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Silva FP, Yela DA, de Barros Meneguetti M, Torelli F, Gibran L, Benetti-Pinto CL. Assessment of quality of life, psychological aspects, and sexual function of women with endometriosis according to pain and infertility: a cross sectional study. Arch Gynecol Obstet 2024; 309:2741-2749. [PMID: 38563981 DOI: 10.1007/s00404-024-07464-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE To evaluate the quality of life, sexual function, anxiety, and depression of women with endometriosis according to pain symptoms and infertility. METHODS This cross-sectional multicenter study included 229 women with endometriosis followed up at a tertiary hospital in Campinas, a tertiary hospital in São Paulo, and a reproductive medicine clinic in Campinas from 2018 to 2021. The women were divided into four groups according to the presence of pain symptoms and infertility. The Endometriosis Health Profile Questionnaire, Female Sexual Function Index, Beck Depression Inventory, and Beck Anxiety Index were applied to assess quality of life, sexual function, depression, and anxiety of women with endometriosis. RESULTS The women were grouped as follows: group 1 (45 women without infertility and without pain), group 2 (73 women without infertility and with pain), group 3 (49 women with infertility and without pain), and group 4 (62 women with infertility and pain). Of the women with infertility, the majority had primary infertility. Most women had deep endometriosis (p = 0.608). Women with pain had higher anxiety and depression scores and worse quality of life than women without pain (p < 0.001). Regarding sexual function, all the groups were at risk for sexual dysfunction (p = 0.671). The group of women with pain and infertility have worse anxiety scores (25.31 ± 15.96) and depression (18.81 ± 11.16) than the other groups. CONCLUSION Pain symptoms worsen anxiety, depression, and quality of life of women with endometriosis and when associated with infertility, greater impairment of psychological aspects may occur.
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Affiliation(s)
- Fabia Pigatti Silva
- Department of Gynecology and Obstetrics, School of Medical Sciences, University of Campinas (Unicamp), 101, Rua Alexander Fleming, Cidade Universitária, Campinas, SP, CEP 13083-881, Brazil
| | - Daniela Angerame Yela
- Department of Gynecology and Obstetrics, School of Medical Sciences, University of Campinas (Unicamp), 101, Rua Alexander Fleming, Cidade Universitária, Campinas, SP, CEP 13083-881, Brazil.
| | - Melissa de Barros Meneguetti
- Department of Gynecology and Obstetrics, School of Medical Sciences, University of Campinas (Unicamp), 101, Rua Alexander Fleming, Cidade Universitária, Campinas, SP, CEP 13083-881, Brazil
| | - Flavia Torelli
- Department of Gynecology and Obstetrics, School of Medical Sciences, University of Campinas (Unicamp), 101, Rua Alexander Fleming, Cidade Universitária, Campinas, SP, CEP 13083-881, Brazil
| | - Luciano Gibran
- Department of Gynecology and Obstetrics, School of Medical Sciences, University of Campinas (Unicamp), 101, Rua Alexander Fleming, Cidade Universitária, Campinas, SP, CEP 13083-881, Brazil
| | - Cristina Laguna Benetti-Pinto
- Department of Gynecology and Obstetrics, School of Medical Sciences, University of Campinas (Unicamp), 101, Rua Alexander Fleming, Cidade Universitária, Campinas, SP, CEP 13083-881, Brazil
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Molina A, Carter A, Alexander L, Davé A, Riley K. Holistic approach to care for patients with endometriosis. Curr Opin Obstet Gynecol 2024:00001703-990000000-00132. [PMID: 38837362 DOI: 10.1097/gco.0000000000000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW Endometriosis is a chronic, often debilitating, disease which is typically managed with surgery and hormonal medications. However, many patients feel they lack agency when managing endometriosis symptoms. The purpose of this review is to discuss the mental and physical management strategies, the long-term health consequences, and the role of a multidisciplinary team in the treatment of endometriosis. RECENT FINDINGS Evidence is becoming more robust regarding the role of complementary care and physical activity in the management of endometriosis. Health risks such as infertility are well known and newer evidence is evolving regarding perinatal and cardiovascular health risks. There are also trends towards multiple specialist involvement in the care of endometriosis and the benefit of interdisciplinary collaboration. SUMMARY Endometriosis is a frequently recurrent condition requiring not only meticulous medical and surgical care, but also coordinated longitudinal disease management and impact mitigation. Gynecologists should be aware of the short-term and long-term implications of the disease to empower patients on the management of their overall health.
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Affiliation(s)
- Andrea Molina
- Department of Minimally Invasive Gynecologic Surgery, Penn State Health
| | - Ashlie Carter
- Department of Minimally Invasive Gynecologic Surgery, Penn State Health
| | - Lacy Alexander
- Department of Kinesiology, Penn State, College of Health and Human Development, Pennsylvania, USA
| | - Arpit Davé
- Department of Minimally Invasive Gynecologic Surgery, Penn State Health
| | - Kristin Riley
- Department of Minimally Invasive Gynecologic Surgery, Penn State Health
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As-Sanie S, Shafrir AL, Halvorson L, Chawla R, Hughes R, Merz M. The Burden of Pelvic Pain Associated with Endometriosis among Women in Selected European Countries and the United States: A Restricted Systematic Review. J Minim Invasive Gynecol 2024:S1553-4650(24)00206-1. [PMID: 38729420 DOI: 10.1016/j.jmig.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 04/03/2024] [Accepted: 05/07/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE To evaluate the burden of endometriosis-associated pelvic pain (EAPP) on health-related quality of life (HRQoL) among women living in similar socio-economic conditions. DATA SOURCES Searches were performed in PubMed and Embase on September 26, 2022. The review was performed in conformity with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol (PRISMA-P) and was registered on PROSPERO (ID: CRD42023370363). METHODS OF STUDY SELECTION Due to the high volume of eligible publications following initial review, inclusion criteria were restricted to studies undertaken in France, Germany, Italy, Spain, the United Kingdom, and the United States. This restriction was applied before screening as these countries have broad social and economic similarities, and previous studies in the literature suggest pain reporting and experience are influenced by numerous socio-cultural factors. Eligible studies were those published between 2013 and 2022 and include a sample size of ≥50 participants. The search strategy identified all relevant publications relating to the burden of illness due to EAPP. A variety of terms are used in the literature to describe pain associated with endometriosis, and this was considered in the design of the search strategy and screening procedure. TABULATION, INTEGRATION, AND RESULTS The database searches resulted in a total of 6139 records. After removal of duplicates, 3855 records were assessed further. A total of 27 publications were identified as eligible. Fourteen (52%) were from Italy, 5 (19%) were multinational studies, 4 (15%) were from the United States, 3 (11%) were from Spain, and 1 (4%) was from Germany. Most studies were cross-sectional (n = 15; 56%); 7 (26%) were case-control studies; 3 (11%) were cohort studies; and 2 (7%) were longitudinal studies. These publications collectively highlighted an association between EAPP and reduced HRQoL. Several studies showed that EAPP was associated with lower HRQoL when compared with endometriosis without pain and potentially with chronic pelvic pain caused by other conditions, although the evidence is limited in this case. Moreover, the studies reported detrimental effects on general HRQoL, mental health functioning, and sexual functioning, culminating in reduced work productivity and difficulties in performing everyday activities. The associations were generally similar across study populations, including adolescents, as well as younger and older women. Results were consistent across the range of different patient-reported outcome tools used to assess HRQoL. CONCLUSION The existing literature suggests that, among women in selected European countries and the United States, EAPP is associated with reduced HRQoL, including impaired mental and sexual functioning, as well as reduced work performance and productivity; each of which may contribute to the societal burden of endometriosis.
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Affiliation(s)
- Sawsan As-Sanie
- Department of Obstetrics and Gynecology, University of Michigan (Dr. As-Sanie), Ann Arbor, Michigan.
| | - Amy L Shafrir
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School (Dr. Shafrir), Boston, Massachusetts; Department of Nutrition and Public Health, School of Nursing and Health Sciences, Merrimack College (Dr. Shafrir), North Andover, Massachusetts; Department of Nutrition and Public Health, School of Nursing and Health Sciences, Merrimack College (Dr. Shafrir), North Andover, MA
| | - Lisa Halvorson
- Bayer US Pharmaceuticals (Dr. Halvorson), Whippany, New Jersey
| | - Rajinder Chawla
- AccuScript Consultancy (Dr. Chawla), Ludhiana, Punjab, India
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Chang E, Shi YF, Liu JF, Wei W. Post-marketing safety concerns with elagolix: a disproportionality analysis of the FDA adverse event reporting system. Expert Opin Drug Saf 2024:1-8. [PMID: 38700323 DOI: 10.1080/14740338.2024.2351451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/01/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE Elagolix is approved for the treatment of moderate-to-severe pain associated with endometriosis. However, the long-term safety of elagolix in a large sample of real-world patients is unknown. METHODS The U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) reports were collected and analyzed from January 2019 to June 2023. Disproportionality analyses, including the reporting odds ratio (ROR), the proportional reporting ratio (PRR), the Bayesian confidence propagation neural network (BCPNN), and the multi-item gamma Poisson shrinker (MGPS) algorithms, were employed in data mining to quantify the signals of elagolix-related adverse events (AEs). RESULTS After removing the non-drug-related AE signals, we detected several AE signals such as hot flushes, bone pain, suicidal ideation, depression, and increased liver enzymes, which were known during the clinical trial phase. In addition to this, we detected several unexpected important AEs that were not mentioned in the drug insert, including cystitis interstitial, parosmia, and epiploic appendagitis. The median onset time of elagolix-associated AEs was 28.5 days. CONCLUSION Our study provides a comprehensive picture of the safety of elagolix in the post-marketing setting, while also identifying potential new AE signals. These findings emphasize the importance of continued monitoring of the potential risks of elagolix.
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Affiliation(s)
- En Chang
- Department of Pharmacy, People's Hospital of Zhongjiang County, Deyang, Sichuan, China
| | - Yong-Fang Shi
- College of Pharmacy, Heze University, Heze, Shandong, China
| | - Jin-Feng Liu
- Department of Pharmacy, People's Hospital of Zhongjiang County, Deyang, Sichuan, China
| | - Wei Wei
- Department of Pharmacy, People's Hospital of Zhongjiang County, Deyang, Sichuan, China
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van Eickels D, Schick M, Germeyer A, Rösner S, Strowitzki T, Wischmann T, Ditzen B. Predictors of partnership and sexual satisfaction and dyadic effects in couples affected by endometriosis and infertility. Arch Gynecol Obstet 2024:10.1007/s00404-024-07516-z. [PMID: 38705889 DOI: 10.1007/s00404-024-07516-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 04/15/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE Endometriosis and infertility are associated with impaired partnership and sexuality of the patients, but also of their male partners. Also, endometriosis is one of the most common causes of infertility, resulting in a large overlap of both pathologies. The aim of this study was to determine the association of different predictors of partnership and sexual satisfaction and dyadic effects in couples with endometriosis and infertility. METHODS A cross-sectional study was conducted with n = 62 women with endometriosis and n = 46 partners, including a total of n = 44 couples, some of whom were affected by infertility. The questionnaire included items on partnership, sexuality, depression, social support, and desire for a child. Multiple linear regression and the actor-partner-interdependence-model were used for analysis. RESULTS Significant dyadic effects only occurred in couples with both endometriosis and infertility. Depression showed a significant negative actor effect in men for partnership satisfaction and a negative actor and partner effect in women for sexuality satisfaction (p < .05). For women, social support showed a significant positive actor effect for partnership satisfaction (p < .05), age showed a significant actor and partner effect for sexuality satisfaction (p < .05). CONCLUSION The results show a significant association of endometriosis and infertility with partnership and sexuality satisfaction. Infertility could be a decisive factor. However, the large overlapping of both endometriosis und infertility in many couples support the importance of further studies to differentiate between the both effects. TRIAL REGISTRATION German Clinical Trials Register DRKS00014362 on the 29.03.2018.
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Affiliation(s)
- Deborah van Eickels
- Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg, Germany.
| | - Maren Schick
- Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ariane Germeyer
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Heidelberg, Germany
| | - Sabine Rösner
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Heidelberg, Germany
| | - Thomas Strowitzki
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Heidelberg, Germany
| | - Tewes Wischmann
- Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg, Germany
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Van Niekerk L, Pugh S, Mikocka-Walus A, Ng C, O’Hara R, Armour M, Leonardi M, Evans S. An evaluation of sexual function and health-related quality of life following laparoscopic surgery in individuals living with endometriosis. Hum Reprod 2024; 39:992-1002. [PMID: 38563055 PMCID: PMC11063542 DOI: 10.1093/humrep/deae063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
STUDY QUESTION What is the relationship between sexual function, health-related quality of life (HRQoL), and laparoscopic surgery in individuals living with endometriosis? SUMMARY ANSWER A higher number of laparoscopic surgeries is significantly associated with poorer HRQoL and greater levels of sexual dysfunction in individuals with endometriosis. WHAT IS KNOWN ALREADY Prior research indicates that endometriosis is associated with lowered HRQoL and sexual function and that these outcomes are influenced by endometriosis-related symptom profiles, medical, and surgical management. A limited number of studies have examined changes in sexual function in individuals with endometriosis following laparoscopic surgery or following repeated surgeries. STUDY DESIGN, SIZE, DURATION A cross-sectional community-based online survey was used to examine the relationships between sexual function, HRQoL, and laparoscopic surgery (n = 210). PARTICIPANTS/MATERIALS, SETTING, METHODS Individuals with a self-reported diagnosis of endometriosis were recruited via online advertising through social media and gynaecology clinics. Endometriosis-specific data (e.g. diagnostic delay, symptom experience) was collected in addition to engagement with laparoscopic surgery, level of HRQoL (EuroQol-5 Dimension: EQ-5D-5L), and sexual function (Female Sexual Function Index: FSFI). Bivariate correlational analyses and hierarchical multiple regression were used to determine the associations between the variables of interest. MAIN RESULTS AND THE ROLE OF CHANCE Individuals with endometriosis have substantially poorer HRQoL in comparison to Australian normative samples, with greater levels of endometriosis-related symptom burden, distress, and pain significantly associated with lower levels of HRQoL. The mean FSFI score was suggestive of clinically significant female sexual dysfunction, with the lowest level of function noted in the domain of sexual pain and the highest level of function noted in the sexual satisfaction domain. A greater number of laparoscopic surgeries was significantly associated with poorer overall HRQoL and greater levels of sexual dysfunction. LIMITATIONS, REASONS FOR CAUTION The cross-sectional nature of the data precludes direct findings of causality and further longitudinal research is recommended. The information pertaining to engagement in laparoscopic surgery was self-report in nature and was not medically verified. WIDER IMPLICATIONS OF THE FINDINGS The study's findings highlight the pervasive impact of endometriosis on all domains of living, emphasizing the need to extend treatment planning beyond that of physical pain management alone. Early referral for assessment and management of sexual wellbeing is recommended prior to, and post-surgical intervention, with a focus on maintaining post-surgical changes, potentially reducing the need for multiple surgeries. STUDY FUNDING, COMPETING INTEREST(S) The study was not associated with research funding. Author CN reports grant funding from the Australian Government and Medical Research Future Fund (MRFF) and was a previous employee of CSL Vifor (formerly Vifor Pharma Pty Ltd). TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Leesa Van Niekerk
- School of Psychological Sciences, College of Health & Medicine, University of Tasmania, Hobart, TAS, Australia
- National Endometriosis Clinical and Scientific Trials (NECST) Network, UNSW, Sydney, Australia
| | - Shaunagh Pugh
- School of Psychological Sciences, College of Health & Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Antonina Mikocka-Walus
- National Endometriosis Clinical and Scientific Trials (NECST) Network, UNSW, Sydney, Australia
- School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Cecilia Ng
- National Endometriosis Clinical and Scientific Trials (NECST) Network, UNSW, Sydney, Australia
- Division of Obstetrics and Gynaecology, School of Clinical Medicine, Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Rebecca O’Hara
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, North Adelaide, SA, Australia
| | - Mike Armour
- National Endometriosis Clinical and Scientific Trials (NECST) Network, UNSW, Sydney, Australia
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Mathew Leonardi
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, North Adelaide, SA, Australia
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Subhadra Evans
- School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
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Vallée A, Carbonnel M, Ceccaldi PF, Feki A, Ayoubi JM. Postmenopausal endometriosis: a challenging condition beyond menopause. Menopause 2024; 31:447-456. [PMID: 38531006 DOI: 10.1097/gme.0000000000002338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
IMPORTANCE AND OBJECTIVE Postmenopausal endometriosis is a complex condition that challenges the conventional belief that endometriosis resolves with menopause. Despite the cessation of menstruation, a subset of women continues to experience or develop endometriosis-related symptoms during the postmenopausal period. Thus, this review aimed to shed light on postmenopausal endometriosis, exploring its clinical features, diagnostic considerations, management approaches, and the potential impact on women's health. METHODS PubMed/Medline, Scopus, and Web of Science databases were used for the research, with only articles in English language, using the following terms: "postmenopausal endometriosis," "menopause," "management," "treatment," and "quality of life," from inception to 2023. DISCUSSION AND CONCLUSION The clinical features of postmenopausal endometriosis include persistent or recurrent pelvic pain, dyspareunia, bowel, or urinary symptoms and, occasionally, abnormal vaginal bleeding. The absence of menstrual cycles presents a diagnostic challenge, as the traditional diagnostic criteria for endometriosis rely on menstrual patterns. Visual cues may be less evident, and the symptoms often overlap with other gynecological conditions, necessitating a thorough evaluation to differentiate postmenopausal endometriosis from other potential causes. Management approaches for postmenopausal endometriosis encompass surgical intervention, hormonal therapies, pain management, and individualized care. Postmenopausal endometriosis significantly impacts the quality of life, sexual health, and long-term well-being of women. Understanding the clinical features, diagnostic challenges, and management approaches of postmenopausal endometriosis is crucial for healthcare professionals to provide effective care and to improve the quality of life of women affected by this condition.
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Affiliation(s)
- Alexandre Vallée
- From the Department of Epidemiology and Public Health, Foch Hospital, Suresnes, France
| | | | | | - Anis Feki
- Department of Gynecology and Obstetrics, University Hospital of Fribourg, Fribourg, Switzerland
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Gete DG, Doust J, Mortlock S, Montgomery G, Mishra GD. Risk of Iron Deficiency in Women With Endometriosis: A Population-Based Prospective Cohort Study. Womens Health Issues 2024; 34:317-324. [PMID: 38658289 DOI: 10.1016/j.whi.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 02/25/2024] [Accepted: 03/15/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Endometriosis may be linked to the risk of iron deficiency through chronic systemic inflammation or heavy menstrual bleeding. No longitudinal studies, however, have examined the relationship between endometriosis and the risk of iron deficiency. METHODS This study included 3,294 participants born from 1973 to 1978 and followed as part of the Australian Longitudinal Study on Women's Health from 2000 to 2018. Participants with endometriosis were identified using self-reported longitudinal surveys linked to administrative health records. During each survey, participants were also asked to report the diagnosis of iron deficiency, and we validated diagnoses using an administrative health database. Generalized estimating equations for binary responses with an autoregressive correlation matrix were used to examine the association between endometriosis and the risk of iron deficiency over the seven time points. FINDINGS We found that women with endometriosis had a significantly higher risk of iron deficiency than those without endometriosis after adjusting for sociodemographic, lifestyle, reproductive, and nutrition factors (adjusted odds ratio [aOR] = 1.46; 95% confidence interval [CI] [1.29, 1.66]; p < .0001). Women with a surgically confirmed diagnosis and those with clinically suspected endometriosis had a higher risk of iron deficiency (aOR = 1.38; 95% CI [1.17, 1.64] and aOR = 1.53; 95% CI [1.30, 1.81]), respectively. These associations, however, were slightly attenuated (by 8%) when adjusted for the presence of heavy menstrual bleeding. CONCLUSIONS Women with endometriosis are at a higher risk of developing iron deficiency than those without endometriosis. The findings suggest that iron deficiency should be concomitantly addressed during initial diagnosis and successive management of endometriosis.
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Affiliation(s)
- Dereje G Gete
- Australian Women and Girls' Health Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
| | - Jenny Doust
- Australian Women and Girls' Health Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Sally Mortlock
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Grant Montgomery
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Gita D Mishra
- Australian Women and Girls' Health Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Silva T, Oliveira M, Oliveira E, Macena R, de Oliveira Silva GT, Câmara SMA, Micussi M. Are women with endometriosis more likely to experience reduced physical performance compared to women without the condition? PeerJ 2024; 12:e16835. [PMID: 38666082 PMCID: PMC11044877 DOI: 10.7717/peerj.16835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/04/2024] [Indexed: 04/28/2024] Open
Abstract
Background Endometriosis is a condition of the female reproductive system associated with pelvic pain. Chronic pain can affect physical performance by limiting the functional activities, thus, it is hypothesized that women with endometriosis may also present decreased functional capacity, decreased strength, and mobility. The objective of this study is to compare physical performance in women with and without endometriosis. Methods This is a cross-sectional study composed of 115 women equally divided into two groups: the endometriosis group (EG), composed of women with a confirmed diagnosis of the disease by magnetic resonance imaging, and the comparator group (CG), consisting of women without suspicion of the disease. Physical performance (dependent variable) was assessed using hand dynamometry, the 6-min walk test (6MWT), gait speed, and the chair stands test. CG participants performed the tests during the luteal phase of the menstrual cycle. Descriptive statistics, unpaired t-tests, and chi-square tests were used to describe and compare the groups. Multiple linear regression tested the associations adjusted for covariates (age, income, education, age at menarche, and body mass index). Results The EG had worse gait speed (mean difference: -0.11; 95% CI: [-0.18 to -0.04]), weaker grip strength (mean difference: -3.32; 95% CI: [-5.30 to -1.33]), shorter distance covered in the 6MWT (mean difference: -83.46; 95% CI: [-121.38 to -45.53]), and a lower number of repetitions in the chair stands test (mean difference: -8.44; 95% CI: [-10.64 to -6.25]) than the CG, even after adjusting for covariates. Conclusion Grip strength, lower limb strength, mobility, and functional capacity were worse in women diagnosed with endometriosis. Women with endometriosis should be encouraged to engage in physical exercise, adopt healthy lifestyle habits, and participate in rehabilitation activities to control pain, with the aim of reducing functional impairments.
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Affiliation(s)
- Tatiana Silva
- Programa de Pós-Graduação em Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Maiara Oliveira
- Programa de Pós-Graduação em Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Edwiges Oliveira
- Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Rayllanne Macena
- Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | | | - Saionara M. A. Câmara
- Programa de Pós-Graduação em Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Maria Micussi
- Programa de Pós-Graduação em Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Vanhie A, Caron E, Vermeersch E, O D, Tomassetti C, Meuleman C, Mestdagh P, D’Hooghe TM. Circulating microRNAs as Non-Invasive Biomarkers in Endometriosis Diagnosis-A Systematic Review. Biomedicines 2024; 12:888. [PMID: 38672242 PMCID: PMC11048084 DOI: 10.3390/biomedicines12040888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/18/2023] [Accepted: 01/25/2024] [Indexed: 04/28/2024] Open
Abstract
The aim of this systematic review is to assess the power of circulating miRNAs as biomarkers as a diagnostic tool in endometriosis. In endometriosis-suspected women with uncertain imaging, the only way to confirm or exclude endometriosis with certainty is currently laparoscopy. This creates a need for non-invasive diagnostics. We searched the literature through the PubMed database using the Mesh terms 'endometriosis' and 'miRNAs'. Some, but limited, overlap was found between the 32 articles included, with a total of 20 miRNAs reported as dysregulated in endometriosis in two or more studies. MiR-17-5p was reported as dysregulated in six studies, followed by miR-451a and let-7b-5p in four studies and miR-20a-5p, miR-143-3p, miR-199a-5p and miR-3613-5p in three studies. Furthermore, a possible impact of the menstrual phase on miRNA expression was noted in five studies, while no influence of hormonal intake was observed in any included study. The modest reproducibility between studies may be attributable to biological variability as well as to the lack of universal protocols, resulting in pre- and analytical variability. Despite the identification of several suitable candidate biomarkers among the miRNAs, the need for high-quality studies with larger and well-defined population cohorts and the use of standardized protocols lingers.
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Affiliation(s)
- Arne Vanhie
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Ellen Caron
- Department of Obstetrics and Gynecology, University Hospital Leuven, 3000 Leuven, Belgium
| | - Eveline Vermeersch
- Department of Obstetrics and Gynecology, University Hospital Leuven, 3000 Leuven, Belgium
| | - Dorien O
- Department of Obstetrics and Gynecology, University Hospital Leuven, 3000 Leuven, Belgium
| | - Carla Tomassetti
- Department of Obstetrics and Gynecology, University Hospital Leuven, 3000 Leuven, Belgium
| | - Christel Meuleman
- Department of Obstetrics and Gynecology, University Hospital Leuven, 3000 Leuven, Belgium
| | - Pieter Mestdagh
- UGent, Center for Medical Genetics, Thent University, 9000 Ghent, Belgium
- UGent, Cancer Research Institute Ghen, Ghent University, 9000 Ghent, Belgium
| | - Thomas M. D’Hooghe
- Department of Obstetrics and Gynecology, University Hospital Leuven, 3000 Leuven, Belgium
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Ul Ain R. The etiology of endometriosis: Is Fusobacterium to blame? Int J Gynaecol Obstet 2024. [PMID: 38619324 DOI: 10.1002/ijgo.15500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 02/25/2024] [Accepted: 03/12/2024] [Indexed: 04/16/2024]
Abstract
SynopsisA recent cohort study has highlighted the potential role of Fusobacterium in causing endometriosis which, after further evidence, might call for a modified treatment plan.
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Affiliation(s)
- Rai Ul Ain
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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12
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Qing X, He L, Ma Y, Zhang Y, Zheng W. Systematic review and meta-analysis on the effect of adjuvant gonadotropin-releasing hormone agonist (GnRH-a) on pregnancy outcomes in women with endometriosis following conservative surgery. BMC Pregnancy Childbirth 2024; 24:237. [PMID: 38575880 PMCID: PMC10993455 DOI: 10.1186/s12884-024-06430-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 03/15/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Endometriosis frequently results in pain and infertility. While conservative surgery offers some relief, it often falls short of ensuring satisfactory pregnancy outcomes. Adjuvant GnRH-a is administered post-surgery to mitigate recurrence; however, its impact on pregnancy outcomes remains debated. This study endeavors to assess the efficacy of adjuvant GnRH-a in enhancing pregnancy outcomes post-conservative surgery in endometriosis patients. METHODS Databases including PubMed, Embase, the Cochrane Library, Medline (Ovid), Web of Science, and Scopus were rigorously searched up to 02 August 2023, without linguistic constraints. Identified articles were screened using strict inclusion and exclusion criteria. Evaluated outcomes encompassed pregnancy rate, live birth rate, miscarriage rate, ectopic pregnancy rate, multiple pregnancy rate, mean postoperative pregnancy interval, recurrence rate, and adverse reaction rate. The Cochrane risk of bias tool and the Jadad score evaluated the included studies' quality. Subgroup and sensitivity analysis were implemented to analyze the pooled results. A meta-analysis model expressed results as standardized mean difference (SMD) and Risk ratio (RR). RESULTS A total of 17 studies about 2485 patients were assimilated. Meta-analysis revealed that post-surgery, the GnRH-a cohort experienced a marginally elevated pregnancy rate (RR = 1.20, 95% CI = 1.02-1.41; P = 0.03) and a reduced mean time to conceive (RR = -1.17, 95% CI = -1.70- -0.64; P < 0.0001). Contrarily, other evaluated outcomes did not exhibit notable statistical differences. CONCLUSIONS Incorporating adjuvant GnRH-a following conservative surgery may be deemed beneficial for women with endometriosis, especially before Assisted Reproductive Technology (ART). Nonetheless, owing to pronounced heterogeneity, subsequent research is warranted to substantiate these potential advantages conclusively. REGISTRATION NUMBER CRD42023448280.
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Affiliation(s)
- Xuemei Qing
- Department of Obstetrics and Gynecology, Southwest Medical University, Luzhou, Sichuan, 646000, China
- Department of Obstetrics and Gynecology, Qingbaijiang District People's Hospital, Chengdu, Sichuan, 610300, China
| | - Lele He
- Department of Obstetrics and Gynecology, Southwest Medical University, Luzhou, Sichuan, 646000, China
- Department of Obstetrics and Gynecology, Chongzhou Maternal and Child Health Care Hospital, Chengdu, Sichuan, 611200, China
| | - Ying Ma
- Department of Obstetrics and Gynecology, Mianyang Central Hospital, Mianyang, Sichuan, 621000, China.
- Department of Obstetrics and Gynecology, Chengdu Medical College, Chengdu, Sichuan, 610500, China.
| | - Yong Zhang
- Department of Obstetrics and Gynecology, Southwest Medical University, Luzhou, Sichuan, 646000, China.
- Department of Obstetrics and Gynecology, Mianyang Central Hospital, Mianyang, Sichuan, 621000, China.
| | - Wenxin Zheng
- Department of Obstetrics and Gynecology, Department of Pathology, Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
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13
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Gomes FH, Fonseca MDF, Favorito LA, Gasparoni MP, da Silva Filho FS, Diniz ALL, de Resende Júnior JAD. Changes in lower urinary tract function after minimally invasive nerve-sparing for complete excision of endometriosis: An observational study. Neurourol Urodyn 2024; 43:862-873. [PMID: 38497524 DOI: 10.1002/nau.25414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/04/2024] [Accepted: 01/24/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES The objective of this paper is to evaluate changes in lower urinary tract symptoms (LUTS), severity of pain and urodynamic parameters after minimally invasive nerve-sparing surgery for patients with endometriosis. METHODS We analyzed 143 patients undergoing minimally invasive nerve-sparing surgery for endometriosis excision (laparoscopy/robot-assisted). The endometriosis was confirmed by preoperative clinical evaluation, magnetic resonance imaging (MRI) showing at least one lesion deeper than 5 mm, and histological confirmation after laparoscopy. We evaluated three points prior and after surgery: LUTS parameters according to the International Urogynecological Association; urodynamic measures of storage and voiding and the severity of the dyspareunia, dyschezia and dysmenorrhea assessed on a self-reported 11-point numeric rating scale. The Wilcoxon signed rank and McNemar tests were used for statistical analyses (p < 0.05). RESULTS We observed significant improvements in LUTS after the surgery with postoperative symptom-free probabilities in urgency (64.5%), daytime frequency (38.5%), and dysuria (87.1%). However, slow stream prevalence increased significantly postsurgery (p = 0.022), with a 20.5% risk of asymptomatic patients developing this symptom. Urodynamic responses varied; for instance, maximum cystometric capacity improved significantly (p = 0.004), while postvoiding residual worsened (p = 0.006). Significant worsening in postvoiding residual occurred in women with normal preoperative values (p = 0.002), with a 17.7% risk of normal values becoming abnormal. Compliance or maximum cystometric capacity not considered normal preoperatively showed significant improvements (p < 0.001), but the risk of normal values becoming abnormal after surgery was 14.5%. CONCLUSION The minimally invasive nerve-sparing surgery for endometriosis excision shows improvement in lower urinary tract symptoms, urodynamics parameters and severity of pain. The majority of patients became asymptomatic in the postoperative period. When compared to the benefits of the patients' surgical treatment, particularly when considering the reduction of pain, the risks of the lower urinary tract treatment seem to be acceptable. The surgical intervention seems to be a safe alternative in patients with endometriosis, although studies with larger samples are needed to confirm these findings.
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Affiliation(s)
- Fernanda Hack Gomes
- Hospital Federal da Lagoa and Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Luciano Alves Favorito
- Hospital Federal da Lagoa and Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - André Luiz Lima Diniz
- Hospital Federal da Lagoa and Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Zhang J, Zhao W, Zhou Y, Xi S, Xu X, Du X, Zheng X, Hu W, Sun R, Tian Z, Fu B, Wei H. Pyroptotic T cell-derived active IL-16 has a driving function in ovarian endometriosis development. Cell Rep Med 2024; 5:101476. [PMID: 38508138 PMCID: PMC10983113 DOI: 10.1016/j.xcrm.2024.101476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/09/2024] [Accepted: 02/21/2024] [Indexed: 03/22/2024]
Abstract
Endometriosis, affecting 6%-10% of women, often leads to pain and infertility and its underlying inflammatory mechanisms are poorly understood. We established endometriosis models in wild-type and IL16KO mice, revealing the driver function of IL-16 in initiating endometriosis-related inflammation. Using an in vitro system, we confirmed iron overload-induced GSDME-mediated pyroptosis as a key trigger for IL-16 activation and release. In addition, our research led to the development of Z30702029, a compound inhibiting GSDME-NTD-mediated pyroptosis, which shows promise as a therapeutic intervention for endometriosis. Importantly, our findings extend beyond endometriosis, highlighting GSDME-mediated pyroptosis as a broader pathway for IL-16 release and offering insights into potential treatments for various inflammatory conditions.
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Affiliation(s)
- Jinghe Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; The CAS Key Laboratory of Innate Immunity and Chronic Disease, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China; Institute of Immunology, University of Science and Technology of China, Hefei, Anhui, China
| | - Weidong Zhao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
| | - Yonggang Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; The CAS Key Laboratory of Innate Immunity and Chronic Disease, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China; Institute of Immunology, University of Science and Technology of China, Hefei, Anhui, China
| | - Shengdi Xi
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; The CAS Key Laboratory of Innate Immunity and Chronic Disease, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China; Institute of Immunology, University of Science and Technology of China, Hefei, Anhui, China
| | - Xiuxiu Xu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; The CAS Key Laboratory of Innate Immunity and Chronic Disease, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China; Institute of Immunology, University of Science and Technology of China, Hefei, Anhui, China
| | - Xianghui Du
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; The CAS Key Laboratory of Innate Immunity and Chronic Disease, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China; Institute of Immunology, University of Science and Technology of China, Hefei, Anhui, China
| | - Xiaohu Zheng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; The CAS Key Laboratory of Innate Immunity and Chronic Disease, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China; Institute of Immunology, University of Science and Technology of China, Hefei, Anhui, China
| | - Weiping Hu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Rui Sun
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; The CAS Key Laboratory of Innate Immunity and Chronic Disease, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China; Institute of Immunology, University of Science and Technology of China, Hefei, Anhui, China
| | - Zhigang Tian
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; The CAS Key Laboratory of Innate Immunity and Chronic Disease, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China; Institute of Immunology, University of Science and Technology of China, Hefei, Anhui, China
| | - Binqing Fu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; Institute of Health and Medicine, Hefei Comprehensive National Science Center, Hefei, Anhui, China; The CAS Key Laboratory of Innate Immunity and Chronic Disease, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China; Institute of Immunology, University of Science and Technology of China, Hefei, Anhui, China.
| | - Haiming Wei
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; The CAS Key Laboratory of Innate Immunity and Chronic Disease, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China; Institute of Immunology, University of Science and Technology of China, Hefei, Anhui, China.
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Dowding C, Mikocka-Walus A, Skvarc D, O'Shea M, Olive L, Evans S. Learning to cope with the reality of endometriosis: A mixed-methods analysis of psychological therapy in women with endometriosis. Br J Health Psychol 2024. [PMID: 38467518 DOI: 10.1111/bjhp.12718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVES Despite the need and uptake of mental health support by women with endometriosis, no research to date has explored their experience of psychological therapy. We aimed to understand the factors that predict engagement in psychological therapy by Australian women with endometriosis and to qualitative explore their experience of psychological support. DESIGN Mixed-methods design. METHODS A total of 200 women with self-reported endometriosis were recruited from the community. We explored; (1) the demographic and clinical predictors of engagement in psychological therapy, (2) the psychological approaches that seem most valuable to women in the management of endometriosis and (3) their experience engaging in psychological therapy for endometriosis. RESULTS Nearly half of women reported to have seen a psychologist within the past year, particularly for pain. Younger age (OR, .94; 95% CI, .886-.993), depressive symptoms (OR, 1.05; 95% CI, 1.002-1.099), and working part time compared to full time (OR, 2.17, 95% CI, 1.012-4.668), increased the likelihood of engaging in psychological therapy. Template thematic analysis identified three themes; (1) endometriosis and pain have multi-faceted psychological effects, (2) psychological support is sought to adjust and live with endometriosis and (3) there are helpful and unhelpful psychological tools for women with endometriosis. CONCLUSIONS Our findings support the use of psychological therapy in the management of endometriosis, and the need for psychological therapy to acknowledge the chronicity and impact of symptoms, to enlist multidisciplinary support and to consider alternative options. Further advocacy is required to educate women on the benefits of psychological therapy for endometriosis.
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Affiliation(s)
- Charlotte Dowding
- Faculty of Health, School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Antonina Mikocka-Walus
- Faculty of Health, School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre for Social and Early Emotional Development, Faculty of Health, School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - David Skvarc
- Faculty of Health, School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Melissa O'Shea
- Faculty of Health, School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Lisa Olive
- Faculty of Health, School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre for Social and Early Emotional Development, Faculty of Health, School of Psychology, Deakin University, Geelong, Victoria, Australia
- IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Subhadra Evans
- Faculty of Health, School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre for Social and Early Emotional Development, Faculty of Health, School of Psychology, Deakin University, Geelong, Victoria, Australia
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Vallée A, Ceccaldi PF, Carbonnel M, Feki A, Ayoubi JM. Pollution and endometriosis: A deep dive into the environmental impacts on women's health. BJOG 2024; 131:401-414. [PMID: 37814514 DOI: 10.1111/1471-0528.17687] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/05/2023] [Accepted: 09/14/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND The interaction between pollution and endometriosis is a pressing issue that demands immediate attention. The impact of pollution, particularly air and water pollution, or occupational hazards, on hormonal disruption and the initiation of endometriosis remains a major issue. OBJECTIVES This narrative review aims to delve into the intricate connection between pollution and endometriosis, shedding light on how environmental factors contribute to the onset and severity of this disease and, thus, the possible public health policy implications. DISCUSSION Endocrine-disrupting chemicals (EDCs) in pollutants dysregulate the hormonal balance, contributing to the progression of this major gynaecological disorder. Air pollution, specifically PM2.5 and PAHs, has been associated with an increased risk of endometriosis by enhancing chronic inflammation, oxidative stress, and hormonal imbalances. Chemical contaminants in water and work exposures, including heavy metals, dioxins, and PCBs, disrupt the hormonal regulation and potentially contribute to endometriosis. Mitigating the environmental impact of pollution is required to safeguard women's reproductive health. This requires a comprehensive approach involving stringent environmental regulations, sustainable practices, responsible waste management, research and innovation, public awareness, and collaboration among stakeholders. CONCLUSION Public health policies have a major role in addressing the interaction between pollution and endometriosis in a long-term commitment.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology and Public Health, Foch Hospital, Suresnes, France
| | - Pierre-François Ceccaldi
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Foch Hospital, Suresnes, France
- Medical School, University of Versailles, Saint-Quentin-en-Yvelines (UVSQ), Versailles, France
| | - Marie Carbonnel
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Foch Hospital, Suresnes, France
- Medical School, University of Versailles, Saint-Quentin-en-Yvelines (UVSQ), Versailles, France
| | - Anis Feki
- Department of Gynaecology and Obstetrics, University Hospital of Fribourg, Fribourg, Switzerland
| | - Jean-Marc Ayoubi
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Foch Hospital, Suresnes, France
- Medical School, University of Versailles, Saint-Quentin-en-Yvelines (UVSQ), Versailles, France
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17
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Bertocchi E, Meoli F, Masini G, Ceccaroni M, Bruni F, Roviglione G, Rossini R, Barugola G, Mazzi C, Ruffo G. Early Quality of Life Assessment After Segmental Colorectal Resection for Deep Infiltrating Endometriosis. J Minim Invasive Gynecol 2024; 31:221-226. [PMID: 38114018 DOI: 10.1016/j.jmig.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/22/2023] [Accepted: 12/15/2023] [Indexed: 12/21/2023]
Abstract
STUDY OBJECTIVE Endometriosis is a benign condition afflicting women of reproductive age that significantly impacts their quality of life (QoL). Given its debilitating symptoms and prevalence, it is essential to define its proper management. In this study, we have assessed patient-reported outcomes among women having undergone segmental colorectal resection for deep infiltrating endometriosis. Any correlation between preoperative nutritional status and overall postoperative complications has also been analyzed. STUDY DESIGN Prospective observational study. SETTING Public medical center. PATIENTS One hundred forty consecutive patients that had undergone segmental colorectal resection for DIE between November 2020 and October 2021 at IRCCS Sacro Cuore Don Calabria Hospital of Negrar of Valpolicella (Verona, Italy). INTERVENTIONS Patient-reported outcomes were measured using data collected from the MD Anderson Symptom Inventory for gastrointestinal surgery patients and Euro-QoL Group EQ-5D-5L (EQ-5Q-5L) questionnaires, which were administered preoperatively (T0), at discharge (T1) and at 4 to 6 weeks after surgery (T2). Nutritional status was examined through the Mini Nutritional Assessment Short form and Prognostic Nutritional Index. MEASUREMENTS AND MAIN RESULTS A significant improvement in the EQ-5Q-5L and MDASI-GI scores was noted between T0 and T2 (p <. 001 and p <. 001, respectively.) No statistically significant differences were found in scores at T2 between patients who had experienced postoperative complications and those who had not. No statistically significant association was observed between the presence of malnutrition and overall postoperative complications and their severity. CONCLUSION This study confirms, through patient-reported outcomes, the pivotal role of surgery in improving the QoL at 4 to 6 weeks of women affected by endometriosis who have previously been unresponsive to medical therapy.
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Affiliation(s)
- Elisa Bertocchi
- General Surgery Unit, IRCCS Sacro Cuore Don Calabria Hospital (Drs. Bertocchi, Masini, Rossini, Barugola, and Ruffo).
| | - Francesca Meoli
- Department of General Surgery and Surgical Specialities (Dr. Meoli), Sapienza University of Rome, Rome, Italy
| | - Gaia Masini
- General Surgery Unit, IRCCS Sacro Cuore Don Calabria Hospital (Drs. Bertocchi, Masini, Rossini, Barugola, and Ruffo)
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology (Drs. Ceccaroni, Bruni, and Roviglione)
| | - Francesco Bruni
- Department of Obstetrics and Gynecology (Drs. Ceccaroni, Bruni, and Roviglione)
| | - Giovanni Roviglione
- Department of Obstetrics and Gynecology (Drs. Ceccaroni, Bruni, and Roviglione)
| | - Roberto Rossini
- General Surgery Unit, IRCCS Sacro Cuore Don Calabria Hospital (Drs. Bertocchi, Masini, Rossini, Barugola, and Ruffo)
| | - Giuliano Barugola
- General Surgery Unit, IRCCS Sacro Cuore Don Calabria Hospital (Drs. Bertocchi, Masini, Rossini, Barugola, and Ruffo)
| | - Cristina Mazzi
- Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Clinical Research Unit, IRCCS Ospedale Sacro Cuore Don Calabria (Dr. Mazzi), Negrar di Valpolicella, Verona
| | - Giacomo Ruffo
- General Surgery Unit, IRCCS Sacro Cuore Don Calabria Hospital (Drs. Bertocchi, Masini, Rossini, Barugola, and Ruffo)
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18
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Sarvestani MH, Noroozi M, Hashemi M, Mostafavi F. A comprehensive interventional program to improve the sexual function of women with endometriosis: a mixed-methods protocol study. Reprod Health 2024; 21:29. [PMID: 38414010 PMCID: PMC10900588 DOI: 10.1186/s12978-024-01759-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/21/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Endometriosis is a chronic disease affecting 6-10% of women worldwide. Sexual dysfunction has been reported in a significant percentage of these patients. Thus, the present study will be conducted to design, implement, and determine the effectiveness of an interventional program to improve the sexual function of women with endometriosis. MATERIALS AND METHODS This mixed-methods study will be carried out in three phases with a sequential exploratory approach. In the first phase (qualitative study) participants will be selected by purposive sampling in Isfahan, Iran. The data will be collected through in-depth interviews and field notes and analyzed using conventional content analysis. The interventional program will be designed in the second phase based on the results of the qualitative study and literature review and using the Delphi method and panel of experts. The interventional program will be implemented at the individual level in the third phase to investigate its effect on improving women's sexual function. This phase includes quasi-experimental research, in which the pre- and post-intervention data will be collected from the intervention and control groups using the FSFI questionnaire and analyzed by descriptive and inferential statistical methods. Ultimately, a suitable interventional program will be presented by combining the data obtained in the qualitative and quantitative phases of the research. CONCLUSION Conducting the present study, along with the design and implementation of an appropriate, native, and culturally sensitive interventional program, can contribute to improving the sexual function of women with endometriosis and enhancing the quality of sexual relations between couples.
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Affiliation(s)
- Maryam Heidari Sarvestani
- Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahnaz Noroozi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Maryam Hashemi
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Firoozeh Mostafavi
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Howard AF, Noga H, Kelly MT, Gholamian B, Lett S, Sutherland J, Yong PJ. Women's Self-Management of Dyspareunia Associated With Endometriosis: A Qualitative Study. THE JOURNAL OF PAIN 2024:104492. [PMID: 38341015 DOI: 10.1016/j.jpain.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/24/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024]
Abstract
Given the limitations of medical treatment for endometriosis, self-management is a critical component of symptom management, and providing patients with information and education is a necessary complement to medical interventions. Though 50 to 70% of people with endometriosis experience dyspareunia (painful sex), there is limited knowledge of self-management specific to painful sex. A comprehensive understanding of the self-management strategies used is foundational to developing supportive care interventions that help ease pain and related psychosocial sequelae. The objective was to describe people's experiences of navigating endometriosis-associated painful sex and developing self-management strategies. We analyzed interview data from 20 women using constant comparative and thematic analysis techniques, guided by qualitative interpretive description methodology. Participants (age range 18-44 years) all identified as women and were predominately Caucasian (90%) and heterosexual (80%). Throughout their lives, the women appeared to gradually develop self-management strategies while navigating painful sexual experiences. This complex journey encompassed four phases: 1) viewing painful sex as normal, 2) experiencing evolving thoughts and emotions, 3) coming to understand painful sex and seeking help, and 4) learning strategies to navigate painful sex, these include preparing mentally and physically for sex and communicating with intimate partner(s). Women in this study developed self-management strategies over time through engagement with others who understood their challenges. Future research is warranted regarding initiatives to counter the normalization of painful sex, develop and disseminate patient-facing information, provide education specific to dyspareunia, improve access to multidisciplinary care, facilitate social connections and support, and enhance communication with intimate partners. PERSPECTIVE: In this paper, we report on the experiences of women with endometriosis-associated painful sex and their self-management strategies. Clinicians may be interested in a qualitative exploration of endometriosis-associated painful sex as they seek to further understand their patient's experiences and what strategies can be implemented to alleviate dyspareunia. DATA AVAILABILITY: The data sets generated during and/or analyzed during the current study are not publicly available as participants did not consent to making their data publicly available but are available from the corresponding author on reasonable request.
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Affiliation(s)
- A Fuchsia Howard
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada; Women's Health Research Institute, British Columbia Women's Hospital & Health Centre, Vancouver, British Columbia, Canada
| | - Heather Noga
- Women's Health Research Institute, British Columbia Women's Hospital & Health Centre, Vancouver, British Columbia, Canada
| | - Mary T Kelly
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bita Gholamian
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Lett
- Endometriosis Patient Advisory Board, British Columbia Women's Hospital & Health Centre, Vancouver, British Columbia, Canada
| | - Jessica Sutherland
- Endometriosis Patient Advisory Board, British Columbia Women's Hospital & Health Centre, Vancouver, British Columbia, Canada
| | - Paul J Yong
- Women's Health Research Institute, British Columbia Women's Hospital & Health Centre, Vancouver, British Columbia, Canada; Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Women's Centre for Pelvic Pain & Endometriosis, British Columbia Women's Hospital & Health Centre, Vancouver, British Columbia, Canada
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Helbig M, Schaal NK, Drumm J, Fürst F, Reinhart L, Fehm T, Beyer I. Correlation between pain and depressive symptoms in patients with confirmed endometriosis during COVID-19 pandemic. Arch Gynecol Obstet 2024; 309:631-637. [PMID: 38103055 PMCID: PMC10808472 DOI: 10.1007/s00404-023-07295-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 11/07/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Endometriosis is a chronic, estrogen-dependent, inflammatory condition which affects women of reproductive age physically and psychologically in their everyday life. The most common symptom is chronic lower abdominal pain. Apart from physical pain, endometriosis often also leads to an unfulfilled desire to give birth. In general, these two main aspects alone lead to emotional stress for patients and often initiate depressive symptoms. To what extent endometriosis patients are additionally affected by the COVID pandemic and its effects is to be determined in this study. METHODS Patients who presented at our endometriosis center and met the study criteria were offered participation in the study. A link to an online questionnaire (SoSci-Survey) was sent by email. The online questionnaire evaluated depressive symptoms before and during the pandemic as well as the pain perception and perceived support during the pandemic. The data of 167 fully completed questionnaires were evaluated and analyzed using SPSS. RESULTS The analysis of the questionnaires revealed a significant association between pain levels and depressive symptomatology in endometriosis patients during the pandemic. Patients with more severe pain showed significantly higher depressive symptoms than patients with little or no pain. During the pandemic, patients showed higher depressive symptoms than before. In addition, it was found that those endometriosis patients who felt left alone with their pain due to the consequences of the COVID pandemic, or who felt they had to endure the pain alone, also had higher depressive symptoms. CONCLUSION In summary, it can be observed that endometriosis patients with a high pain burden had significantly higher depressive symptoms during the COVID pandemic. The consequences of the pandemic often led to the feeling of having to cope with the symptoms alone or having to endure pain alone, which in turn increased the depressive symptoms. As treating physicians, we should be aware of these connections and try to counteract them with targeted offers and support.
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Affiliation(s)
- Martina Helbig
- Clinic for Gynecology and Obstetrics, University Hospital, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Nora K Schaal
- Department of Experimental Psychology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Johannes Drumm
- Clinic for Gynecology and Obstetrics, University Hospital, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Flurina Fürst
- Clinic for Gynecology and Obstetrics, University Hospital, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Lisa Reinhart
- Clinic for Gynecology and Obstetrics, University Hospital, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Tanja Fehm
- Clinic for Gynecology and Obstetrics, University Hospital, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Ines Beyer
- Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- Academic Teaching Hospital Leverkusen, University of Cologne, Cologne, Germany
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21
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Hebert T. Robotic assisted laparoscopy for deep infiltrating endometriosis. Best Pract Res Clin Obstet Gynaecol 2024; 92:102422. [PMID: 38007964 DOI: 10.1016/j.bpobgyn.2023.102422] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 10/09/2023] [Accepted: 10/22/2023] [Indexed: 11/28/2023]
Abstract
Deep infiltrative endometriosis is a condition affecting up to 15 % of women of childbearing age, defined by extra uterine location of endometrial like tissues. The symptoms of endometriosis range from severe dysmenorrhea to infertility, chronic pelvic pain, bowel dysfunction and urinary tract involvement to name the most common. Endometriosis has an impact on the quality of life of patients, with personal and social consequences. Although medical treatment is indicated in the first instance, surgery may be necessary. Standard laparoscopy has become the gold standard for this surgery. However, surgery for deep infiltrative endometriosis is known to be highly complex, and the significant development of robotic assistance in recent years has had an impact on the evolution of surgical practice. This comprehensive review of the literature provides an overview of the contributions of robotic surgery in the field of endometriosis and gives an insight into the next steps in its development.
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Affiliation(s)
- T Hebert
- Centre Olympe de Gouges, Gynecologic Surgery Department, University Hospital, Tours, France.
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22
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Yang X, Yan K, Zhan Q, Chen H, Pei CZ, Zhu L. Exploration of Diagnostic Deubiquitinating Enzymes in Endometriosis and Its Immune Infiltration. Biochem Genet 2024:10.1007/s10528-023-10653-w. [PMID: 38302849 DOI: 10.1007/s10528-023-10653-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/27/2023] [Indexed: 02/03/2024]
Abstract
The mechanism involved in the pathogenesis of endometriosis is poorly understood. The purpose of this study is to identify key deubiquitinating enzymes (DUBs) for endometriosis diagnosis and elucidate the possible mechanism, offering novel insights for noninvasive early diagnosis and treatment. Four gene expression datasets were employed from the Gene Expression Omnibus to identify differentially expressed genes (DEGs) between endometriosis and normal controls. GO and KEGG pathways were performed for enrichment analysis. Calibration curves, ROC, DCA, and clinical impact curves verified the clinical usefulness of the nomogram model. In addition, the ssGSEA method was conducted to estimate 23 types of immune cells. A specific DUB gene signature was constructed with Lasso regression, univariate logistic regression, and SVM analysis. RT-qPCR validated the expression of biomarkers. A total of 85 endometriosis-related DUBs were identified in the eutopic endometrium. Among them, 20 DUBs were found to be correlated with the severity of endometriosis. A diagnostic risk model based on five DUB-related genes (USP21, USP48, ZRANB1, COPS5, and EIF3F) was developed using lasso-cox regression analysis. The nomogram model exhibited a strong predictive ability to diagnose endometriosis. KEGG analysis revealed that ubiquitin-mediated proteolysis was activated in patients suffering from severe symptoms. Analysis of immune cell infiltration revealed a positive correlation between USP21 and multiple immune cells in the eutopic endometrium. However, EIF3F showed an opposite relationship. Dysregulation of DUBs was related to the immune microenvironment in endometriosis. Results from RT-qPCR confirmed the expression of DEGs in clinical samples. In summary, the diagnostic model for endometriosis constructed using five differentially expressed DUB genes demonstrates strong diagnostic capability, suggesting that these genes could serve as potential candidate biomarkers and therapeutic targets.
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Affiliation(s)
- Xinyun Yang
- Department of Reproductive Endocrinology, Zhejiang University School of Medicine, Women's Hospital, Hangzhou, Zhejiang, People's Republic of China
| | - Kai Yan
- Department of Reproductive Endocrinology, Zhejiang University School of Medicine, Women's Hospital, Hangzhou, Zhejiang, People's Republic of China
| | - Qitao Zhan
- Department of Reproductive Endocrinology, Zhejiang University School of Medicine, Women's Hospital, Hangzhou, Zhejiang, People's Republic of China
| | - Hao Chen
- Department of Pathology, Hangzhou Women's Hospital, Hangzhou, Zhejiang, People's Republic of China
| | - Chang-Zhu Pei
- Reproductive Medicine Center, Yanbian University Hospital, Yanji, Jilin, People's Republic of China.
| | - Linling Zhu
- Department of Reproductive Endocrinology, Zhejiang University School of Medicine, Women's Hospital, Hangzhou, Zhejiang, People's Republic of China.
- Department of Gynecology, Hangzhou Women's Hospital, Hangzhou, Zhejiang, People's Republic of China.
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23
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Huijs E, van Stigt BJ, de Roos N, Nap A. The feasibility of an anti-inflammatory diet in endometriosis: barriers and facilitators perceived by endometriosis patients. Reprod Biomed Online 2024; 48:103624. [PMID: 38181648 DOI: 10.1016/j.rbmo.2023.103624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/05/2023] [Accepted: 10/12/2023] [Indexed: 01/07/2024]
Abstract
RESEARCH QUESTION What is the feasibility of an anti-inflammatory diet in women diagnosed with endometriosis? DESIGN Qualitative study using semi-structured focus groups and individual interviews among patients with endometriosis. Transcripts of the focus groups and interviews were thematically analysed using ATLAS.ti 9. To identify and structure the ideas and views from the focus groups and interviews, two behavioural change models were used. The Capability Opportunity Motivation Behaviour (COM-B) model and domains of the Theoretical Domains Framework (TDF) helped to identify factors that make adherence to an anti-inflammatory diet more or less feasible for women with endometriosis. RESULTS The study population consisted of 23 patients with endometriosis. Numerous perceived barriers and facilitators were identified from all COM-B components and 13 out of 15 TDF domains. Knowledge and social influences were the most prominent TDF domains. Key barriers were eating with others; disbelief in a patients' own capability regarding specific dietary guidelines; concerns about taste; lack of knowledge on how to follow the diet; lack of noticeable beneficial effect; and lack of intention to follow the diet to full extent. Key facilitators were receiving social support; general confidence in a participant's own capabilities; knowing how and why to follow the diet; noticing beneficial effect; and belief that the diet would alleviate symptoms. CONCLUSION Provision of knowledge, stimulating social support and enhancing self-efficacy should be emphasized. Overall, an anti-inflammatory diet in endometriosis patients, especially when identified barriers and facilitators are addressed in an intervention, is feasible.
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Affiliation(s)
- Emma Huijs
- Department of Gynaecology and Obstetrics, Radboudumc, Nijmegen, the Netherlands.
| | - Brenda Joëlle van Stigt
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Nicole de Roos
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Annemiek Nap
- Department of Gynaecology and Obstetrics, Radboudumc, Nijmegen, the Netherlands
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24
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de C Williams AC, McGrigor H. A thematic synthesis of qualitative studies and surveys of the psychological experience of painful endometriosis. BMC Womens Health 2024; 24:50. [PMID: 38238741 PMCID: PMC10795225 DOI: 10.1186/s12905-023-02874-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/28/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Endometriosis is a widespread problem in women of reproductive age, causing cyclical and non-cyclical pain in the pelvis and elsewhere, and associated with fatigue, fertility problems, and other symptoms. As a chronic pain problem, psychological variables are important in adjustment and quality of life, but have not been systematically studied. METHODS A systematic search of multiple databases was conducted to obtain surveys and qualitative studies of women's experience of pain from endometriosis. Surveys were combined narratively; qualitative studies were combined by thematic synthesis, and the latter rated for methodological quality. RESULTS Over 2000 records were screened on title and abstract, and provided 22 surveys and 33 qualitative studies from which accounts could be extracted of the psychological components of pain in endometriosis. Surveys mostly addressed quality of life in endometriosis, with poorer quality of life associated with higher levels of pain and of distress, but few referred to coherent psychological models. Qualitative studies focused rather on women's experience of living with endometriosis, including trajectories of diagnosis and treatment, with a few addressing meaning and identity. Thematic synthesis provided 10 themes, under the groupings of internal experience of endometriosis (impact on body, emotions, and life); interface with the external world (through self-regulation and social regulation); effects on interpersonal and social life, and encounters with medical care. CONCLUSIONS The psychological components of pain from endometriosis only partly corresponded with standard psychological models of pain, derived from musculoskeletal pain studies, with fewer fears about physical integrity and more about difficulties of managing pain and other symptoms in social settings, including work. Better understanding of the particular psychological threats of endometriosis, and integration of this understanding into medical care with opportunities for psychologically-based pain management, would substantially improve the experience and quality of life of women with painful endometriosis.
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Affiliation(s)
- Amanda C de C Williams
- Research Dept of Clinical, Educational & Health Psychology, University College London, Gower St, London, WC1E 6BT, UK.
| | - Honor McGrigor
- Research Dept of Clinical, Educational & Health Psychology, University College London, Gower St, London, WC1E 6BT, UK
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25
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Peven K, Wickham AP, Wilks O, Kaplan YC, Marhol A, Ahmed S, Bamford R, Cunningham AC, Prentice C, Meczner A, Fenech M, Gilbert S, Klepchukova A, Ponzo S, Zhaunova L. Assessment of a Digital Symptom Checker Tool's Accuracy in Suggesting Reproductive Health Conditions: Clinical Vignettes Study. JMIR Mhealth Uhealth 2023; 11:e46718. [PMID: 38051574 PMCID: PMC10731551 DOI: 10.2196/46718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/06/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Reproductive health conditions such as endometriosis, uterine fibroids, and polycystic ovary syndrome (PCOS) affect a large proportion of women and people who menstruate worldwide. Prevalence estimates for these conditions range from 5% to 40% of women of reproductive age. Long diagnostic delays, up to 12 years, are common and contribute to health complications and increased health care costs. Symptom checker apps provide users with information and tools to better understand their symptoms and thus have the potential to reduce the time to diagnosis for reproductive health conditions. OBJECTIVE This study aimed to evaluate the agreement between clinicians and 3 symptom checkers (developed by Flo Health UK Limited) in assessing symptoms of endometriosis, uterine fibroids, and PCOS using vignettes. We also aimed to present a robust example of vignette case creation, review, and classification in the context of predeployment testing and validation of digital health symptom checker tools. METHODS Independent general practitioners were recruited to create clinical case vignettes of simulated users for the purpose of testing each condition symptom checker; vignettes created for each condition contained a mixture of condition-positive and condition-negative outcomes. A second panel of general practitioners then reviewed, approved, and modified (if necessary) each vignette. A third group of general practitioners reviewed each vignette case and designated a final classification. Vignettes were then entered into the symptom checkers by a fourth, different group of general practitioners. The outcomes of each symptom checker were then compared with the final classification of each vignette to produce accuracy metrics including percent agreement, sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS A total of 24 cases were created per condition. Overall, exact matches between the vignette general practitioner classification and the symptom checker outcome were 83% (n=20) for endometriosis, 83% (n=20) for uterine fibroids, and 88% (n=21) for PCOS. For each symptom checker, sensitivity was reported as 81.8% for endometriosis, 84.6% for uterine fibroids, and 100% for PCOS; specificity was reported as 84.6% for endometriosis, 81.8% for uterine fibroids, and 75% for PCOS; positive predictive value was reported as 81.8% for endometriosis, 84.6% for uterine fibroids, 80% for PCOS; and negative predictive value was reported as 84.6% for endometriosis, 81.8% for uterine fibroids, and 100% for PCOS. CONCLUSIONS The single-condition symptom checkers have high levels of agreement with general practitioner classification for endometriosis, uterine fibroids, and PCOS. Given long delays in diagnosis for many reproductive health conditions, which lead to increased medical costs and potential health complications for individuals and health care providers, innovative health apps and symptom checkers hold the potential to improve care pathways.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Stephen Gilbert
- Else Kröner Fresenius Center for Digital Health, TUD Dresden University of Technology, Dresden, Germany
| | | | - Sonia Ponzo
- Flo Health UK Limited, London, United Kingdom
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26
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Giese N, Kwon KK, Armour M. Acupuncture for endometriosis: A systematic review and meta-analysis. Integr Med Res 2023; 12:101003. [PMID: 38033648 PMCID: PMC10682677 DOI: 10.1016/j.imr.2023.101003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/02/2023] Open
Abstract
Background Current endometriosis treatments do not always provide symptom relief, with many using complementary approaches. This study examined the effectiveness of acupuncture on pain and quality of life in people with endometriosis. Methods Searches were conducted on Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Allied and Complementary Medicine Database (AMED) and Embase (Ovid), Epistemonikos, and Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCOhost) on 20 March 2023. Trials were included if they used penetrating acupuncture. Risk of bias was assessed with Cochrane RoB2 and GRADE for overall evidence certainty. Random-effects meta-analyses were undertaken, using Hedges' g or mean difference (MD) both with 95 % confidence intervals (CI). Results Six studies involving a total of 331 participants were included. Evidence for benefit was found for acupuncture compared to non-specific acupuncture on overall pelvic pain (g = 1.54, 95 % CI 0.92 to 2.16, 3 RCTs, n = 231, low certainty evidence, p<0.001), menstrual pain (g = 1.67, 95 % CI 1.23 to 2.12, 1 RCT, n = 106, moderate certainty evidence, p<0.001), and non-specified pelvic pain (MD -2.77, 95 % CI 2.15 to 3.38, 2 RCTs, n = 125, low certainty evidence, p<0.001), and compared to usual care on menstrual pain (g = 0.9, 95 % CI 0.15 to 1.64, 1 RCT, n = 19, very low certainty evidence, p = 0.02). Most studies reported low rates of adverse events. Conclusion Acupuncture treatment for endometriosis demonstrated clinically relevant improvements in pelvic pain and should be considered as a potential treatment intervention. Study registration PROSPERO ID: CRD42023408700.
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Affiliation(s)
- Nora Giese
- Praxis für Chinesische Medizin, Bonn, Germany
| | - Ki Kyung Kwon
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Mike Armour
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, Australia
- Medical Research Institute of New Zealand (MRINZ), Wellington, New Zealand
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27
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Deng S, Yang D, Li Q, Dai H, Tang W, Lu L, Liu J, Wu X. Bibliometric analysis of global endometriosis research, 2002 to 2021: A review. Medicine (Baltimore) 2023; 102:e35723. [PMID: 38013311 PMCID: PMC10681485 DOI: 10.1097/md.0000000000035723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/29/2023] [Indexed: 11/29/2023] Open
Abstract
Endometriosis is a common disease of reproductive-age women and an important cause of dysmenorrhea and infertility. Information on endometriosis is complex and there is a lack of summarization of available results. The study aims to evaluate the overall distribution of publications related to endometriosis to provide a foundation for further research. The Web of Science Core Collection was searched for articles published in the field of endometriosis. Our survey revealed the structure, hotspots, and development trends of endometriosis-related research and publications.
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Affiliation(s)
- Siyao Deng
- Country Academy of Pharmacy, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Dongxia Yang
- Department of Gynecology Medicine, Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Qiyao Li
- Country Academy of Pharmacy, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Haoran Dai
- Country Academy of Pharmacy, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Weikang Tang
- Country Academy of Pharmacy, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Lihuang Lu
- Country Academy of Pharmacy, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Jing Liu
- Country Academy of Pharmacy, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Xiuhong Wu
- Country Academy of Pharmacy, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
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28
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Pant A, Dakal TC, Moar K, Dhabhai B, Arora TK, Sharma NK, Ranga V, Maurya PK. Assessment of MMP14, CAV2, CLU and SPARCL1 expression profiles in endometriosis. Pathol Res Pract 2023; 251:154892. [PMID: 37898038 DOI: 10.1016/j.prp.2023.154892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/30/2023]
Abstract
Endometriotic cells exhibit a notable degree of invasiveness and some characteristics of tissue remodeling underlying lesion formation. In this regard, do matrix metalloproteinases 14 (MMP14) and other related genes such as SPARC-like protein 1 (SPARCL1), caveolin 2 (CAV2), and clusterin (CLU) exert any significant influence in the processes of endometriosis development and pathophysiology is not apparent. We aim to assess whether these genes could serve as potential diagnostic biomarkers in endometriosis. Microarray-based gene expression analysis was performed on total RNA extracted from endometriotic tissue samples treated with and without gonadotropin-releasing hormone agonist (GnRHa). The GnRHa untreated patients were considered the control group. The validation of genes was performed using quantitative real-time polymerase chain reaction (qRT-PCR). qRT-PCR analysis showed significant downregulation in the expression of MMP14 (p = 0.024), CAV2 (p = 0.017), and upregulation of CLU (p = 0.005) in endometriosis patients treated with GnRHa. SPARCL1 did not show any significant (p = 0.30) change in the expression compared to the control group. These data have the potential to contribute to the comprehension of the molecular pathways implicated in the remodeling of the extracellular matrix, which is a vital step for the physiology of the endometrium. Based on the result, it is concluded that changes in the expression of MMP14, CAV2, and CLU post-treatment imply their role in the pathophysiology of endometriosis and may serve as a potential diagnostic biomarker of endometriosis in response to GnRHa treatment in patients with ovarian endometrioma.
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Affiliation(s)
- Anuja Pant
- Department of Biochemistry, Central University of Haryana, Mahendergarh 123031, India
| | - Tikam Chand Dakal
- Genome and Computational Biology Lab, Department of Biotechnology, Mohanlal Sukhadia University, Udaipur 313001, Rajasthan, India
| | - Kareena Moar
- Department of Biochemistry, Central University of Haryana, Mahendergarh 123031, India
| | - Bhanupriya Dhabhai
- Genome and Computational Biology Lab, Department of Biotechnology, Mohanlal Sukhadia University, Udaipur 313001, Rajasthan, India
| | - Taruna K Arora
- Reproductive Biology and Maternal Child Health Division, Indian Council of Medical Research, New Delhi 110029, India
| | - Narendra Kumar Sharma
- Department of Bioscience and Biotechnology, Banasthali Vidyapith, Tonk 304022, Rajasthan, India
| | - Vipin Ranga
- Department of Biotechnology-North East Centre for Agricultural Biotechnology (DBT-NECAB), Assam Agricultural University, Jorhat 785013, Assam, India
| | - Pawan Kumar Maurya
- Department of Biochemistry, Central University of Haryana, Mahendergarh 123031, India.
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29
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Hu PW, Zhang XL, Yan XT, Qi C, Jiang GJ. Association between depression and endometriosis using data from NHANES 2005-2006. Sci Rep 2023; 13:18708. [PMID: 37907559 PMCID: PMC10618216 DOI: 10.1038/s41598-023-46005-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 10/26/2023] [Indexed: 11/02/2023] Open
Abstract
Studies on the association between depression and self-reported endometriosis are limited, and further studies are required to investigate this association. Data were collected from the National Health and Nutrition Examination Survey database (2005-2006). Based on the inclusion and exclusion criteria, 100 participants with self-reported endometriosis and 1295 participants without self-reported endometriosis were included, representing a total population of 64,989,430. Depression severity was assessed using the Patient Health Questionnaire 9 (PHQ9). A survey-weighted logistic regression analysis was performed to explore the association between depression and endometriosis. Subgroup analyses were conducted to explore heterogeneity. The prevalence of endometriosis was 7.17%. A significant positive association was found between the PHQ9 score and endometriosis. After adjusting for all covariates, the PHQ9 score positively correlated with endometriosis. Furthermore, compared with the participants without depression, those with moderate depression were more prone to have endometriosis both in unadjusted and fully adjusted model. However, the relationship between severe depression and endometriosis was not significant in all models (P > 0.05). Our findings highlight the influence of depression on the prevalence of self-reported endometriosis. Further studies are required to elucidate the causal relationship between depression and self-reported endometriosis.
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Affiliation(s)
- Pan-Wei Hu
- Department of Obstetrics and Gynecology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, 528 Zhangheng Road, Shanghai, China
| | - Xiao-Le Zhang
- Department of Obstetrics and Gynecology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, 528 Zhangheng Road, Shanghai, China
| | - Xiao-Tong Yan
- Department of Obstetrics and Gynecology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, 528 Zhangheng Road, Shanghai, China
| | - Cong Qi
- Department of Obstetrics and Gynecology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, 528 Zhangheng Road, Shanghai, China.
| | - Guo-Jing Jiang
- Department of Obstetrics and Gynecology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, 528 Zhangheng Road, Shanghai, China.
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30
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Gioia F, Parola A, Boursier V. Alexithymia and Loneliness in Women with Endometriosis. Testing the Factorial Structure of the Italian Endometriosis Health Profile (EHP-30) and a Mediation Model. CLINICAL NEUROPSYCHIATRY 2023; 20:442-452. [PMID: 38106818 PMCID: PMC10723149 DOI: 10.36131/cnfioritieditore20230506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Objective Endometriosis is a pathological condition characterized by endometrial-like tissue outside the uterus, chronic inflammatory reaction, and pelvic pain that dramatically decrease women's health-related quality of life (HRQoL). Furthermore, this invisible and difficultly diagnosable disease might lead women to experience alexithymia, loneliness, and consequent impairment of perceived quality of life. Firstly, the present study aimed at validating the Italian EHP-30 version which is the most used specific questionnaire for HRQoL measurement. Secondly, the present study aimed at exploring the still understudied relationship between alexithymia and HRQoL in endometriosis conditions, evaluating the mediating role of perceived loneliness. Method A total of 435 women with endometriosis (mean age=35.75 years) have been involved. All items were loaded on their own factors. Results The measure showed good internal consistency (Cronbach's α ranged between 0.60-0.95 for core and 0.74-0.94 for modular parts). The Italian EHP-30 is a psychometrically valid measure of HRQoL with endometriosis. The tested mediation model provided adequate goodness-of-fit indices (χ2 (51) = 206.071; p < 0.001; RMSEA = 0.084; 90%CI: 0.072, 0.096, CFI = .933, SRMR= 0.058), showing that alexithymia only indirectly affected women's perceived HRQoL, via the mediating effect of feelings of loneliness. Conclusions The current study highlighted the pivotal role of perceived loneliness in directly affecting women's quality of life and mediating the effect of the alexithymic experiences.
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Affiliation(s)
- Francesca Gioia
- Department of Humanities, University of Naples Federico II, Italy
| | - Anna Parola
- Department of Humanities, University of Naples Federico II, Italy
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31
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Hernández Cardona MI, Ajewole C, Lewis H, Carrillo JF, Castellanos ME, Barish S, Echeverri JDV, Lamvu G. Time to move beyond surgical classification systems for endometriosis. Int J Gynaecol Obstet 2023; 163:58-62. [PMID: 37101408 DOI: 10.1002/ijgo.14786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/03/2023] [Accepted: 03/28/2023] [Indexed: 04/28/2023]
Abstract
Endometriosis is a common condition associated with chronic pelvic pain and infertility. Its pathogenesis is poorly understood, diagnosis relies on laparoscopy, and staging is based on extent of disease. Unfortunately, the current staging systems do not correlate well with pain severity and impact, nor do they predict prognosis, i.e., treatment success and recurrence of disease. In this article, we discuss the strengths and limitations of current staging systems and propose modifications that will enable better classification systems to be developed in the future.
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Affiliation(s)
| | | | - Hannah Lewis
- University of Central Florida College of Medicine/HCA Healthcare Consortium of Greater Orlando, Kissimmee, Florida, USA
| | - Jorge F Carrillo
- Orlando VA Healthcare System, Orlando, Florida, USA
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | | | | | - Juan Diego Villegas Echeverri
- Unidad de Laparoscopia Ginecológica Avanzada ALGIA, Pereira, Risaralda, Colombia
- Clínica Comfamiliar, Pereira, Risaralda, Colombia
- FIGO (the International Federation of Gynecology & Obstetrics) Director of the Division of Benign Surgery, London, UK
| | - Georgine Lamvu
- Orlando VA Healthcare System, Orlando, Florida, USA
- University of Central Florida College of Medicine, Orlando, Florida, USA
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Xin L, Ma Y, Ye M, Chen L, Liu F, Hou Q. Efficacy and safety of oral gonadotropin-releasing hormone antagonists in moderate-to-severe endometriosis-associated pain: a systematic review and network meta-analysis. Arch Gynecol Obstet 2023; 308:1047-1056. [PMID: 36656435 PMCID: PMC10435625 DOI: 10.1007/s00404-022-06862-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 11/15/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE The aim of this NMA is to comprehensively analyze evidence of oral GnRH antagonist in the treatment of moderate-to-severe endometriosis-associated pain. METHODS Literature searching was performed to select eligible studies published prior to April 2022 in PubMed, Cochrane, Embase and Web of Science. Randomized controlled trials involving patients who suffered from moderate-to-severe endometriosis-associated pain and treated with oral nonpeptide GnRH antagonists or placebo were included. RESULTS Elagolix 400 mg and ASP1707 15 mg were most efficient in reducing pelvic pain, dysmenorrhea and dyspareunia. Relugolix 40 mg was best in reducing the analgesics use. The rates of any TEAEs and TEAEs-related discontinuation were highest in relugolix 40 mg and elagolix 250 mg, respectively, while rates of hot flush and headache were highest in relugolix 40 mg and elagolix 150 mg. Significantly decreased spinal BMD was observed in elagolix 250 mg. CONCLUSION Oral GnRH antagonists were effective in endometriosis-associated pain in 12w, and most of the efficiency and safety outcomes were expressed in a dose-dependent manner, but linzagolix 75 mg was an exception.
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Affiliation(s)
- Lingli Xin
- Department of Obstetrics and Gynecology, PLA Rocket Force Characteristic Medical Center, Xinjiekou Outer Street 16#, Xicheng District, Beijing, 100088, China.
| | - Yinghao Ma
- Department of Quality Management, PLA Rocket Force Characteristic Medical Center, Xinjiekou Outer Street 16#, Xicheng District, Beijing, 100088, China
| | - Mei Ye
- Department of Obstetrics and Gynecology, PLA Rocket Force Characteristic Medical Center, Xinjiekou Outer Street 16#, Xicheng District, Beijing, 100088, China
| | - Ling Chen
- Department of Obstetrics and Gynecology, PLA Rocket Force Characteristic Medical Center, Xinjiekou Outer Street 16#, Xicheng District, Beijing, 100088, China
| | - Fuzhou Liu
- Department of Orthopaedics, PLA Rocket Force Characteristic Medical Center, Xinjiekou Outer Street 16#, Xicheng District, Beijing, 100088, China
| | - Qingxiang Hou
- Department of Obstetrics and Gynecology, PLA Rocket Force Characteristic Medical Center, Xinjiekou Outer Street 16#, Xicheng District, Beijing, 100088, China.
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Yang Q, Wang Y, Cai H, Zhou Q, Zeng L, Li S, Du H, Wei W, Zhang W, Dai W, Wu R. Translocation of vaginal and cervical low-abundance non-Lactobacillus bacteria notably associate with endometriosis: A pilot study. Microb Pathog 2023; 183:106309. [PMID: 37586463 DOI: 10.1016/j.micpath.2023.106309] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 08/18/2023]
Abstract
The etiology remains to be understood for endometriosis (EMS) which affected health negatively for 10% of reproductive-age women globally. Emerging studies found the associations of EMS with genital microbiota dysbiosis. However, the role of vaginal and cervical microbiota is not fully understood for Chinese women. This study recruited forty Chinese women (21 healthy women and 19 EMS patients) to analyze vaginal and cervical microbiota using 16S rRNA amplicon sequencing method. For both sites, there were no significant differences for distribution of microbial samples between control and EMS group, which was concordant with dominated Lactobacillus in both groups. In contrast, we observed accumulation of several low-abundance genera in vaginal and cervical microbiota of EMS patients, such as Fannyhessea, Prevotella, Streptococcus, Bifidobacterium, Veillonella, Megasphaera and Sneathia. Random forest analysis found that translocation of these genera had the significant importance in differentiating EMS patients from controls. In addition, cervix/vagina ratio of these genera also associated with EMS severity. And these genera had notable associations with ascending infection-related functional pathways, including flagellar assembly, bacterial motility proteins, bacterial toxins and epithelial cell signaling in Helicobacter pylori infection. These findings suggest that translocation of specific genera between vaginal and cervical sites play a role in EMS.
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Affiliation(s)
- Qing Yang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China; Institute of Obstetrics and Gynecology, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, Shenzhen, China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yinan Wang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China; Institute of Obstetrics and Gynecology, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, Shenzhen, China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Peking University Shenzhen Hospital, Shenzhen, China
| | - Han Cai
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China; Institute of Obstetrics and Gynecology, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, Shenzhen, China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Peking University Shenzhen Hospital, Shenzhen, China
| | - Qian Zhou
- Department of Computer Science, City University of Hong Kong, Hong Kong, China
| | - Liping Zeng
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China; Institute of Obstetrics and Gynecology, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, Shenzhen, China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Peking University Shenzhen Hospital, Shenzhen, China
| | - Shuaicheng Li
- Department of Computer Science, City University of Hong Kong, Hong Kong, China
| | - Hui Du
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China; Institute of Obstetrics and Gynecology, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, Shenzhen, China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Peking University Shenzhen Hospital, Shenzhen, China
| | - Weixia Wei
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China; Institute of Obstetrics and Gynecology, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, Shenzhen, China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Peking University Shenzhen Hospital, Shenzhen, China
| | - Wei Zhang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China; Institute of Obstetrics and Gynecology, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, Shenzhen, China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Peking University Shenzhen Hospital, Shenzhen, China
| | - Wenkui Dai
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China; Institute of Obstetrics and Gynecology, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, Shenzhen, China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Peking University Shenzhen Hospital, Shenzhen, China.
| | - Ruifang Wu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China; Institute of Obstetrics and Gynecology, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, Shenzhen, China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Peking University Shenzhen Hospital, Shenzhen, China.
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Kalaitzopoulos DR, Samartzis N, Eberhard M, Grigoriadis G, Miliaras D, Papanikolaou A, Daniilidis A. Co-Existence of Endometriosis with Ovarian Dermoid Cysts: A Retrospective Cohort Study. J Clin Med 2023; 12:6308. [PMID: 37834953 PMCID: PMC10574005 DOI: 10.3390/jcm12196308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Both endometriosis and ovarian dermoid cysts are benign conditions characterized by the presence of well-differentiated tissues in ectopic locations. The presence and surgical excision of these entities can potentially impact ovarian reserves, contributing to reduced chances of future pregnancy. The objective of our study is to investigate the bidirectional association between endometriosis and ovarian dermoid cysts, as well as to analyze the clinical characteristics of patients diagnosed with both conditions. A retrospective cohort study was conducted, including women who underwent laparoscopy and received histological diagnoses of endometriosis and/or dermoid cysts between 2011 and 2019 at the Cantonal Hospital of Schaffhausen. We identified 985 women with endometriosis and 83 women with ovarian dermoid cysts. Among these groups, 22 women presented with both endometriosis and ovarian dermoid cysts. The majority of the above patients had endometriosis stage rASRM I-II (72.7%), with peritoneal endometriosis being the most common phenotype of endometriosis (77.2%). Out of the 14 patients with a desire for future pregnancy, the majority (11/14, 78.5%) had an EFI score of 7-8. The prevalence of bilateral ovarian dermoid cysts was higher in women with both ovarian dermoid cysts and endometriosis in comparison to women with ovarian dermoid cysts without endometriosis (18% vs. 6.5%). Our study revealed that 26.5% of women with ovarian dermoid cysts also had endometriosis, a notably higher prevalence than observed in the general population. Clinicians should be aware of this co-existence, and preoperative counseling should be an integral part of the care plan for affected individuals, where the potential risks and the available options for fertility preservation should be discussed in detail.
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Affiliation(s)
| | - Nicolas Samartzis
- Department of Obstetrics and Gynecology, Cantonal Hospital of Schaffhausen, 8208 Schaffhausen, Switzerland; (N.S.); (M.E.)
| | - Markus Eberhard
- Department of Obstetrics and Gynecology, Cantonal Hospital of Schaffhausen, 8208 Schaffhausen, Switzerland; (N.S.); (M.E.)
| | - Georgios Grigoriadis
- 2nd University Department in Obstetrics and Gynecology, Hippokratio General Hospital, School of Medicine, Aristotle University of Thessaloniki, 54643 Thessaloniki, Greece; (G.G.)
| | - Dimosthenis Miliaras
- Laboratory of Histology and Embryology, School of Medicine, Aristotle University of Thessaloniki, 54643 Thessaloniki, Greece;
| | - Alexis Papanikolaou
- 2nd University Department in Obstetrics and Gynecology, Hippokratio General Hospital, School of Medicine, Aristotle University of Thessaloniki, 54643 Thessaloniki, Greece; (G.G.)
| | - Angelos Daniilidis
- 1st University Department in Obstetrics and Gynaecology, Papageorgiou General Hospital, School of Medicine, Aristotle University of Thessaloniki, 54643 Thessaloniki, Greece
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Pant A, Moar K, K Arora T, Maurya PK. Biomarkers of endometriosis. Clin Chim Acta 2023; 549:117563. [PMID: 37739024 DOI: 10.1016/j.cca.2023.117563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023]
Abstract
Endometriosis is one of the most severe female reproductive disorders, affecting 6-10% of women between 18 and 35. It is a gynaecological condition where endometrial tissue develops and settles outside the uterus. The aetiology of endometriosis is primarily influenced by genetic, epigenetic, and non-genetic variables, making it highly challenging to create a therapeutic therapy explicitly targeting the ectopic tissue. The delay in the treatment is due to the limitations in the diagnostic approaches, which are restricted to invasive techniques such as laparoscopy or laparotomy. This accords to 70% of the women being diagnosed at later stages. By understanding the subject, several treatment medications have been produced to lessen the disease's symptoms. Nevertheless, endometriosis cannot be permanently cured. A viable or persuasive standard screening test for endometriosis must be utilized in a clinical context. A helpful assessment method for the early identification of endometriosis could be biomarkers. A major research priority is the identification of a biomarker that is sensitive and specific enough for detecting endometriosis. The present article has reviewed studies published on the expression of biomarkers of endometriosis. It outlines various biomarkers from different sample types, such as serum/plasma and urine, in addition to tissue. This would provide a non-invasive approach to diagnosing the disease at the initial stages without any harmful repercussions. Future high-throughput advances in science and technology are anticipated to result in the creation of a potent remedy for endometriosis. To achieve successful outcomes, it is necessary to research the discussed biomarkers that demonstrate substantial results extensively.
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Affiliation(s)
- Anuja Pant
- Department of Biochemistry, Central University of Haryana, Mahendergarh 123031, India
| | - Kareena Moar
- Department of Biochemistry, Central University of Haryana, Mahendergarh 123031, India
| | - Taruna K Arora
- Reproductive Biology and Maternal Child Health Division, Indian Council of Medical Research, New Delhi 110029, India
| | - Pawan Kumar Maurya
- Department of Biochemistry, Central University of Haryana, Mahendergarh 123031, India.
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Sachs MK, Dedes I, El-Hadad S, Haufe A, Rueff D, Kohl Schwartz AS, Haeberlin F, von Orelli S, Eberhard M, Leeners B. Physical Activity in Women with Endometriosis: Less or More Compared with a Healthy Control? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6659. [PMID: 37681799 PMCID: PMC10487726 DOI: 10.3390/ijerph20176659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/15/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Endometriosis, i.e., endometrial-like tissue outside the uterus, is a chronic inflammatory condition affecting physical functioning. However, the specific levels of physical activity (PA) in the context of endometriosis and different disease symptoms remain unclear. METHODS This multi-center, cross-sectional study compared PA levels and influencing factors in endometriosis patients and non-endometriosis patients. Data were collected through questionnaires. Endometriosis was surgically confirmed. A statistical analysis was performed with appropriate tests. RESULTS The study included 460 women with endometriosis and 460 age-matched women without this condition. The two groups did not differ significantly in terms of age, education level, or stable partnership. Women with endometriosis exhibited lower PA levels, practicing fewer hours of sports weekly and climbing fewer stairs daily compared to the control group. These differences remained significant after controlling for confounding factors. Factors such as endometriosis, current dysmenorrhea, and depression were associated with decreased PA. CONCLUSIONS These findings suggest that women with endometriosis engage in less PA compared to those without this condition. These results highlight the need for interventions to promote increased PA in endometriosis patients and harness the associated health benefits. Further research is warranted to explore the underlying mechanisms and develop tailored exercise therapies for this population.
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Affiliation(s)
- Maike Katja Sachs
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (S.E.-H.); (A.H.); (D.R.); (B.L.)
| | - Ioannis Dedes
- Division of Gynecology and Obstetrics, Inselspital Bern, 3010 Bern, Switzerland;
| | - Samia El-Hadad
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (S.E.-H.); (A.H.); (D.R.); (B.L.)
| | - Annika Haufe
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (S.E.-H.); (A.H.); (D.R.); (B.L.)
| | - Dalia Rueff
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (S.E.-H.); (A.H.); (D.R.); (B.L.)
| | | | - Felix Haeberlin
- Department of Gynecology and Obstetrics, Canton Hospital St. Gallen, 9007 St. Gallen, Switzerland;
| | - Stephanie von Orelli
- Department of Gynecology and Obstetrics, Triemli Hospital Zurich, 8063 Zurich, Switzerland;
| | - Markus Eberhard
- Department of Gynecology and Obstetrics, Canton Hospital Schaffhausen, 8208 Schaffhausen, Switzerland;
| | - Brigitte Leeners
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland; (S.E.-H.); (A.H.); (D.R.); (B.L.)
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Zamani P, Hemati Z, Kelishadi R, Kolahdozan S, Dianatinasab M, Keikha M. Association between anogenital distance as a noninvasive index in the diagnosis and prognosis of reproductive disorder: A systematic review. Int J Reprod Biomed 2023; 21:599-618. [PMID: 37885976 PMCID: PMC10598470 DOI: 10.18502/ijrm.v21i8.14016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 01/03/2023] [Accepted: 06/07/2023] [Indexed: 10/28/2023] Open
Abstract
Background There are 2 measures of anogenital distance (AGD) in men and women. AGD has been used as an indicator of fetal androgen dysfunction and an adverse outcome in adulthood. Some studies have shown the association of AGD as a predictor in the diagnosis and prognosis of diseases and disorders. Objective To systematically summarize the latest evidence for presenting AGD as a new approach for prognosis and early diagnosis of diseases. Materials and Methods A systematic review of the available literature was performed using Medline via PubMed, Scopus, and ISI Web of Knowledge up to July 2021, using search terms "anogenital distance" OR "anogenital index" OR "ano genital distance" OR "ano genital index". Language restrictions were not imposed. Results After reviewing the retrieved articles, 47 unique studies were included in this systematic review. Different outcomes, including endometriosis, prostate cancer, polycystic ovary syndrome, pelvic organ prolapse, hypospadias, cryptorchidism, fertility and semen parameters, maternal and birth development, and ovarian and gynecological-related disorders, have been studied in the included evidence. A negative association was observed between AGD and endometriosis and hypospadias and a positive association between AGD and prostate cancer, polycystic ovary syndrome, male fetal gender, and fertility parameters. Conclusion Using quantitative indicators such as AGD may be a useful clinical tool for the diagnosis of diseases. Although many studies have shown an association between AGD and diseases, some factors, including different measurement methods, different measurement tools, age, and different definitions of AGD, can be involved in the variation of AGD.
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Affiliation(s)
- Parisa Zamani
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Zeinab Hemati
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sakineh Kolahdozan
- Clinical Research Development Unit, Bahar Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mostafa Dianatinasab
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Malaysia
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Mojtaba Keikha
- Department of Biostatistics and Epidemiology, Faculty of Public Health, Kerman University of Medical Sciences, Kerman, Iran
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Romaniuk A, Oniszczenko W. Resilience, anxiety, depression, and life satisfaction in women suffering from endometriosis: a mediation model. PSYCHOL HEALTH MED 2023; 28:2450-2461. [PMID: 36998108 DOI: 10.1080/13548506.2023.2197649] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/27/2023] [Indexed: 04/01/2023]
Abstract
The main goal of this cross-sectional study was to assess the relationship between resilience and life satisfaction in women suffering from endometriosis and examine anxiety and depression as mediators in this relationship. The study sample included 349 Caucasian women aged from 18 to 56 years (M = 32.94; SD = 6.74) suffering from endometriosis surgically diagnosed and histologically confirmed. The life satisfaction level was assessed by the Satisfaction with Life Scale (SWLS). Unspecific anxiety was evaluated using the General Anxiety Disorder-7 scale (GAD-7). Depression symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Resilience was measured using the Resilience Assessment Scale (SPP-25). Life satisfaction correlated negatively with anxiety and depression, but positively with resilience. Resilience correlated negatively with anxiety and depression. Anxiety and resilience accounted for 25% of the life satisfaction variance. Depression and resilience explained 35% of the variance in life satisfaction. Among resilience components, personal coping skills, tolerance of negative affect, tolerance of failures and treating life as a challenge, openness to new experiences and a sense of humour, and optimistic life attitude and ability to mobilize in difficult situations were the best predictors of life satisfaction. Anxiety and depression may serve as mediators in the relationship between resilience and life satisfaction. Our results suggested that resilience may be related to life satisfaction in women suffering from endometriosis directly and indirectly as mediated by anxiety and depression.
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Barberis N, Cannavò M, Cuzzocrea F, Saladino V, Verrastro V. "Illness perceptions and factors of distress as mediators between trait emotional intelligence and quality of life in endometriosis". PSYCHOL HEALTH MED 2023; 28:1818-1830. [PMID: 36747368 DOI: 10.1080/13548506.2023.2175878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/22/2023] [Indexed: 02/08/2023]
Abstract
Past findings highlighted the presence of distress symptoms and poor quality of life in people with endometriosis. Several studies showed that trait Emotional Intelligence (trait EI) is a key component of one's wellbeing, whilst Illness Perceptions may play an important role in psychological distress and perceived quality of life. The current study sought to test the hypothesis that an association between trait EI and Quality of Life in individuals with endometriosis would be mediated by Illness Perceptions, examining also the relations with General Distress (depression, anxiety, and stress). 364 women with endometriosis aged between 18 and 58 years old (M = 33.87; SD = 8.64) filled a protocol to assess Trait EI, Illness Perceptions, General Distress, and Quality of Life. Structural Equation Modelling was used to assess the relationship between the observed variables. Illness Perception was a mediator in the relationship between Trait EI, General Distress, and Quality of Life. Moreover, General Distress was a mediator between Trait EI and Quality of Life, and between Illness Perceptions and Quality of Life. Results showed that both Trait EI and Illness perceptions are key components for levels of distress and quality of life in women with endometriosis.
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Affiliation(s)
- Nadia Barberis
- Dipartimento di Scienze della Salute, Università degli Studi MagnaGraecia di Catanzaro, viale Europa, Catanzaro (CZ), Italy
| | - Marco Cannavò
- Dipartimento di Scienze della Salute, Università degli Studi MagnaGraecia di Catanzaro, viale Europa, Catanzaro (CZ), Italy
| | - Francesca Cuzzocrea
- Dipartimento di Scienze della Salute, Università degli Studi MagnaGraecia di Catanzaro, viale Europa, Catanzaro (CZ), Italy
| | - Valeria Saladino
- Dipartimento di Scienze umane, sociali e della salute, Università degli studi di Cassino e del Lazio Meridionale, viale dell'Università, Cassino (FR), Italy
| | - Valeria Verrastro
- Dipartimento di Scienze della Salute, Università degli Studi MagnaGraecia di Catanzaro, viale Europa, Catanzaro (CZ), Italy
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40
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Luo L, Zhou H, Wang S, Pang M, Zhang J, Hu Y, You J. The Application of Nanoparticle-Based Imaging and Phototherapy for Female Reproductive Organs Diseases. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023:e2207694. [PMID: 37154216 DOI: 10.1002/smll.202207694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/06/2023] [Indexed: 05/10/2023]
Abstract
Various female reproductive disorders affect millions of women worldwide and bring many troubles to women's daily life. Let alone, gynecological cancer (such as ovarian cancer and cervical cancer) is a severe threat to most women's lives. Endometriosis, pelvic inflammatory disease, and other chronic diseases-induced pain have significantly harmed women's physical and mental health. Despite recent advances in the female reproductive field, the existing challenges are still enormous such as personalization of disease, difficulty in diagnosing early cancers, antibiotic resistance in infectious diseases, etc. To confront such challenges, nanoparticle-based imaging tools and phototherapies that offer minimally invasive detection and treatment of reproductive tract-associated pathologies are indispensable and innovative. Of late, several clinical trials have also been conducted using nanoparticles for the early detection of female reproductive tract infections and cancers, targeted drug delivery, and cellular therapeutics. However, these nanoparticle trials are still nascent due to the body's delicate and complex female reproductive system. The present review comprehensively focuses on emerging nanoparticle-based imaging and phototherapies applications, which hold enormous promise for improved early diagnosis and effective treatments of various female reproductive organ diseases.
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Affiliation(s)
- Lihua Luo
- College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang, 310058, P. R. China
| | - Huanli Zhou
- College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang, 310058, P. R. China
| | - Sijie Wang
- College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang, 310058, P. R. China
| | - Mei Pang
- College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang, 310058, P. R. China
| | - Junlei Zhang
- College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang, 310058, P. R. China
| | - Yilong Hu
- College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang, 310058, P. R. China
| | - Jian You
- College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang, 310058, P. R. China
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Gete DG, Doust J, Mortlock S, Montgomery G, Mishra GD. Impact of endometriosis on women's health-related quality of life: A national prospective cohort study. Maturitas 2023; 174:1-7. [PMID: 37182389 DOI: 10.1016/j.maturitas.2023.04.272] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 04/14/2023] [Accepted: 04/30/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To examine the association between endometriosis and women's health-related quality of life (HRQoL). STUDY DESIGN This study included 3728 women born in 1973-78 using data from the Australian Longitudinal Study on Women's Health. Women with endometriosis were identified using self-reported longitudinal surveys linked to administrative health records. A mixed effect model with only random intercept and generalised estimating equations with binary logistic regressions were used to examine the association between endometriosis and health-related quality of life over eight time points. Each HRQoL scale was analysed in terms of binary outcomes by comparing women who had a lower HRQoL (scoring below the 25th percentile) with those who had a higher HRQoL (scoring above the 25th percentile). MAIN OUTCOME MEASURES Women's HRQoL was assessed using the 36-item Short Form Survey every 3 years from 1996 to 2018. RESULTS Endometriosis was associated with significantly worse reports of HRQoL over time. In the comparison against women without endometriosis, the following adjusted odds ratios (95 % confidence intervals) were calculated for women with endometriosis having worse scores on the eight domains of the Short Form Survey: physical functioning 1.33 (1.19, 1.50), role physical 1.57 (1.41, 1.74), bodily pain 1.65 (1.48, 1.82), general health 1.61 (1.42, 1.81), vitality 1.38 (1.23, 1.55), social functioning 1.38 (1.25, 1.53), role emotion 1.19 (1.06, 1.33), mental health 1.32 (1.18, 1.48). Women with endometriosis also had significantly lower physical health 1.68 (1.51, 1.88) and mental health components scores 1.28 (1.14, 1.44). CONCLUSIONS Endometriosis is associated with worse physical, mental, and social functioning and well-being. Bodily pain was the most affected HRQoL domain.
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Affiliation(s)
- Dereje G Gete
- Australian Women and Girls' Health Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, 266 Herston Road, Brisbane, Queensland 4006, Australia.
| | - Jenny Doust
- Australian Women and Girls' Health Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, 266 Herston Road, Brisbane, Queensland 4006, Australia.
| | - Sally Mortlock
- Institute for Molecular Bioscience, The University of Queensland, 306 Carmody Road, Brisbane, Queensland 4072, Australia.
| | - Grant Montgomery
- Institute for Molecular Bioscience, The University of Queensland, 306 Carmody Road, Brisbane, Queensland 4072, Australia.
| | - Gita D Mishra
- Australian Women and Girls' Health Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, 266 Herston Road, Brisbane, Queensland 4006, Australia.
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Westwood S, Fannin M, Ali F, Thigpen J, Tatro R, Hernandez A, Peltzer C, Hildebrand M, Fernandez-Pacheco A, Raymond-Lezman JR, Jacobs RJ. Disparities in Women With Endometriosis Regarding Access to Care, Diagnosis, Treatment, and Management in the United States: A Scoping Review. Cureus 2023; 15:e38765. [PMID: 37303418 PMCID: PMC10250135 DOI: 10.7759/cureus.38765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Endometriosis is a benign gynecological condition that elicits chronic pain in 2-10% of reproductive-age women in the United States and exists in approximately 50% of women with infertility. It creates complications such as hemorrhage and uterine rupture. Historically, the gynecologic symptoms of endometriosis have been associated with economic strain and inferior quality of life. It is suspected that endometriosis diagnosis and treatment are affected by health disparities throughout gynecological care. The goal of this review was to collate and report the current evidence on potential healthcare disparities related to endometriosis diagnosis, treatment, and care across race, ethnicity, and socioeconomic status. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched the Excerpta Medica Database (EMBASE), Medline Ovid, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and PsycInfo databases for relevant articles on the topic. Eligibility was established a priori to include articles written in English, published between 2015-2022, and reported on cohort, cross-sectional, or experimental studies conducted in the United States. Initially, 328 articles were found, and after screening and quality assessment, four articles were retained for the final review. Results indicated that White women had higher rates of minimally invasive procedures versus open abdominal surgeries than non-White women. White women also had fewer surgical complications compared to all other races and ethnicities. Black women had higher rates of perioperative complications, higher mortality, and spent more time in the perioperative stage than any other race or ethnicity. In the management of endometriosis, the limited research available showed that all non-White women encountered an increased risk of perioperative and postoperative complications compared to White women. More research is needed to explore diagnostic and treatment disparities beyond surgical management, socioeconomic barriers, and improved representation of racial and ethnic minority women.
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Affiliation(s)
- Shannon Westwood
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Mackenzie Fannin
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Fadumo Ali
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Justice Thigpen
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Rachel Tatro
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Amanda Hernandez
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Cadynce Peltzer
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Mariah Hildebrand
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Alexnys Fernandez-Pacheco
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Jonathan R Raymond-Lezman
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Robin J Jacobs
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
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Lindgren S, Richardson L. Endometriosis pain and epistemic community: Mapping discourses in online discussions among sufferers. Soc Sci Med 2023; 326:115889. [PMID: 37121071 DOI: 10.1016/j.socscimed.2023.115889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 03/30/2023] [Accepted: 04/02/2023] [Indexed: 05/02/2023]
Abstract
We focused in this study on how the private experience of pain is made public through online discourse by sufferers of endometriosis. Empirically, we analyse two highly active endometriosis communities on the online social platform Reddit. Drawing on a mixed-methods design, we leverage large-scale social data, and a combination of computational and interpretive approaches for text analysis to study the role and shape of interactions relating to 'pain' for the formation of epistemic community online around endometriosis. The dataset, consisting of 70,817 forum posts and comments, was collected in May of 2021. Our study shows how pain becomes meaningful for endometriosis sufferers in relation to a multidimensional discursive space of words and concepts that are used to express it. Pain was frequently disguised, underplayed or hidden altogether, from fears of misunderstanding, medical dismissal, and embarrassment. Clearly, peer validation can be found in the relative anonymity of Reddit discussions. While the experience of pain is individual and subjective, when communities share similar experiences this reinforces patient ownership of the pain, which in turn supports the epistemic authority of the patient collective. A detailed understanding of how and why pain is discussed in online spaces has much to contribute more broadly to discussions of experiential collective knowledge production among individuals with endometriosis and other chronic illnesses.
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Affiliation(s)
- Simon Lindgren
- DIGSUM, Department of Sociology, Umeå University, 901 87, Umeå, Sweden.
| | - Lorna Richardson
- School of Art, Media and American Studies, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
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Ashkenazi MS, Huseby OL, Kroken G, Trocha M, Henriksson A, Jasiak H, Cuartas K, Loschiavo A, Kuhn I, Støve D, Grindahl H, Latour E, Melbø M, Holstad K, Kwiatkowski S. The Clinical Presentation of Endometriosis and Its Association to Current Surgical Staging. J Clin Med 2023; 12:jcm12072688. [PMID: 37048771 PMCID: PMC10095514 DOI: 10.3390/jcm12072688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/25/2023] [Accepted: 04/02/2023] [Indexed: 04/14/2023] Open
Abstract
(1) Despite its high prevalence, the diagnostic delay of endometriosis is still estimated to be about 7 years. The objective of the present study is to understand the symptomatology of endometriosis in patients across various countries and to assess whether the severity of symptoms correlates with the diagnosed stage of disease. (2) An international online survey collected self-reported responses from 2964 participants from 59 countries. Finalization of the questionnaire and its distribution was achieved by cooperation with various organizations and centers around the globe. (3) Chronic pain presentation remarkably increased between Stage 1 and 2 (16.2% and 32.2%, respectively). The prevalence of pain only around and during menstruation was negatively correlated to the stage, presenting with 15.4% and 6.9% in Stages 1 and 4, respectively. Atypical presentation of pain was most commonly reported in stage 4 (11.4%). Pain related solely to triggering factors was the most uncommon presentation of pain (3.2%). (4) Characteristics of pain and quality of life tend to differ depending on the reported stage of the endometriosis. Further research may allow a better stage estimation and identification of patients with alarming symptomatic presentation indicative of a progressive stage, even those that are not yet laparoscopically diagnosed.
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Affiliation(s)
- Matilda Shaked Ashkenazi
- Department of Obstetrics and Gynaecology, Pomeranian Medical University in Szcezcin, 70-204 Szczecin, Poland
| | - Ole Linvåg Huseby
- Department of Obstetrics and Gynaecology, Pomeranian Medical University in Szcezcin, 70-204 Szczecin, Poland
| | - Gard Kroken
- Fiskeridirektoratet, Strandgaten, 5004 Bergen, Norway
| | - Marcela Trocha
- Department of Obstetrics and Gynaecology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Aurora Henriksson
- Department of Obstetrics and Gynaecology, Pomeranian Medical University in Szcezcin, 70-204 Szczecin, Poland
| | - Hanna Jasiak
- Department of Obstetrics and Gynaecology, Pomeranian Medical University in Szcezcin, 70-204 Szczecin, Poland
| | - Karen Cuartas
- Department of Obstetrics and Gynaecology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Alessandra Loschiavo
- The Department of Woman, Child, and General and Specialized Surgery, Università della Campania Luigi Vanvitelli, 81100 Caserta, Italy
| | - Isabella Kuhn
- Musculoskeletal University Center Munich, Department of Orthopaedics and Trauma Surgery, University Hospital, LMU Munich, 80336 Munich, Germany
| | - Dina Støve
- Department of Obstetrics and Gynaecology, Pomeranian Medical University in Szcezcin, 70-204 Szczecin, Poland
| | - Hanna Grindahl
- Department of Obstetrics and Gynaecology, Pomeranian Medical University in Szcezcin, 70-204 Szczecin, Poland
| | - Emilia Latour
- Department of Obstetrics and Gynaecology, Pomeranian Medical University in Szcezcin, 70-204 Szczecin, Poland
| | - Mathias Melbø
- Department of Obstetrics and Gynaecology, Pomeranian Medical University in Szcezcin, 70-204 Szczecin, Poland
| | - Katrine Holstad
- Department of Obstetrics and Gynaecology, Pomeranian Medical University in Szcezcin, 70-204 Szczecin, Poland
| | - Sebastian Kwiatkowski
- Department of Obstetrics and Gynaecology, Pomeranian Medical University in Szcezcin, 70-204 Szczecin, Poland
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45
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Van Niekerk LM, Dell B, Johnstone L, Matthewson M, Quinn M. Examining the associations between self and body compassion and health related quality of life in people diagnosed with endometriosis. J Psychosom Res 2023; 167:111202. [PMID: 36812662 DOI: 10.1016/j.jpsychores.2023.111202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE An understanding of the role that self and body compassion may play as protective mechanisms in the context of psychological and physical health conditions is steadily increasing. The availability of research pertaining to their role in mitigating the health-related quality of life (HRQoL) impacts associated with endometriosis is limited. The current study examined the influence of self and body compassion on HRQoL in people diagnosed with endometriosis. METHODS Individuals aged 18+ years (n = 318), assigned female at birth, with a self-reported diagnosis of symptomatic endometriosis completed an online cross-sectional survey. Participant demographics and endometriosis-related data was collected in addition to self and body compassion and HRQoL. Standard multiple regression analyses (MRA) were conducted to estimate the proportion of variance in HRQoL that can be accounted for by self and body compassion in endometriosis. RESULTS Self and body compassion were both associated with higher HRQoL across all domains. However, when both self and body compassion were entered into a regression, only body compassion was significantly associated with HRQoL domains of physical wellbeing, bodily pain, vitality, social engagement and general HRQoL; self-compassion explained no unique variance. In the domain of emotional wellbeing, when both self and body compassion were entered into a regression, both were significantly associated, and explained unique variance. CONCLUSIONS It is suggested that future psychological interventions for individuals living with endometriosis should emphasise building general self-compassionate abilities with a subsequent specific focus on strategies designed to improve body compassion.
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Affiliation(s)
- L M Van Niekerk
- University of Tasmania, College of Health & Medicine, School of Psychological Science, Hobart, Australia.
| | - B Dell
- University of Tasmania, College of Health & Medicine, School of Psychological Science, Hobart, Australia
| | - L Johnstone
- University of Tasmania, College of Health & Medicine, School of Psychological Science, Hobart, Australia
| | - M Matthewson
- University of Tasmania, College of Health & Medicine, School of Psychological Science, Hobart, Australia
| | - M Quinn
- University of Tasmania, College of Health & Medicine, School of Psychological Science, Hobart, Australia
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46
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Helfenstein F, Kohl Schwartz AS, Imesch P, Rauchfuss M, Wölfler MM, Haeberlin F, von Orelli S, Leeners B. Comparison of male and female perspective in couples involved in sexual relationships and facing endometriosis. Sex Med 2023; 11:qfad013. [PMID: 37256216 PMCID: PMC10226817 DOI: 10.1093/sexmed/qfad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 06/01/2023] Open
Abstract
Background While the sexuality of patients with endometriosis is an established topic in research, the possible effect of endometriosis on partnership sexuality has come to the fore only recently. To improve counseling, more information is needed on how both partners experience sexuality in the context of endometriosis. Aim Previous research regarding endometriosis and sexuality normally focused on one partner to explore couples' intimate relations, whereas this study provides a comparison on both partners' perspectives on their common sexuality. Methods An overall 302 couples received a questionnaire based on the Brief Index of Sexual Functioning and Sexual History Form, which was modified by endometriosis specialists to better focus on endometriosis-specific aspects. To detect different perspectives on common sexuality within the couple, the Wilcoxon test and the Pearson chi-square test were performed. Outcomes Various aspects of couple sexuality were assessed by both partners to investigate divergent perspectives between the man and the woman within a couple. Results On one hand, male and female partners seem to have divergent perspectives on sexual satisfaction in general, desired frequency of sexual contacts, and the question of the female partner engaging in sexual activity despite discomfort. On the other, they have similar perspectives on who takes initiative in sexual contacts, satisfaction with variety in the sexual relationship, and the impact of sexual limitations on their satisfaction within the partnership. Clinical implications Endometriosis research addressing issues related to sexuality should include male partners; the same applies to consulting women with endometriosis in the context of their relationships rather than as individuals. Strengths and Limitations This is the first analysis conducted on a larger scale of data from both partners in couples dealing with endometriosis. As it provides quantitative information only, some qualitative information remains unexplored. Conclusion As both partners showed tendencies to overestimate their partners' sexual satisfaction and had different perspectives on sensitive topics in sexuality, such as the female partner engaging in sexual activity despite discomfort, addressing sexual communication could be a starting point in counseling couples dealing with endometriosis.
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Affiliation(s)
- Fabienne Helfenstein
- Department of Reproductive Endocrinology, University Hospital Zurich, 8910 Zurich, Switzerland
| | - Alexandra S Kohl Schwartz
- Department of Reproductive Endocrinology, University Hospital Zurich, 8910 Zurich, Switzerland
- Department of Reproductive Endocrinology, Canton Hospital Lucerne, 6000 Lucerne, Switzerland
| | - Patrick Imesch
- Department of Gynecology, University Hospital Zurich, 8910 Zurich, Switzerland
| | | | - Monika M Wölfler
- Division of Gynecology, Endocrinology, and Reproductive Medicine, Department of Obstetrics and Gynecology, University Hospital Graz, 8036 Graz, Austria
| | - Felix Haeberlin
- Department of Gynecology and Obstetrics, Canton Hospital St Gallen, 9000 St Gallen, Switzerland
| | - Stefanie von Orelli
- Department of Gynecology and Obstetrics, Triemli Hospital Zurich, 8063 Zurich, Switzerland
| | - Brigitte Leeners
- Corresponding author: Department of Reproductive Endocrinology, University Hospital Zürich, Frauenklinikstr 10, 8910 Zürich, Switzerland.
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Elias MH, Lazim N, Sutaji Z, Abu MA, Abdul Karim AK, Ugusman A, Syafruddin SE, Mokhtar MH, Ahmad MF. HOXA10 DNA Methylation Level in the Endometrium Women with Endometriosis: A Systematic Review. BIOLOGY 2023; 12:biology12030474. [PMID: 36979165 PMCID: PMC10045497 DOI: 10.3390/biology12030474] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023]
Abstract
Endometriosis is an inflammatory chronic systemic disease resulting in pelvic pain and infertility. However, despite a high prevalence of endometriosis, disease identification is still insufficient, and a high percentage of misdiagnosing was observed. Hence, a comprehensive study needs to be done to improve our understanding of the pathogenesis of endometriosis. Aberrant hypermethylation of HOXA10 has been reported to play a role in endometriosis. Thus, a comprehensive literature search was conducted to identify the DNA methylation level of HOXA10 among endometriosis patients across populations. The literature search was done using PubMed, Scopus, EBSCOhost, and Science Direct applying (HOXA10 OR "homeobox A10" OR "HOXA-10" OR HOX1) AND ("DNA methylation" OR methylation) AND (endometriosis OR endometrioma) as keywords. From 491 retrieved studies, five original articles investigating the DNA methylation level of HOXA10 from endometrium tissues among endometriosis women were included. All five included studies were classified as high-quality studies. High HOXA10 DNA methylation level was observed in the endometrium tissue of women with endometriosis in all the included studies. The secretory phase was identified as the best sampling time for HOXA10 DNA methylation study in endometriosis, and the most studied DNA methylation site is the promoter region of the HOXA10. However, more studies are needed to expose the HOXA10 mechanism in the pathogenesis of endometriosis.
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Affiliation(s)
- Marjanu Hikmah Elias
- Advanced Reproductive Centre (ARC) HCTM UKM, Department of Obstetrics & Gynecology, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
- Faculty of Medicine & Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Negeri Sembilan, Malaysia
| | - Nurunnajah Lazim
- Advanced Reproductive Centre (ARC) HCTM UKM, Department of Obstetrics & Gynecology, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Zulazmi Sutaji
- Advanced Reproductive Centre (ARC) HCTM UKM, Department of Obstetrics & Gynecology, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
- Faculty of Medicine & Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Negeri Sembilan, Malaysia
| | - Mohammad Azrai Abu
- Advanced Reproductive Centre (ARC) HCTM UKM, Department of Obstetrics & Gynecology, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Abdul Kadir Abdul Karim
- Advanced Reproductive Centre (ARC) HCTM UKM, Department of Obstetrics & Gynecology, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Azizah Ugusman
- Department of Physiology, Faculty of Medicine, National Univeristy of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Saiful Effendi Syafruddin
- Medical Molecular Biology Institute, National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Mohd Helmy Mokhtar
- Department of Physiology, Faculty of Medicine, National Univeristy of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Mohd Faizal Ahmad
- Advanced Reproductive Centre (ARC) HCTM UKM, Department of Obstetrics & Gynecology, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
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Saad M, Rafiq A, Jamil A, Sarfraz Z, Sarfraz A, Robles-Velasco K, Cherrez-Ojeda I. Addressing the Endometriosis Knowledge Gap for Improved Clinical Care—A Cross-Sectional Pre- and Post-Educational-Intervention Study among Pakistani Women. Healthcare (Basel) 2023; 11:healthcare11060809. [PMID: 36981467 PMCID: PMC10048359 DOI: 10.3390/healthcare11060809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/23/2023] [Accepted: 03/08/2023] [Indexed: 03/11/2023] Open
Abstract
This study explored the baseline knowledge and symptoms associated with endometriosis, educated women about endometriosis, and documented the improvement in endometriosis knowledge. A brief intervention with an educational brochure on endometriosis was administered among 303 female participants. A paired-sample t-test and one-way ANOVA were run to compute endometriosis knowledge scores. In total, 49.5% of the participants had consistent access to annual healthcare, 25.1% were healthcare workers, and 45.2% had an undergraduate education. The entire sample had a pre-test endometriosis knowledge score of 4.2 (SD = 2.48), and the score was 6.3 (SD = 2.3) on the post-test. One-way ANOVA yielded no significant improvement in knowledge scores across the groups with consistent and inconsistent access to annual healthcare, despite a significant overall increase in scores (t = 16.63, df = 302, p < 0.001). We identified a significant improvement in the knowledge concerning endometriosis. Educational strategies among women who are menstruating are essential for addressing diagnostic delays and bridging the endometriosis knowledge gap.
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Affiliation(s)
- Muhammad Saad
- Department of Research, Services Institute of Medical Sciences, Lahore 54000, Pakistan
| | - Aiman Rafiq
- Department of Research, Nishtar Medical University, Multan 66000, Pakistan
| | - Anam Jamil
- Department of Research, Continental Medical College, Lahore 54000, Pakistan
| | - Zouina Sarfraz
- Department of Research and Publications, Fatima Jinnah Medical University, Lahore 54000, Pakistan
| | - Azza Sarfraz
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi 74800, Pakistan
- Correspondence: (A.S.); (I.C.-O.)
| | - Karla Robles-Velasco
- Department of Allergy and Pulmonology, Universidad Espíritu Santo, Samborondón 092301, Ecuador
| | - Ivan Cherrez-Ojeda
- Department of Allergy and Pulmonology, Universidad Espíritu Santo, Samborondón 092301, Ecuador
- Correspondence: (A.S.); (I.C.-O.)
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Rossi M, Seidita I, Vannuccini S, Prisinzano M, Donati C, Petraglia F. Epigenetics, endometriosis and sex steroid receptors: An update on the epigenetic regulatory mechanisms of estrogen and progesterone receptors in patients with endometriosis. VITAMINS AND HORMONES 2023; 122:171-191. [PMID: 36863793 DOI: 10.1016/bs.vh.2023.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Endometriosis is a benign gynecological disease affecting ∼10% of reproductive-aged women and is defined as the presence of endometrial glands and stroma outside the uterine cavity. Endometriosis can cause a variety of health problems, from pelvic discomfort to catamenial pneumothorax, but it's mainly linked with severe and chronic pelvic pain, dysmenorrhea, and deep dyspareunia, as well as reproductive issues. The pathogenesis of endometriosis involves an endocrine dysfunction, with estrogen dependency and progesterone resistance, and inflammatory mechanism activation, together with impaired cell proliferation and neuroangiogenesis. The present chapter aims to discuss the main epigenetic mechanisms related to estrogen receptors (ERs) and progesterone receptors (PRs) in patients with endometriosis. There are numerous epigenetic mechanisms participating in endometriosis, regulating the expression of the genes encoding these receptors both indirectly, through the regulation of transcription factors, and directly, through DNA methylation, histone modifications, micro RNAs and long noncoding RNAs. This represents an open field of investigation, which may lead to important clinical implications such as the development of epigenetic drugs for the treatment of endometriosis and the identification of specific and early biomarkers for the disease.
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Affiliation(s)
- Margherita Rossi
- Obstetrics and Gynecology, and Molecular Biology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Isabelle Seidita
- Obstetrics and Gynecology, and Molecular Biology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Silvia Vannuccini
- Obstetrics and Gynecology, and Molecular Biology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Matteo Prisinzano
- Obstetrics and Gynecology, and Molecular Biology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Chiara Donati
- Obstetrics and Gynecology, and Molecular Biology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Felice Petraglia
- Obstetrics and Gynecology, and Molecular Biology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy.
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de Barros Meneguetti M, Silva FP, Dias GN, Benetti-Pinto CL, Angerame Yela D. Assessment of quality of life and psychological repercussions in women with endometriosis according to pain intensity. PSYCHOL HEALTH MED 2023; 28:660-669. [PMID: 36072985 DOI: 10.1080/13548506.2022.2121972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The objective is to evaluate quality of life, anxiety, and depression in women with endometriosis, and to correlate these parameters with pain intensity. This multicenter cross-sectional study was conducted on 102 women with endometriosis from 2017 to 2020. The women were divided into two groups according to the pain intensity: group 1 (severe pain, 62 women) and group 2 (mild/moderate pain, 40 women). The Endometriosis Health Profile Questionnaire, Beck Anxiety Inventory, and Beck Depression Inventory were used to assess quality of life and levels of anxiety and depression, respectively. In both groups, mean age and mean body mass index were similar (p˃ 0.5). Most women had deep endometriosis and were on treatment, but group 2 had a longer treatment time (p = 0.044). Group 1 exhibited more depression and anxiety than group 2 (17.1 ± 9.98 vs. 11.15 ± 9.25, p = 0.003 and 23.71 ± 12.92 vs 12.58 ± 10.53, p = 0.001, respectively). Women with high pain had a significantly worse quality of life than those with low pain (48.88 ± 16.02 vs. 23.32 ± 15.93, p < 0.001). Women with endometriosis and high pain intensity have a worse quality of life, and more severe levels of anxiety and depression.
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Affiliation(s)
| | - Fabia Pigatti Silva
- School of Medical Sciences, University of Campinas (UNICAMP), Campinas (SP), Brazil
| | | | | | - Daniela Angerame Yela
- Medical Sciences, University of Campinas (Unicamp), Campinas (SP), Brazil.,Department of Gynecology and Obstetrics, School of Medical Sciences, University of Campinas (Unicamp), Campinas (SP), Brazil
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