Deep Infiltrating Endometriosis Patients Research Articles

Assessment of Quality of Life, Sexual Quality of Life, and Pain Symptoms in Deep Infiltrating Endometriosis Patients With or Without Associated Adenomyosis and the Influence of a Flexible Extended Combined Oral Contraceptive Regimen: Results of a Prospective, Observational Study

The quality of life of women with deep infiltrating endometriosis (DIE) is impaired and may improve with combined oral contraceptives (COCs). To compare the overall and sexual quality of life of patients diagnosed with DIE with or without associated adenomyosis (AD) with that of healthy controls and determine the influence of a COC containing 2 mg dienogest/30 μg ethinyl estradiol on these aspects. We enrolled 42 women diagnosed with DIE; 31 diagnosed with DIE + AD by transvaginal ultrasound, and 39 non-AD/DIE controls. All patients were interviewed regarding pain symptoms (dysmenorrhea, dyspareunia, dyschezia, and dysuria), heavy menstrual bleeding using the Pictorial Blood Loss Assessment Chart, quality of life using the Short Form-36 questionnaire (SF-36), and sexual quality of life using the Sexual Quality of Life-Female questionnaire (SQOL-F) and the Brief Profile of Female Sexual Function (B-PFSF) before starting COCs and after 12 months of treatment. There was significant improvement in overall and sexual quality of life after treatment in DIE and DIE + AD patients. Non-AD/DIE controls showed significantly higher scores in the B-PFSF, the SQOL-F and the SF-36 questionnaires (P < .05) at baseline versus the other groups. DIE + AD patients showed poorer quality of sexual life and greater intensity in pain symptoms compared with DIE patients. After 12 months of treatment, there was a significant improvement in overall and sexual quality of life in the DIE and DIE + AD groups, with improvement in sexual quality of life being slightly greater in DIE + AD patients compared with DIE patients. Pain symptoms also decreased in both groups. Patients with DIE + AD showed greater impairment in overall and sexual quality of life compared with patients with isolated DIE which seems to improve with a COC containing 2 mg dienogest/30 μg ethinyl estradiol. Strengths include the long-term follow up, assessment of the impact of two associated conditions, and administration of the same COC in all patients. Limitations include the relatively small sample size, and the fact that we did not assess the effectiveness of a flexible extended COC regimen containing 2 mg dienogest/30 μg ethinyl estradiol since the groups were different at baseline. Patients diagnosed with DIE with or without AD have a decreased quality of life which may improve with a COC containing 2 mg dienogest/30 μg ethinyl estradiol. Further research is needed to confirm our results.

Increased circulating cell-derived microparticle levels in deep infiltrating endometriosis patients with larger implants

Objective: Circulating cell-derived microparticles have been reported to be elevated in inflammatory and procoagulant conditions including deep infiltrating endometriosis. The objective of this pilot study was to investigate whether higher circulating cell-derived microparticle levels may be associated with specific clinical features and the extension or severity of deep infiltrating endometriosis. Methods: This is an observational analytical cross-sectional study, including three groups of patients undergoing gynecological surgery. The DIE group included 75 patients with deep infiltrating endometriosis, the control group (C group) consisted of 39 patients without endometriosis, and a positive control group was composed of 31 patients with ovarian endometriomas but not deep infiltrating endometriosis (OE group). Venous blood samples for circulating cell-derived microparticle determinations in plasma were obtained before surgery. The following variables were assessed: severe dysmenorrhea, dyspareunia, non-cyclic chronic pelvic pain, dyschezia, dysuria, hematuria, rectal bleeding, sterility, presence of ovarian endometrioma, adenomyosis, and adhesions, rASRM (revised American Society for Reproductive Medicine) stage, Enzian classification, number of sites affected, and the cumulative size of deep infiltrating endometrial implants. Results: Circulating cell-derived microparticle levels were statistically higher in the DIE group compared with the C group ( p-value = 0.001). None of the variables analyzed showed higher levels of circulating cell-derived microparticles in the DIE group, except for a significant positive correlation between the cumulative size of deep infiltrating endometrial lesions and circulating cell-derived microparticle levels ( r = 0.264, p = 0.022). Conclusion: Patients having deep infiltrating endometriosis with a larger cumulative size of endometriotic implants showed higher circulating cell-derived microparticle levels suggesting an increased inflammatory and/or hypercoagulable systemic status in this more severe form of the disease. Further research is needed to assess our findings and to explore the role of circulating cell-derived microparticles in the pathophysiology of deep infiltrating endometriosis.

Distribution of persistent organic pollutants in serum, omental, and parietal adipose tissue of French women with deep infiltrating endometriosis and circulating versus stored ratio as new marker of exposure

Several studies have assessed the potential role of environmental chemicals in the onset, growth, and/or physiopathology of endometriosis. However, their contour in terms of considered exposure markers remains limited. The present study aimed to characterize the internal exposure levels of 78 persistent organic pollutants (POPs, including dioxins, polychlorobiphenyls, brominated flame retardants and organochlorine pesticides) in a set of 113 adult French women (45 controls, 68 cases), and to characterize the distribution of these POPs within three biological compartments (omental adipose tissue, parietal adipose tissue, and serum). For all targeted substances, the correlation between the concentrations measured in omental versus parietal adipose tissue was found strongly significant (p<0.0001). An equivalence of the measures performed in parietal and omental adipose tissue was moreover observed with median levels of 6.4 vs. 7.4pg/gl.w. for WHO-TEQ2005 PCDD/F, 4.5 vs. 4.7pg/gl.w. for WHO-TEQ2005 dl-PCB, 137.1 vs. 147.9ng/gl.w. for sum of 6 ndl-PCB, and 2.1 vs. 2.0ng/gl.w. for sum of 7 i-PBDE, respectively. The same observation was made for individual targeted OCs compounds. Significant correlations were also observed between these concentrations determined in adipose tissue and those measured in serum for dioxins (WHO-TEQ2005 PCDD/F=6.1pg/gl.w), PCBs (WHO-TEQ2005 dl-PCB=3.6pg/gl.w., sum of 6 ndl-PCB=81.1ng/gl.w.), and brominated flame-retardants (sum of 7 i-PBDE=0.9ng/gl.w.). The circulating versus stored ratio of some exposure markers (Sum PCDDs, 1,2,3,6,7,8-HxCDF, slightly versus highly chlorinated PCBs ratio, PBDE 99 and PBB 153) was found statistically different for control and case individuals. These extended exposure data from deep infiltrating endometriosis patients are the first ones available for France and give a new insight about the equilibrium of chemicals between storage and circulating compartments that should be further considered as new marker of exposure in the context of exposure-health relationship studies.

À propos des recommandations de bonne pratique de l'Afssaps sur les traitements médicamenteux de l'endométriose (en dehors de l'adénomyose) (novembre 2005)

The quality of life of women with deep infiltrating endometriosis (DIE) is impaired and may improve with combined oral contraceptives (COCs).To compare the overall and sexual quality of life of patients diagnosed with DIE with or without associated adenomyosis (AD) with that of healthy controls and determine the influence of a COC containing 2 mg dienogest/30 μg ethinyl estradiol on these aspects.We enrolled 42 women diagnosed with DIE; 31 diagnosed with DIE + AD by transvaginal ultrasound, and 39 non-AD/DIE controls. All patients were interviewed regarding pain symptoms (dysmenorrhea, dyspareunia, dyschezia, and dysuria), heavy menstrual bleeding using the Pictorial Blood Loss Assessment Chart, quality of life using the Short Form-36 questionnaire (SF-36), and sexual quality of life using the Sexual Quality of Life-Female questionnaire (SQOL-F) and the Brief Profile of Female Sexual Function (B-PFSF) before starting COCs and after 12 months of treatment.There was significant improvement in overall and sexual quality of life after treatment in DIE and DIE + AD patients.Non-AD/DIE controls showed significantly higher scores in the B-PFSF, the SQOL-F and the SF-36 questionnaires (P < .05) at baseline versus the other groups. DIE + AD patients showed poorer quality of sexual life and greater intensity in pain symptoms compared with DIE patients. After 12 months of treatment, there was a significant improvement in overall and sexual quality of life in the DIE and DIE + AD groups, with improvement in sexual quality of life being slightly greater in DIE + AD patients compared with DIE patients. Pain symptoms also decreased in both groups.Patients with DIE + AD showed greater impairment in overall and sexual quality of life compared with patients with isolated DIE which seems to improve with a COC containing 2 mg dienogest/30 μg ethinyl estradiol.Strengths include the long-term follow up, assessment of the impact of two associated conditions, and administration of the same COC in all patients. Limitations include the relatively small sample size, and the fact that we did not assess the effectiveness of a flexible extended COC regimen containing 2 mg dienogest/30 μg ethinyl estradiol since the groups were different at baseline.Patients diagnosed with DIE with or without AD have a decreased quality of life which may improve with a COC containing 2 mg dienogest/30 μg ethinyl estradiol. Further research is needed to confirm our results.Alcalde AM, Martínez-Zamora MÁ, Gracia M, et al. Assessment of Quality of Life, Sexual Quality of Life, and Pain Symptoms in Deep Infiltrating Endometriosis Patients With or Without Associated Adenomyosis and the Influence of a Flexible Extended Combined Oral Contraceptive Regimen: Results of a Prospective, Observational Study. J Sex Med 2022;19:311–318.

COX-2 Overexpression: A Potential Relevance for Chronic Pelvic Pain in Patients With Peritoneal Endometriosis

To investigate cyclooxygenase-2 (Cox-2) expression in peritoneal, ovarian and deep infiltrating endometriotic lesions and to assess whether these expression patterns correlate with clinical characteristics Retrospective immunohistochemical study of formalin-fixed, paraffin-embedded tissue samples from patients with peritoneal, ovarian or deep infiltrating endometriosis Patients with histologically confirmed exclusively peritoneal (n=20), ovarian (n=19) or deep infiltrating (n=31) endometriosis, respectively, were included in the study. Endometriotic tissue was stained immunohistochemically with a monoclonal Cox-2 antibody (Cayman Chemical, Ann Arbor, Michigan, USA). A detailed medical history was obtained prospectively in all patients prior to surgery. The severity of symptoms (e.g. dysmenorrhoea, dyspareunia and chronic pelvic pain) was assessed by means of a subjective rating scale (0 = none, 1 = mild, 2 = moderate, 3 = severe) based on the patients‘ self-assessment of pain. Staining intensity of endometrial glands was scored on a four-tiered scale as (0) no staining, (1) weak, (2) moderate or (3) strong immunoreaction. Additionally the proportion of stained glandular endometrial cells was scored as (1) low (>10-40%), (2) moderate (>40-60%), (3) high (>60-90%) and (4) all glands (>90-100%). The Cox-2 histological score was calculated as the sum of the maximum staining intensity and the percentage of stained glands. Staining results were correlated with morphological and clinical parameters. Statistical analysis was performed using the Mann Whitney U and χ2 test for non-parametric data. Patients with exclusively peritoneal endometriosis suffering from moderate or severe chronic pelvic pain showed significantly more frequent Cox-2 overexpression than asymptomatic patients or patients with minimal symptoms. In patients with exclusively ovarian or deep-infiltrating endometriosis no association between Cox-2 expression and clinical parameters such as chronic pelvic pain, dysmenorrhoea, dyspareunia, sterility or lower urinary tract symptoms or gastrointestinal symptoms was observed. Cox-2 expression did not differ between distinct morphological types of endometriosis. Cox-2 expression showed no association with the menstrual cycle. Separate analysis of patients with exclusively ovarian, deep-infiltrating or peritoneal endometriosis showed a statistically significant correlation between Cox-2 expression in peritoneal lesions and severity of chronic pelvic pain. Therefore, peritoneal endometriotic lesions with increased Cox-2 expression may have a special relevance for the development of chronic, non-menstruation-associated pelvic pain in endometriosis patients. These patients may benefit from therapy with Cox-2 inhibitors.