Trends among patients with endometriosis over a 7-year period and the impact of the COVID-19 pandemic: experience from an academic high-level endometriosis centre in Germany

Can the CANKADO online application improve quality of life monitoring via the endometriosis health profile-30 in endometriosis patients: A randomized cohort study on acceptance, usability, and correlations with demographics and media usage

BACKGROUND

The global increase in interest in endometriosis highlights the importance of further investigations concerning this so-called benign gynecological disease. Owing to their severe presentation of symptoms, patients suffer from an enormous impact on their health-related quality of life (HRQoL). While the paper-based assessment of quality of life via, e.g., the "Endometriosis Health Profile-30 questionnaire (EHP-30)" seems to be largely accepted and implemented, the electronic measurement of this patient-reported outcome (ePRO) is still rarely applied. This study aimed to analyze the acceptance and usability of electronic assessments of HRQoL in endometriosis patients via the online platform CANKADO.

METHODS

The study was conducted at the Department of Gynecology and Obstetrics of LMU Munich between January 2022 and February 2023. Sixty conservatively treated patients with endometriosis were recruited for the randomized cohort study, followed by randomization due to their planned interrogation modality (n paper-based = 23, n online-based = 17). Afterwards, a HRQoL assessment via the EHP-30 questionnaire was performed. An evaluation of the interrogation modalities was performed at 0, 6 and 12 months. The metric or categorical variables were compared via Fisher's exact test or the Mann‒Whitney U test. Correlation analysis was performed by calculating the Kendall Tau coefficient or Eta coefficient.

RESULTS

Forty patients completed evaluation forms at T0 (0 months), with n = 23 evaluating the paper-based interrogation modality and n = 17 evaluating the online version. At all the time of assessment, more than 80% of the patients showed a positive response to routinely performed ePRO measurements in the clinical context, expecting simplified communication, faster diagnosis, and therapeutic improvement. The online modality was rated more suitably (T0: 72.7% vs. 76.5%; T3: 60.0% vs. 90.0%), less complex (T0: 59.1% vs. 76.5%; T3: 80.0% vs. 70.0%), and less laborious (T0: 72.7% vs. 70.6%; T3: 80% each). Completion time over ten minutes was significantly correlated with low coping ability (r = 0.530; p = 0.029), lower clarity (r = 0.530; p = 0.029) and greater effort (r = 0.593; p = 0.012).

CONCLUSIONS

The findings indicate high acceptance and usability of regularly performed ePRO assessments in patients with endometriosis via the online tool CANKADO.

The Incidence of Endometriosis, 2014–2022. An Analysis of Nationwide Claims Data From Physicians in Private Practice

BACKGROUND

The epidemiological characterization of endometri - osis, particularly with regard to its incidence, has been inadequate to date both in Germany and other countries. The goal of this study was to determine trends in the incidence of diagnosed endometri - osis and changes in age structure at the time of first diagnosis over the period 2014-2022.

METHODS

Nationwide claims data from physicians in private practice, obtained according to relevant German law (§ 295 SGB V), were used to identify the population at risk for a first assured diagnosis of endometriosis (ICD-10-GM: N80) during each year of the study period, consisting of women and girls aged 10-52 who were insured by the statutory health insurance system and for whom at least two years of prior observation were possible. Patients were defined as incident if they were documented as having received a first confirmed diagnosis of endometriosis, according to the case definition, during the study year. The case definition comprised multiple options for validating the diagnosis.

RESULTS

The incidence of diagnosed endometriosis rose over the period of the study from 2.8 per 1000 persons at risk in 2014 to 4.1 per 1000 in 2022, corresponding to a 44% relative increase. There was also a marked shift in agespecific incidence toward higher values at younger ages: the median age at diagnosis fell from 37 years (2014) to 34 (2022).

CONCLUSION

This is the first study providing nationwide population-based data on the incidence of endometriosis in Germany. The observed rise in newly diagnosed cases is presumably mainly due to an increased awareness of endometriosis and to the growing recognition of the disease.

Ovarian reserve markers of women with superficial endometriosis

OBJECTIVE

Endometriosis affects up to 10% of reproductive age women and is associated with pelvic pain and subfertility. While previous studies have shown an association between deep and ovarian endometriosis to reduced ovarian reserve, there is no data on the effect of superficial endometriosis on ovarian reserve markers. Hence, we aimed to compare ovarian reserve markers of women with superficial endometriosis to that of women without endometriosis.

METHODS

This was a case control study in a tertiary medical center. The study group included women aged 18-40 with surgically and histopathology-proven superficial endometriosis with no deep lesions or ovarian involvement. The control group included women with no known or suspected endometriosis and was matched to the study group by age, BMI and parity. We excluded women with other known risk factors for ovarian failure and with other gynecological disorders. Participants completed a questionnaire with demographic, medical and gynecological data. Each patient underwent anti-Mullerian hormone (AMH) testing and an ultrasound to assess their antral follicular count (AFC). AMH and AFC were then compared between groups.

RESULTS

A total of 124 women participated in the study. Of these, 50% (n = 62) had surgically proven superficial endometriosis and 50% (n = 62) were without known or suspected endometriosis. Mean AMH levels of women with and without superficial endometriosis was 3.0 ± 2.8 ng/mL and 2.8 ± 1.9 ng/mL, respectively (P = 0.71). AFC also did not differ between groups (women with superficial endometriosis: 12.0 ± 6.6; women without endometriosis: 10.2 ± 5.0, P = 0.15).

CONCLUSIONS

In our cohort, superficial endometriosis was not associated with diminished ovarian reserve. While further studies are needed, to date, it does not appear to be justified to assess ovarian reserve for patients with superficial endometriosis.

Endometriosis and COVID-19: A Systematic Review and Meta-Analysis

Endometriosis is defined as ectopic endometrial tissues dispersed outside the endometrium. This can cause disruption in hormonal and immunological processes, which may increase susceptibility to SARS-CoV-2 infection. Worsening of endometriosis symptoms may occur as a result of this infection. The aim of our review was to estimate the pooled prevalence of SARS-CoV-2 infection and the health impacts of the COVID-19 pandemic in endometriosis patients. We conducted a systematic review and meta-analysis. MEDLINE, Science Direct, Scopus, and Google Scholar databases were searched, using the keywords: (endometriosis) AND (COVID-19 OR SARS-CoV-2). Forest plots and pooled estimates were created using the Open Meta Analyst software. After screening 474 articles, 19 studies met the eligibility criteria for the systematic review, and 15 studies were included in the meta-analyses. A total of 17,799 patients were analyzed. The pooled prevalence of SARS-CoV-2 infection in endometriosis patients was 7.5%. Pooled estimates for the health impacts were 47.2% for decreased access to medical care, 49.3% increase in dysmenorrhea, 75% increase in anxiety, 59.4% increase in depression, and 68.9% increase in fatigue. Endometriosis patients were undeniably impacted by the COVID-19 pandemic, which caused the worsening of symptoms such as dysmenorrhea, pelvic pain, anxiety, depression, and fatigue.