having negative, physical and psychological consequences for women. Early detection, GP education and community awareness campaigns are imperative to reduce further delayed diagnosis and long-term negative impacts of undiagnosed endometriosis.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"13 1","pages":"40 - 52"},"PeriodicalIF":0.5,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2284026520984366","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43223690","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 : 2021-02-14DOI: 10.1177/2284026521993688
S. Moehner, K. Becker, J. Lange, Sophia von Stockum, M. Serrani, K. Heinemann
Introduction: The Visanne Post-approval Observational Study (VIPOS) was designed to assess the safety of dienogest 2 mg (DNG, Visanne) compared to other hormonal endometriosis treatments. Methods: Large, prospective, non-interventional, active surveillance study in six European countries (Germany, Poland, Russia, Hungary, Switzerland, and Ukraine). Women with a new hormonal therapy for endometriosis were enrolled by gynecologists and specialized centers between 2010 and 2016 and observed for up to 7 years. Self-administered questionnaires during study entry and follow-up collected information on baseline characteristics, health status and endometriosis treatment. Self-reported clinical outcomes of interest were validated by health care professionals. Results: Among the >27,000 enrolled participants, 3262 women started DNG use either at study entry or during follow-up. A total of 798 study participants used DNG during follow-up continuously for 15 months or longer (DNG long-term users). When comparing the occurrence of serious adverse events (SAE) in users treated with DNG, no safety signal emerged for long-term users; the SAE incidence rate per 10,000 women-years was 367.7 (95% CI: 274.1–481.9) in DNG long-term users and 416.4 (349.1–492.5) in short-term users (treated with DNG for less than 15 months). Conclusions: Previous data on DNG long-term safety were derived from studies with relatively low numbers of patients and limited follow-up time. VIPOS provided valuable real-world data on the long-term use of DNG 2 mg in around 800 women treated in Europe and observed no safety signal regarding serious adverse events.
{"title":"Long-term treatment of endometriosis with dienogest: Real-world results from the VIPOS study","authors":"S. Moehner, K. Becker, J. Lange, Sophia von Stockum, M. Serrani, K. Heinemann","doi":"10.1177/2284026521993688","DOIUrl":"https://doi.org/10.1177/2284026521993688","url":null,"abstract":"Introduction: The Visanne Post-approval Observational Study (VIPOS) was designed to assess the safety of dienogest 2 mg (DNG, Visanne) compared to other hormonal endometriosis treatments. Methods: Large, prospective, non-interventional, active surveillance study in six European countries (Germany, Poland, Russia, Hungary, Switzerland, and Ukraine). Women with a new hormonal therapy for endometriosis were enrolled by gynecologists and specialized centers between 2010 and 2016 and observed for up to 7 years. Self-administered questionnaires during study entry and follow-up collected information on baseline characteristics, health status and endometriosis treatment. Self-reported clinical outcomes of interest were validated by health care professionals. Results: Among the >27,000 enrolled participants, 3262 women started DNG use either at study entry or during follow-up. A total of 798 study participants used DNG during follow-up continuously for 15 months or longer (DNG long-term users). When comparing the occurrence of serious adverse events (SAE) in users treated with DNG, no safety signal emerged for long-term users; the SAE incidence rate per 10,000 women-years was 367.7 (95% CI: 274.1–481.9) in DNG long-term users and 416.4 (349.1–492.5) in short-term users (treated with DNG for less than 15 months). Conclusions: Previous data on DNG long-term safety were derived from studies with relatively low numbers of patients and limited follow-up time. VIPOS provided valuable real-world data on the long-term use of DNG 2 mg in around 800 women treated in Europe and observed no safety signal regarding serious adverse events.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"13 1","pages":"104 - 110"},"PeriodicalIF":0.5,"publicationDate":"2021-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2284026521993688","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47599720","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 : 2021-02-14DOI: 10.1177/2284026521993680
A. Alahakoon, D. Wickramarathne
Background: Dysmenorrhea or painful menstrual periods is one of the common health issues the female university students experience which intervenes with academic activities and quality of life. Objectives: We aimed to find the prevalence, intensity, extent of impairment in academic engagement, and efficacy of the management of dysmenorrhea among nursing students at Peradeniya University, Sri Lanka. Methodology: This cross sectional study comprised 86 female nursing students who represented all four academic years. A self-administered questionnaire was used. The intensity and level of dysmenorrhea were assessed. Association of the extent of working impairment with the level of pain determined by Pearson correlation. Duration of dysmenorrhea persisted before and after management was compared using paired sample t-test. The effectiveness of management was analyzed using Wilcoxon signed-rank test. Results: The prevalence of dysmenorrhea was 97.7%. The majority (54.7%) suffered moderate pain. Mean age of the participants was 24.02 (±1.503). During the period of dysmenorrhea, 32.6%, 33.7%, and 17.4% students experienced slight, moderate, and heavy impairment of overall academic engagement. A positive correlation was observed between level of pain and extent of academic impairment (p < 0.05). The majority practiced pharmacological and non-pharmacological pain relieving methods together. Wilcoxon signed-rank test value revealed more negative ranks and statistically significant reduction in intensity in post-management period (z = −7.793, p = 0). Post-management dysmenorrhea duration was significantly reduced than pre-management (t76 = 8.984, p = 0). Conclusion: A substantial percent of undergraduates suffer from dysmenorrhea. It is associated impairment of overall academic engagement. The nursing students were able to manage dysmenorrhea successfully.
背景:痛经是女大学生常见的健康问题之一，严重影响学业和生活质量。目的:我们旨在了解斯里兰卡Peradeniya大学护理专业学生痛经的患病率、强度、程度以及痛经治疗的效果。方法:这项横断面研究包括86名女护理专业的学生，他们代表了所有四个学年。采用自我管理问卷。评估痛经的强度和程度。工作损伤程度与疼痛程度的相关性由Pearson相关性确定。采用配对样本t检验比较治疗前后痛经持续时间。采用Wilcoxon sign -rank检验分析管理的有效性。结果:痛经发生率为97.7%。大多数患者(54.7%)有中度疼痛。参与者平均年龄为24.02岁(±1.503岁)。在痛经期间，32.6%、33.7%和17.4%的学生经历了轻微、中度和重度的整体学业投入受损。疼痛程度与学业障碍程度呈正相关(p < 0.05)。大多数患者同时使用药物和非药物缓解疼痛的方法。Wilcoxon sign -rank检验值显示，管理后期患者的负秩数增多，治疗强度降低，差异有统计学意义(z = - 7.793, p = 0)。治疗后痛经持续时间较治疗前显著缩短(t76 = 8.984, p = 0)。结论:有相当比例的大学生患有痛经。它与整体学术投入的损害有关。护生能够成功地处理痛经。
{"title":"Prevalence of dysmenorrhea, its association with overall academic engagement, and management among nursing undergraduates at Peradeniya University, Sri Lanka: A cross-sectional study","authors":"A. Alahakoon, D. Wickramarathne","doi":"10.1177/2284026521993680","DOIUrl":"https://doi.org/10.1177/2284026521993680","url":null,"abstract":"Background: Dysmenorrhea or painful menstrual periods is one of the common health issues the female university students experience which intervenes with academic activities and quality of life. Objectives: We aimed to find the prevalence, intensity, extent of impairment in academic engagement, and efficacy of the management of dysmenorrhea among nursing students at Peradeniya University, Sri Lanka. Methodology: This cross sectional study comprised 86 female nursing students who represented all four academic years. A self-administered questionnaire was used. The intensity and level of dysmenorrhea were assessed. Association of the extent of working impairment with the level of pain determined by Pearson correlation. Duration of dysmenorrhea persisted before and after management was compared using paired sample t-test. The effectiveness of management was analyzed using Wilcoxon signed-rank test. Results: The prevalence of dysmenorrhea was 97.7%. The majority (54.7%) suffered moderate pain. Mean age of the participants was 24.02 (±1.503). During the period of dysmenorrhea, 32.6%, 33.7%, and 17.4% students experienced slight, moderate, and heavy impairment of overall academic engagement. A positive correlation was observed between level of pain and extent of academic impairment (p < 0.05). The majority practiced pharmacological and non-pharmacological pain relieving methods together. Wilcoxon signed-rank test value revealed more negative ranks and statistically significant reduction in intensity in post-management period (z = −7.793, p = 0). Post-management dysmenorrhea duration was significantly reduced than pre-management (t76 = 8.984, p = 0). Conclusion: A substantial percent of undergraduates suffer from dysmenorrhea. It is associated impairment of overall academic engagement. The nursing students were able to manage dysmenorrhea successfully.","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"13 1","pages":"127 - 135"},"PeriodicalIF":0.5,"publicationDate":"2021-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2284026521993680","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43485333","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 : 2021-02-14DOI: 10.1177/2284026521993699
J. Dobrokhotova, D. Kalimatova, I. Y. Ilyina, I. I. Grishin
Background: A number of works provide information on the effectiveness of dienogest in uterine adenomyosis. However, information on the use of the drug at various degrees of the adenomatous nodes, is not presented in the available literature. Aim: The aim of the study was to evaluate the clinical efficacy of dienogest in the treatment of patients with adenomyosis 2nd and 3rd stage and chronic pelvic pain. Materials and methods: A comprehensive clinical survey and treatment of 46 patients with signs of adenomyosis were carried out. Patients were divided into two groups: 28 patients with stage 2 adenomyosis, 18 patients with type 3 adenomyosis were included in the 2nd group. On the first phase of the menstrual cycle all patients underwent hysteroscopy for endoscopic verification of the diagnosis using the traditional Karl Storz hysteroscopic stand with separate treatment and diagnostic curettage of the uterine cavity and cervical canal, followed by histological examination. After surgical treatment all patients received dienogest at a dose 2 mg/day for 6 months. The treatment was performed during 6 months. After 3, 6, and 12 months of the study, the patients included in the survey underwent a comprehensive examination with a clinical assessment of the manifestations of the disease. The level of pain manifestations was evaluated on a visual analog scale (VAS) with a range of 0–10 points. During pain assessment, its manifestations were differentiated—pain due to dyspareunia, dysmenorrhea, dyschezia, and chronic pelvic pain were evaluated. Results: In the group of patients with 2nd adenomyosis stage, the intake of dienogest for 6 months led to the absence of manifestations of uterine bleeding and dyschezia, a decrease in the frequency of dyspareunia—by 7.7 times. In patients with the 3rd stage of the disease, the decrease in the symptoms of adenomyosis was less pronounced, however, after taking the drug, a decrease in the frequency of uterine bleeding was found to be 6 times, dyspareunia 4 times, and dyschezia 5 times. Twelve months after the start of observation (6 months after the end of treatment), none of the patients with 2nd stage of disease showed severe pelvic pain, in the group with 3rd stage of adenomyosis there were only two of these patients (11.1%). At the same time, the vast majority of patients included in the study did not have manifestations of chronic pelvic pain—78.6% of patients with 2nd stage of adenomyosis and 55.6% of patients with 3rd stage of disease, the remaining 21.4% and 33.3% of patients of the first and second groups reported a significant decrease in the severity of pain. Conclusions: The inclusion of dienogest in the combined treatment of adenomyosis is clinically effective, contributing to the rapid and reliable relief of the main manifestations of the disease in patients with adenomyosis with grade 2 and 3 nodes. Treatment of adenomyosis with the use of dienogest is clinically effective, contributing to the rapid and
{"title":"Study of dienogest clinical efficacy in the treatment of adenomyosis","authors":"J. Dobrokhotova, D. Kalimatova, I. Y. Ilyina, I. I. Grishin","doi":"10.1177/2284026521993699","DOIUrl":"https://doi.org/10.1177/2284026521993699","url":null,"abstract":"Background: A number of works provide information on the effectiveness of dienogest in uterine adenomyosis. However, information on the use of the drug at various degrees of the adenomatous nodes, is not presented in the available literature. Aim: The aim of the study was to evaluate the clinical efficacy of dienogest in the treatment of patients with adenomyosis 2nd and 3rd stage and chronic pelvic pain. Materials and methods: A comprehensive clinical survey and treatment of 46 patients with signs of adenomyosis were carried out. Patients were divided into two groups: 28 patients with stage 2 adenomyosis, 18 patients with type 3 adenomyosis were included in the 2nd group. On the first phase of the menstrual cycle all patients underwent hysteroscopy for endoscopic verification of the diagnosis using the traditional Karl Storz hysteroscopic stand with separate treatment and diagnostic curettage of the uterine cavity and cervical canal, followed by histological examination. After surgical treatment all patients received dienogest at a dose 2 mg/day for 6 months. The treatment was performed during 6 months. After 3, 6, and 12 months of the study, the patients included in the survey underwent a comprehensive examination with a clinical assessment of the manifestations of the disease. The level of pain manifestations was evaluated on a visual analog scale (VAS) with a range of 0–10 points. During pain assessment, its manifestations were differentiated—pain due to dyspareunia, dysmenorrhea, dyschezia, and chronic pelvic pain were evaluated. Results: In the group of patients with 2nd adenomyosis stage, the intake of dienogest for 6 months led to the absence of manifestations of uterine bleeding and dyschezia, a decrease in the frequency of dyspareunia—by 7.7 times. In patients with the 3rd stage of the disease, the decrease in the symptoms of adenomyosis was less pronounced, however, after taking the drug, a decrease in the frequency of uterine bleeding was found to be 6 times, dyspareunia 4 times, and dyschezia 5 times. Twelve months after the start of observation (6 months after the end of treatment), none of the patients with 2nd stage of disease showed severe pelvic pain, in the group with 3rd stage of adenomyosis there were only two of these patients (11.1%). At the same time, the vast majority of patients included in the study did not have manifestations of chronic pelvic pain—78.6% of patients with 2nd stage of adenomyosis and 55.6% of patients with 3rd stage of disease, the remaining 21.4% and 33.3% of patients of the first and second groups reported a significant decrease in the severity of pain. Conclusions: The inclusion of dienogest in the combined treatment of adenomyosis is clinically effective, contributing to the rapid and reliable relief of the main manifestations of the disease in patients with adenomyosis with grade 2 and 3 nodes. Treatment of adenomyosis with the use of dienogest is clinically effective, contributing to the rapid and","PeriodicalId":15725,"journal":{"name":"Journal of endometriosis and pelvic pain disorders","volume":"13 1","pages":"136 - 141"},"PeriodicalIF":0.5,"publicationDate":"2021-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2284026521993699","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45730841","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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