Consensus on current management of endometriosis

What is the global consensus on the classification of endometriosis that considers the views of women with endometriosis? We have produced an international consensus statement on the classification of endometriosis through systematic appraisal of evidence and a consensus process that included representatives of national and international, medical and non-medical societies, patient organizations, and companies with an interest in endometriosis. Classification systems of endometriosis, developed by several professional organizations, traditionally have been based on lesion appearance, pelvic adhesions, and anatomic location of disease. One system predicts fertility outcome and none predicts pelvic pain, response to medications, disease recurrence, risks for associated disorders, quality of life measures, and other endpoints important to women and health care providers for guiding appropriate therapeutic options and prognosis. A consensus meeting, in conjunction with pre- and post-meeting processes, was undertaken. A consensus meeting was held on 30 April 2014 in conjunction with the World Endometriosis Society's 12th World Congress on Endometriosis. Rigorous pre- and post-meeting processes, involving 55 representatives of 29 national and international, medical and non-medical organizations from a range of disciplines, led to this consensus statement. A total of 28 consensus statements were made. Of all, 10 statements had unanimous consensus, however none of the statements was made without expression of a caveat about the strength of the statement or the statement itself. Two statements did not achieve majority consensus. The statements covered women's priorities, aspects of classification, impact of low resources, as well as all the major classification systems for endometriosis. Until better classification systems are developed, we propose a classification toolbox (that includes the revised American Society for Reproductive Medicine and, where appropriate, the Enzian and Endometriosis Fertility Index staging systems), that may be used by all surgeons in each case of surgery undertaken for women with endometriosis. We also propose wider use of the World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonisation Project surgical and clinical data collection tools for research to improve classification of endometriosis in the future, of particular relevance when surgery is not undertaken. This consensus process differed from that of formal guideline development, although based on the same available evidence. A different group of international experts from those participating in this process may have yielded subtly different consensus statements. This is the first time that a large, global, consortium-representing 29 major stake-holding organizations, from 19 countries - has convened to systematically evaluate the best available evidence on the classification of endometriosis and reach consensus. In addition to 21 international medical organizations and companies, representatives from eight national endometriosis organizations were involved, including lay support groups, thus generating and including input from women who suffer from endometriosis in an endeavour to keep uppermost the goal of optimizing quality of life for women with endometriosis. The World Endometriosis Society convened and hosted the consensus meeting. Financial support for participants to attend the meeting was provided by the organizations that they represented. There was no other specific funding for this consensus process. Mauricio Abrao is an advisor to Bayer Pharma, and a consultant to AbbVie and AstraZeneca; G David Adamson is the Owner of Advanced Reproductive Care Inc and Ziva and a consultant to Bayer Pharma, Ferring, and AbbVie; Deborah Bush has received travel grants from Fisher & Paykel Healthcare and Bayer Pharmaceuticals; Linda Giudice is a consultant to AbbVie, Juniper Pharmaceutical, and NextGen Jane, holds research grant from the NIH, is site PI on a clinical trial sponsored by Bayer, and is a shareholder in Merck and Pfizer; Lone Hummelshoj is an unpaid consultant to AbbVie; Neil Johnson has received conference expenses from Bayer Pharma, Merck-Serono, and MSD, research funding from AbbVie, and is a consultant to Vifor Pharma and Guerbet; Jörg Keckstein has received a travel grant from AbbVie; Ludwig Kiesel is a consultant to Bayer Pharma, AbbVie, AstraZeneca, Gedeon Richter, and Shionogi, and holds a research grant from Bayer Pharma; Luk Rombauts is an advisor to MSD, Merck Serono, and Ferring, and a shareholder in Monash IVF. The following have declared that they have nothing to disclose: Kathy Sharpe Timms; Rulla Tamimi; Hugh Taylor. N/A.

The aim of this paper is to examine the view of women's life course, especially in their occupational careers. A survey was conducted on the relation between the survey objects' ideal image of a women's life course and that of their mother's, and their mother's work style. Data from 662 female university students in Kawasaki City, Kanagawa Prefecture was collected. The findings are as follows:(1) The students grew up modeling themselves on their parents.(2) The student's ideal image of a women's life course is related to that of the parent's expectations of their daughter.

The life course of Chilean women has experienced profound transformations in the past decades. It has been argued that transitions to marriage and motherhood are being postponed as they are experienced by women at an older age and are becoming events that characterize an increasingly smaller part of the female population. These changes have been often interpreted as part of a process of individualization that would have reconfigured the cultural norms and social practices regarding gender roles and family formation in Chilean society. Nevertheless, the prevalence and diversification of the practices and norms that shape the transitions to marriage and motherhood at an empirical level remain unexplored. This article aims to assess the individualization of the life course of women in Chile by empirically analysing the destandardization of the practices and norms that shape the transitions to marriage and motherhood. By analysing data from the Encuesta Nacional Bicentenario Universidad Católica – Adimark (2009), it demonstrates that changes in the prevalence of the transitions to marriage and motherhood and the diversification of the practices and norms that shape their timing are ambivalent regarding destandardization. These results suggest that the life course of women in Chile is becoming individualized to some extent, but that this trend of cultural and social change is not consistent and uniform, but rather partial and fragmented, non-linear, and significantly conditioned by the social structure.

BackgroundStudies aimed at understanding the association between induced abortion and HIV are scarce and differ on the direction of the association. This paper aims to show the prevalence of induced abortion in a sample of pregnancies of women living and not living with HIV/Aids, determining variables associated with pregnancy termination and linked to the life course of women and to the specific context of the pregnancy.MethodsData came from a cross-sectional study, using interviewer-administered questionnaire, developed with women that attended public health services in Porto Alegre, Brazil. A generalized estimating equation model with logit link measured the association between determinants and abortion.FindingsThe final sample was composed of 684 women living with HIV/Aids (2,039 pregnancies) and 639 women not living with HIV/Aids (1,539 pregnancies). The prevalence of induced abortion among pregnancies in women living with HIV/Aids was 6.5%, while in women not living with HIV/Aids was 2.9%. Among women living with HIV/Aids, the following were associated with induced abortion in the multivariable analysis: being older, having a higher education level, having had more sexual partners (i.e., variables linked to the life course of women), having had children prior to the index pregnancy and living with a sexual partner during pregnancy (i.e., variables linked to the context of each pregnancy). On the other hand, among women not living with HIV/Aids, only having a higher education level and having had more sexual partners (i.e., determinants linked to the life course of women) were associated with voluntary pregnancy termination in multivariable analysis.ConclusionAlthough determinants are similar between women living and not living with HIV/Aids, prevalence of induced abortion is higher among pregnancies in women living with HIV/Aids, pointing to their greater social vulnerability and to the need for public policy to address prevention and treatment of HIV associated with reproductive issues.

The life chart offers rich information that provides a broader picture of the lives of women who have experienced abuse. Life charts could be useful for nurses identifying women in general psychiatric care who have experienced abuse. Despite experiences of abuse and stressful events during childhood, there were only a few indications of them receiving support in the life charts. Many of the women had as adults been in contact with or received care at numerous healthcare services. Violence against women is a worldwide problem and has an impact on the lives of women and girls. The study aims to investigate the life course of women within psychiatric care who have experienced abuse. The women's resources, stressful events, experience of abuse, perpetrators, mental ill health, and care and support throughout the life course are also highlighted. Eleven women who had all sought general psychiatric care in an urban area in Sweden participated. A computer software program was used for constructing life charts for each participant, and manifest content analysis was used to analyse the data. The women's social status and resources differed, and some of them spoke of only experiencing few stressful events growing up, while others described a stressful childhood. All of the women had been abused sometime during their life course, and most of the perpetrators were known to the women. Even so, the women had seldom disclosed their childhood abuse. As adults, the women were diagnosed with psychiatric diagnoses, and suicidal behaviour increased. The life chart offers rich information and a broader picture of the life history of women who experienced abuse as well as constituting a tool useful for identifying women with experiences of abuse.

Many family science and human development scholars argue that it is critically important to examine women’s histories of physical and sexual abuse in studies of their life course. Yet, given the sensitivity of this topic and respondents’ tendency to withhold troubling information about themselves, it is difficult to gather accurate and detailed information about the prevalence and nature of these experiences in women’s lives (see Jouriles, McDonald, Norwood, & Ezell, 2001). For example, panel surveys of life course and family transitions, such as the National Survey of Families and Households and the Panel Study of Income Dynamics, either do not include questions about abuse or they employ less than ideal measures that result in significant underreporting of these experiences. Moreover, studies such as the National Violence Against Women surveys are designed specifically to identify the prevalence of abuse, but they do not gather information about processes (e.g., nuanced behaviors and styles of communication) involved in women’s disclosures of abuse (Bachman & Saltzman, 1995; Finkelhor, 1994). Overall, most surveys rely on limited measures that fail to capture the full range of women’s subjective experiences of abuse, or they neglect to consider abuse as a phenomenon affecting the entire life course of women and their families (Macmillan, 2001; Williams, 2003). Such problems in measurement and assessment impede our understanding of abuse prevalence and the ways it shapes the life course of women, particularly low-income women who face heightened vulnerabilities from its effects (Leone, Johnson, Cohan, & Lloyd, 2004; Sokoloff & Dupont, 2005).

A house of one's own – The Eigenheim within rural women's biographies

In order to gain a comprehensive understanding of the interplay between women's life course work patterns and their financial planning for later life, we examined data from semi-structured interviews with retired women (n = 28) aged 59 to 92. The majority of women disrupted their careers at some point in time, for an average of 14 years, primarily for child-rearing responsibilities. We found that financial preparedness and income security in later life are structured by women's life course work patterns. However, individuals also have the ability to shape their own lives and many of the women took the initiative to acquire financial knowledge irrespective of their work situation. Financial-planning advice that participants gave to future generations of older women was also explored and centred on the importance of saving, avoiding debt, maintaining financial independence, and planning ahead.

Abstract: This paper examines the impact of family and labour market on male and female life course patterns. For women in particular, aggregate survey data have often suggested orderly, phased transitions between family and work. A combination of quantitative and qualitative methods reveals not only a much greater discontinuity in women's life courses, but sheds light on the hidden normality assumptions that affect women's self-perceptions and shape their work histories. Data come from two German research projects. One followed the life sequences of women -- now in their 60s -- between the years 1949 and 1991. The other examined the life course data of their husbands. Resume: Cet article examine l'impact que la famille et le marche du travail ont sur les modalites de la vie des femmes et celles des hommes. Les donnees cumulees d'etudes precedentes avaient souvent suggere que ces modalites etaient organisees selon des transitions periodiques et ordonnees, en particulier dans le cas des femmes. Notre etude qui combine methodes quantitatives et qualitatives, revele deux elements contredisant cette affirmation. Scion nos resultats, les modalites de la vie des femmes connaissent une plus grande discontinuite que celles des hommes. Cette etude met aussi en lumiere l'existence de suppositions cachees de normalite; ces suppositions affectent la perception qu'ont les femmes d'elles-memes et modelent l'historique de leur vie professionelle. Nos donnees proviennent de deux projets de recherche allemands. L'un de ces projets a suivi de la vie des femmes sur une periode qui debute en 1949 et se termine en 1991. Ces femmes sont maintenant dans leur soixantaine. L'autre projet se concentrait sur les donnees de la vie de leur mari. IntroductionparAlthough a relative newcomer to sociology, life course research with its ability to follow a variety of social and personal dynamics through a person's life span has created a number of theoretical and methodological challenges for sociology (Elder, 1992; George, 1993; Kohli, 1986; Hagestad, 1991; Rosenfeld and Birkelund, 1995; Hakim, 1993). One of its most productive areas has been the intersection of personal life courses with social institutions such as education, family, labour market, or the welfare system (Heinz, 1991; Kohli, Meyer, 1986; Mayer, 1986; Mayer, Muller, 1986; Levy, 1977, 1991). These institutions order the life course by creating formal entry and exit points, but also through informal norms which influence people's ambitions, stock-taking, and self-image at various times during their lives. This perspective is of theoretical relevance for the structure-agency debate in sociology because tracking multiple dimensions of life course development over an extended period of time makes it very clear that structure and personal action determine the life course. But life course research has also revealed new policy challenges stemming from discontinuities between schooling and labour market entry (Blossfeld, 1987; Heinz, 1991; Heinz et al., 1985; Krahn, Lowe, 1993; Lowe, Krahn, 1992), labour market changes and loss of employment, or gender- or age-dependent labour market exits and resources for retirement. Such discontinuities disrupt individual life plans and may require profound changes in personal as well as institutional strategies designed to cope with the resulting stress and insecurity (Esping-Anderson, 1990; Leibfried and Pierson, 1995; Beck, 1986; Weymann, 1989). This study looks at the structural and normative impact of the family and the labour market on male and female life courses. We examine how their institutional characteristics translate into gender-specific differences in female and male life course patterns and their personal interpretation. Data and MethodsparAn examination of the interaction between organizational contexts and subjective meanings requires both quantitative and qualitative data analyses. Such a combined methodology has never before been used in life course research. …

This chapter focuses on gender role changes related to childcare through comparative studies of women's life course patterns and the structures of social networks in each society. The societies the chapter discusses are China, Thailand, Singapore, Taiwan, South Korea, and Japan, the six societies covered by our project. The chapter provides a comprehensive overview of the results of the entire project. It examines in detail each society under study, then makes comparisons and synthesizes the findings from different societies. For each society, the chapter delineates the actual childcare practices that people experience everyday based on interviews, observations, and questionnaire surveys. It then focuses on who the agents of childcare are in the society under consideration, whether they are effective, and how people combine different types of agents in different situations. The chapter examines the effect of childcare practices on women's life course and the changes taking place. Keywords: childcare; gender role; social networks

Cardiovascular risk management following gestational diabetes and hypertensive disorders of pregnancy: a narrative review.

Although lower urinary tract symptoms (LUTS) may occur at different periods during the life course of women, a little research on LUTS has adopted a life course perspective. The purpose of this conceptual paper is to demonstrate how life course theory and life course epidemiology can be applied to study bladder health and LUTS trajectories. We highlight conceptual work from the Prevention of Lower Urinary Tract Symptoms Research Consortium to enhance the understanding of life course concepts. Consortium members worked in transdisciplinary teams to generate examples of how life course concepts may be applied to research on bladder health and LUTS in eight prioritized areas: (a) biopsychosocial ecology of stress and brain health; (b) toileting environment, access, habits, and techniques; (c) pregnancy and childbirth; (d) physical health and medical conditions; (e) musculoskeletal health; (f) lifestyle behaviors; (g) infections and microbiome; and (h) hormonal status across the life span. Life course concepts guided consortium members' conceptualization of how potential risk and protective factors may influence women's health. For example, intrapartum interventions across multiple pregnancies may influence trajectories of bladder health and LUTS, illustrating the principle of life span development. Consortium members also identified and summarized methodologic and practical considerations in designing life course research. This paper may assist researchers from a variety of disciplines to design and implement research identifying key risk and protective factors for LUTS and bladder health across the life course of women. Results from life course research may inform health promotion programs, policies, and practices.

Most studies about infant and young child feeding (IYCF) practices are often perceived as an individual choice depending on mothers' or caregivers' knowledge or attitudes and are focused on mothers' failure rather than successes in adequately feeding their children. However, the role of life course experiences in IYCF is less investigated. Applying a Salutogenic Model of Health, this study on 14 mothers looks at women's life course learning experiences shaping appropriate IYCF practices during the first year of child's life in a rural district of Rwanda. Transcripts from in‐depth interviews were analysed using thematic analysis. Results indicate that positive social interaction with parents or grandmothers during childhood such as sharing meals, parental role models for dietary choices and cooking skills gained by participating in household food preparation played a role in shaping appropriate IYCF practices. Negative experiences during childhood also had a positive influence on IYCF practices for some participants by converting life course constraints into learning opportunities. Motherhood increased mothers' sense of responsibility over their children's health and nutrition. Moreover, mothers' participation in community cooking classes and role modelling approach were strong avenues that enabled their learning through positive interactions and encouragement. Nutrition promotion interventions should consider tailoring nutrition advice to the complexity of mothers' life course experiences by creating opportunities for positive learning experiences of appropriate IYCF practices.

Unintended pregnancy in the life-course perspective.

The transformations that are now taking place in women's lives are of great interest to social scientists and policy makers, yet we know very little about the impact of this social change over time. This new study uses longitudinal data — information gathered over a considerable period of time — to provide new insights into the changing dynamics of lives of women today. In particular, it explores the potential of longitudinal or life course analysis as a powerful tool for appreciating the gender dimension of social life. The contributors view the data from a policy perspective and use comparative analysis from Britain, Germany, the Netherlands, Sweden and Japan to expand our understanding of women's life courses in relation to both men and women and the system of inequality.