Endometriosis Patients Research Articles

OC09.04: Uterine contractility of adenomyosis patients normalises under hormonal contraception use

OC09.04: Uterine contractility of adenomyosis patients normalises under hormonal contraception use

Efficacy of GnRH-α combined with Mirena in the treatment of adenomyosis and its impact on ovarian function

Objective : To discuss and analyze the clinical effects and changes of ovarian function after GnRH-α combined with Mirena treatment in patients with adenomyosis. Methods: The research subjects in this study were all adenomyosis patients (60 cases) who were admitted to our hospital from January 2020 to June 2022. They were randomly divided into control group (30 cases, receiving Mirena treatment) and observation group (30 cases, receiving GnRH-α combined with Mirena treatment). Compare the relevant indicators of the two groups. Results: After treatment, the uterine volume of the observation group and the control group were smaller than before treatment, the thickness of endometrium was thinner than before treatment, the VAS score, PBAC score, serum FSH, LH, E2 levels were all lower than before treatment, the serum AMH level, and various FSFI scores were higher than before treatment, and the trend of the former was more obvious. The comparison of the total incidence of adverse reactions between the observation group and the control group showed that the former was lower (all P < 0.05 ). Conclusion: The application of GnRH-α combined with Mirena in patients with adenomyosis can reduce the amount of menstrual bleeding, reduce the volume of the uterus, relieve pain, promote the recovery of ovarian function, improve the quality of sexual life, and have high safety. It is worthy of extensive follow-up application.

Effects of duration of long-acting GnRH agonist downregulation on assisted reproductive technology outcomes in patients with adenomyosis: a retrospective cohort study.

To elucidate the relationship between long-acting GnRH agonist (GnRHa) downregulation and assisted reproductive technology (ART) outcomes and identify the optimal duration of downregulation in patients with adenomyosis. Retrospective cohort study. The study was designed to evaluate ART outcomes in adenomyosis patients with and without GnRHa downregulation between January 2016 and December 2020. A total of 374 patients with adenomyosis (621 cycles) were included with 281 cycles in downregulation group versus 340 cycles in non-downregulation group. After 1:1 propensity score matching (PSM), a sample size of 272 cycles in each group was matched. The matched downregulation group was further divided into 1-month (147 cycles), 2-months (72 cycles), and ≥3 months downregulation (53 cycles) subgroups. Stratification analysis was conducted on pregnancy outcomes in 239 fresh embryo transfer (ET) cycles and 305 frozen embryo transfer (FET) cycles. The downregulation group had larger mean diameter of initial uterus and higher proportion of severer dysmenorrhea compared to non-downregulation group. The pregnancy-related parameters in GnRHa downregulation group were similar to those in non-downregulation group, except for higher late miscarriage rate (MR) (13.4% vs. 3.1%, P = 0.003). The subgroup comparisons in fresh ET cycles indicated that implantation rate (75.0% vs. 39.2%, P = 0.002), biochemical pregnancy rate (91.7% vs. 56.0%, P = 0.036) and clinical pregnancy rate (83.3% vs. 47.0%, P = 0.016) could be improved by prolonged GnRHa downregulation (≥3 months), whereas late MR was difficult to be reversed (30.0% vs. 3.2%, P = 0.017). In FET cycles, higher MR (53.6% vs. 29.9%, P = 0.029; 58.8% vs. 29.9%, P = 0.026) and lower live birth rate (18.8% vs. 34.1%, P = 0.023; 17.1% vs. 34.1%, P = 0.037) were observed in the 1-month and ≥3 months downregulation group, while no differences were found in the 2-months downregulation group compared to the non-downregulation group. In patients with severer adenomyosis, long-acting GnRHa downregulation might be correlated with improved ART outcomes. In fresh ET cycles, prolonged downregulation (≥3 months) might be beneficial to improve live birth rate, which needed to be verified by further study with larger sample. In FET cycles, the optimal duration of downregulation was not certain and still needed further exploration.

Extracellular ATP (eATP) inhibits the progression of endometriosis and enhances the immune function of macrophages

BackgroundExtracellular adenosine triphosphate (eATP) is an important inflammatory mediator that can boost the antitumour immune response, but its role in endometriosis remains unknown. We hypothesized that eATP could inhibit endometriosis cell function both directly and indirectly through macrophages. MethodsPeritoneal and cyst fluid from endometriosis patients and non-endometriosis controls was collected to measure eATP levels. The addition of eATP was performed to explore its effects on endometriotic cell and macrophage functions, including cell proliferation, apoptosis, pyroptosis, mitochondrial membrane potential, phagocytosis, and the production of inflammatory cytokines and reactive oxygen species. A coculture of endometriotic epithelial cells and U937 macrophages was established, followed by P2X7 antagonist and eATP treatment. Endometriosis model eATP-treated rats were used to evaluate in situ cell death and macrophage marker expression. ResultsThe pelvic microenvironment of endometriosis patients shows high eATP levels, which could induce endometriotic epithelial cell apoptosis and pyroptosis and significantly inhibit cell growth via the MAPK/JNK/Akt pathway. eATP treatment ameliorated endometriosis-related macrophage dysfunction and promoted macrophage recruitment. eATP treatment in the presence of macrophages exerted a stronger cytotoxic effect on endometriotic epithelial cells by regulating P2X7. eATP treatment effectively induced cell death in an endometriosis rat model and prominently increased the macrophage number without affecting the eutopic endometrium. ConclusioneATP induces endometriotic epithelial cell death and enhances the immune function of macrophages to inhibit the progression of endometriosis, while eutopic endometrium is not affected. eATP treatment may serve as a nonhormonal therapeutic strategy for endometriosis.

The Effect of Hypnotherapy on the Pain Intensity of Endometriosis Patients Treated with Dienogest: A Pilot Double-Blind Randomized Clinical Trial

Background: Endometriosis is a chronic disease in women of reproductive age accompanied by chronic pelvic pain and painful intercourse. It has a severe negative impact on these patients' psychosocial parameters. The noninvasive treatment of endometriosis remains challenging. Objectives: This study aimed to investigate the effectiveness of hypnotherapy on the pain intensity of endometriosis patients treated with dienogest. Methods: In this preliminary study (a pilot double-blind, randomized clinical trial), conducted from November 2021 to July 2022, 22 patients (18 to 45 years old) with endometriosis treated with dienogest in Shahid Akbar Abadi Hospital (Tehran, Iran) were enrolled. Via block randomization, they were divided into a control group and an intervention group (n = 11 each). The patients of both groups were given 2 mg of dienogest tablets daily as prescribed by the gynecologist. The main intervention involved hypnotherapy, which was administered only for the intervention group individually for 8 weekly sessions online (on WhatsApp) for 30 - 45 minutes. Dysmenorrhea, dyspareunia, and chronic pelvic pain were evaluated using the visual analog scale (VAS) at the beginning of the intervention, immediately after the intervention, and 4 weeks after the intervention in both groups. Mean, standard deviation, frequency, chi-square, Fisher's exact test, Mann-Whitney U, and Friedman test were used for data analysis. Results: Dysmenorrhea severity score in the intervention group was 6.30 ± 1.25 before the intervention, 5.50 ± 1.08 after the intervention, and 4.60 ± 0.97 during the follow-up, and the changes were significant (P < 0.001, effect size = 0.93). Dyspareunia severity score was 3.14 ± 4.50 before the intervention, 2.91 ± 4.30 after the intervention, and 2.42 ± 3.50 during the follow-up. These changes were also significant (P = 0.015, effect size = 0.41). However, the pelvic pain score did not significantly change despite the average decrease of 0.2 during the follow-up (P = 0.135). Conclusions: Hypnotherapy, along with drug treatment, was more effective in relieving endometriosis pain than drug treatment alone.

Presence of Adenomyosis Impairs Clinical Outcomes in Women Undergoing Frozen Embryo Transfer: A Retrospective Cohort Study.

(1) Background: The presence of adenomyosis among pregnant patients has been associated with a higher incidence of miscarriage and pregnancy complications. Although the role of adenomyosis in women undergoing in vitro fertilization (IVF) was investigated in several studies and demonstrated a potentially detrimental effect on live birth rates following IVF, most of them were small studies in which the adenomyosis diagnosis was not confirmed based on solid ultrasonographic criteria. (2) Methods: 3503 patients undergoing their first blastocyst frozen transfer through a hormonal replacement (HRT) FET cycle. Among them, 140 women had a confirmed diagnosis of adenomyosis based on the MUSA criteria. (3) Results: Adenomyosis patients were more likely to proceed with deferred FET compared with no-adenomyosis women (p = 0.002) and were significantly more likely to be treated with GnRH agonist pre-treatment (2 months) (p < 0.001). The presence of adenomyosis significantly decreased the clinical pregnancy rates (aOR 0.62, 95% CI: 0.39-0.98, p = 0.040) and live birth rates (aOR 0.46, 95% CI: 0.27-0.75, p = 0.003) and significantly increased the miscarriage rates (aOR 2.13, 95% CI: 0.98-4.37, p = 0.045). Multivariable logistic regression adjusting for age, autologous or donor oocytes, PGT-A, deferred FET, serum progesterone levels the day before FET, GnRH agonist pre-treatment, number of embryos transferred, and adenomyosis demonstrated that the use of the GnRH agonist protocol did not decrease or increase the miscarriage rate, clinical pregnancy rate, or live birth rate. (4) Conclusions: The presence of adenomyosis had a significant negative impact on the clinical outcomes of patients undergoing FET and was associated with higher miscarriage, lower clinical pregnancy, and live birth rates. GnRH agonist pre-treatment does not appear to improve clinical outcomes.

Effects of Ulipristal Acetate on Reactive Oxygen Species and Proinflammatory Cytokine Release by Epithelial and Stromal Cells from Human Endometrium and Endometriosis.

Endometriosis is a condition characterized by increased oxidative stress and chronic inflammation, which can be treated with progestins and other progesterone receptor ligands. However, some patients are refractory to this treatment and the reason is uncertain. Here we investigated the effects of the selective progesterone receptor modulator ulipristal acetate (UPA) on proliferation, reactive oxygen species (ROS), and proinflammatory cytokine production by endometriotic cells and endometrial cells from women with histologically proven endometriosis (n=22) and endometriosis-free controls (n=6). Epithelial and stromal cells were isolated and treated in triplicate for 24h with 1 μM, 10 μM, or 100 μM UPA. Cells were tested for proliferation and ROS production, while cell supernatants were assayed for interleukin (IL)-6, C-C motif chemokine ligand 2 (CCL2), and tumor necrosis factor (TNF)-α concentrations. Proliferation, ROS production, and IL-6 and CCL2 secretion were increased in non-stimulated epithelial and stromal cells from endometriotic lesions compared to endometrial cells from endometriosis patients and controls. UPA induced a dose-dependent increase of cell proliferation only in endometriosis, while enhancing ROS production by all cell types evaluated. UPA reduced CCL2 production in controls but failed to do that in endometriosis, whereas TNF-α was undetectable. We conclude that treatment of endometriotic cells with UPA stimulated in vitro proliferation and ROS production and failed to revert the proinflammatory cytokine excess that characterized these cells, unravelling possible mechanisms of drug resistance in the treatment of endometriosis.

Correlation between Triclosan (TCS) exposure and endometriosis.

To study the correlation of Triclosan (TCS) exposure with typing and staging of endometriosis, and with other potential influencing factors. This was a retrospective study. Thirty two patients that were diagnosed with endometriosis by laparoscopy or surgery in Taicang First People's Hospital from May 2020 to December 2021 were enrolled in the endometriosis group, and patients who were confirmed free of endometriosis by surgeries for other purposes during the same period were enrolled as the control group. All blood samples were tested twice in two different vials. The association of TCS exposure level with occurrence, staging, typing of endometriosis, and income of the patients were analyzed. Patients with endometriosis had significantly higher TCS exposure levels than the control group. TCS exposure level in patients with endometriosis was positively correlated with patient income), and was significantly higher in patients with Stage-IV endometriosis than in those with Stage-III and II diseases. TCS exposure levels showed no significant difference among patients with ovarian type, ovarian + peritoneal type, and deep nodular type endometriosis TCS exposure level in patients with endometriosis was positively correlated with the staging of the disease. TCS exposure was highly positively correlated with the staging of the disease in patients with ovarian type endometriosis and in patients with deep nodular endometriosis, but there's no such correlation in patients with ovarian + peritoneal type endometriosis. TCS exposure level in endometriosis patients was higher than that in normal women, and is positively correlated with endometriosis staging and income of the patients.

Pelvic floor hypertension: possible factors for pelvic floor tenderness in endometriosis patients—a pilot study

PurposeChronic pelvic pain (CPP) is one of the main problems of endometriosis, leading to a significant impairment of quality of life. Understanding the pain mechanisms and the pelvic floor muscles (PFM) changes in these patients is essential to integrate additional therapeutic strategies. We hypothesize that endometriosis patients have changes in PFM and that targeted vaginal electrostimulation can be a treatment option for CPP in this disease.MethodsFifteen patients with endometriosis and chronic acyclical pelvic pain were included. PFM electromyography with the Multiple Array Probe Leiden (MAPLe) was performed. Mapping of PFM was utilized and targeted electrostimulation of the hypertensive muscles was conducted. Control electromyography was performed afterward to evaluate the electrostimulation therapeutic effect.ResultsIn 12/15 (80%) patients, the myofascial trigger point could be localized by digital examination. The most frequently affected muscle was the puborectalis (10/15—66.7%). Most of the patients showed serious changes in the average resting tone (aRT) of PFM. aRT was significantly increased in all patients and decreased after stimulation, whereby the difference prior to and after stimulation was not significant (p = 0.064). The detailed separated analysis of the hypertensive muscles showed a significant (p = 0.026) reduction in their resting tone (hRT), after targeted stimulation.ConclusionVaginal electrostimulation is a promising and feasible complementary treatment option for CPP in endometriosis patients. Targeted treatment of pelvic floor dysfunction should be included in clinical trials.

Retrospective analysis of the endometrial preparation protocols for frozen-thawed embryo transfer cycles in women with endometriosis

BackgroundThere was inconsistency in optimal endometrial preparation protocol for frozen-thawed embryo transfer (FET) in patients with endometriosis. We conducted this study to investigate the effect of different endometrial preparation protocols on the pregnancy outcomes in patients with endometriosis undergoing FET cycles, and determine the optimal number of GnRHa injections in GnRHa-HRT protocols.Method(s)This was a retrospective cohort analysis of women with endometriosis who underwent FET cycles at a single university-based center. This study retrospectively analyzed 2048 FET cycles in our center from 2011 to 2020. According to the endometrial preparation protocols, patients were divided into 4 groups: gonadotropin releasing hormone agonist-hormone replacement therapy(GnRHa-HRT), hormone replacement therapy(HRT), ovulation induction(OI), and natural cycle(NC). In the GnRHa-HRT group, patients were further divided into 3 groups: one injection of GnRHa, two injections of GnRHa, and three or more injections of GnRHa. The primary outcome was the clinical pregnancy rate. Propensity score matching was used to adjust for potential non-similarities among the groups. Multivariate logistic regression analysis was performed to figure out the risk factors for pregnancy outcomes.Result(s)There were no statistical differences in pregnancy outcomes among the four endometrial preparation protocols in FET cycles with endometriosis patients, the results retained after propensity score matching(PSM). And in endometriosis patients complicated with adenomyosis, the results remained similar. In patients with GnRHa-HRT protocol, there were no differences in clinical pregnancy rate and live birth rate with different numbers of GnRHa injections, the early miscarriage rate were 18% in the two injections of GnRHa group and 6.5% in the one injection of GnRHa group(P = 0.017). Multifactorial logistic regression analysis showed that two injections of GnRHa before FET was associated with increased early miscarriage rate compared with one injection of GnRHa[adjusted OR (95% CI): 3.116(1.079–8.998),p = 0.036].Conclusion(s)The four kinds of endometrial preparation protocols for FET, GnRHa-HRT, HRT, OI and NC had similar pregnancy outcomes in patients with endometriosis. In endometriosis patients complicated with adenomyosis, the results remained similar. In patients with endometriosis undergoing GnRHa-HRT protocol for FET, more injections of GnRHa had no more advantages in pregnancy outcomes, on the contrary, it might increase the early miscarriage rate.

Brain-derived neurotrophic factor and nerve growth factor expression in endometriosis: A systematic review and meta-analysis.

Endometriosis is diagnosed by laparoscopic surgery. The availability of biomarkers can help understand the pathophysiology and aid in the diagnosis of the condition. In this context, this review aimed to examine levels of expression of brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) are increased amongst patients with endometriosis and if they can serve as a potential biomarker. PubMed, CENTRAL, Scopus, Web of Science, and Embase databases were searched for studies comparing BDNF or NGF levels amongst endometriosis patients and controls. Data were pooled for serum and tissue levels of BDNF and NGF. Ten fulfilled the inclusion criteria. On comparing BDNF levels, it was noted that endometrial tissue had significantly higher expression of BDNF levels as compared to controls (SMD: 1.73 95% CI: 0.64, 2.82 I2=89%). Similarly, the meta-analysis found significantly higher serum levels of BDNF in endometriosis patients as compared to controls (SMD: 1.66 95% CI: 0.73, 2.59 I2=95%). Pooled analysis showed significantly increased levels of NGF in endometrial tissue as compared to controls (SMD: 4.15 95% CI: 0.11, 8.18 I2=98%) but with unstable results on sensitivity analysis. Only one study showed higher levels of NGF in serum amongst endometriosis patients. Limited data shows higher expression of BDNF in endometrial lesions and increased serum levels of BDNF in endometriosis patients. Similar results were noted for NGF but with very scarce data. Further research is needed to establish BDNF and NGF as suitable biomarkers for the disease.

Effect of coexisting adenomyosis on tumour characteristics and prognosis of endometrial cancer: A systematic review and meta-analysis.

To compare clinicopathological features and survival outcomes in patients with endometrial cancer, with and without associated adenomyosis. PubMed, Embase and Scopus databases were systematically searched for relevant observational studies. The pooled effect sizes were reported as either hazards ratio (HR) for survival-related outcomes or as odds ratio (OR) for other categorical outcomes. Weighted mean difference (WMD) was reported for continuous outcomes. All the analyses used the random effects model. A total of 21 studies (N=46,420) were included. Compared to endometrial cancer patients without adenomyosis, patients with associated adenomyosis had improved overall 5-year survival (OS) (HR 0.62, 95% CI: 0.50, 0.79) and disease-free survival (DFS) (HR 0.60, 95% CI: 0.44, 0.82). Disease-specific survival was statistically similar in patients with and without adenomyosis (HR 0.60, 95% CI: 0.35, 1.05). Among patients with adenomyosis, the risk of having an advanced tumour grade (Grade 2 or 3) was lower (OR 0.51, 95% CI: 0.42, 0.62) and a risk of having International Federation of Gynaecology and Obstetrics (FIGO) stage I or II was higher (OR 2.23, 95% CI: 1.65, 3.01). Patients with adenomyosis had lower risk of tumour invasion of adnexa, cervical stromal invasion, deep myometrial involvement (DMI), lympho-vascular space invasion (LVSI) and peritoneal invasion. Presence of adenomyosis in patients with endometrial cancer is associated with favourable tumour characteristics and may improve the survival.

Stigma and mental health in endometriosis.

This review provides an overview of patient experiences of endometriosis, endometriosis-related types and sources of stigma pertaining to menstruation, chronic pain, and infertility, and their impact on patients' mental health with particular implications for patient care. Because endometriosis is a complex disease with multifactorial etiology, complicated pathophysiology, and a spectrum of clinical features, diagnosis of endometriosis is typically a lengthy process, and many patients experience initial misdiagnosis. A hallmark symptom is severe menstrual pain with other symptoms including chronic pelvic pain, dysmenorrhea, and infertility. Prior research documents that the diagnostic odyssey, complex management, disabling and unpredictable nature of the disease, and painful symptom profile affect multiple life domains of patients, resulting in poor physical, social, and psychological functioning and clinically-significant rates of anxiety and depression for many. More recently, stigma has been recognized as a potent contributor to poor mental health in endometriosis patients, but existing research is limited and largely atheoretical. We identify major sources of stigma related to endometriosis, including menstrual stigma, chronic pain stigma, and infertility stigma, and their likely impact on patients and health care provision. An integrative theoretical approach is described to facilitate research on the prevalence and effects of endometriosis stigma and their explanatory mechanisms, highlighting specific well-validated psychological instruments to assess stigma. Implications for patient care are emphasized. Better understanding of stigma and mental health in people with endometriosis will enhance the standard of care for this patient population.

Intestinal permeability and endometriosis: a pilot investigation

BackgroundThe etiology of endometriosis is likely multifactorial with both heritable and non-heritable factors interacting in complex ways. Impaired intestinal permeability may be associated with endometriosis. ObjectivesThe objective of this project was to determine whether patients with laparoscopically proven endometriosis have impaired intestinal permeability as compared with healthy controls and pelvic pain patients without endometriosis. Study designThis is a proof-of-concept trial. 46 subjects were enrolled. Of these, 35 were patients with pelvic pain (PP) scheduled for laparoscopic surgery. 11 healthy controls (HC) enrolled in the trial. 23 of the PP patients and 6 of the HC subjects completed the trial. Percentage recovery of Lactulose (L) and Mannitol (M) were obtained from urine samples following an oral load of these same 2 sugars to evaluate gut permeability by using a L/M ratio. ResultsOut of 20 patients with endometriosis, 9 (45%) had impaired IP at the time of testing. Of the patients who had pelvic pain and no endometriosis, 0 of 3 had impaired IP and 0 of 6 controls had impaired IP. Of the 29 patients who completed the trial, 100% of those who had impaired IP had endometriosis (n = 9). A significant difference was seen between endometriosis and IP (9/20) and patients without endometriosis and IP (0/9) p = 0.027. ConclusionsTotal 45% of pelvic pain patients with endometriosis had impaired intestinal permeability, demonstrating a significant association. These results suggest that further research evaluating intestinal permeability and endometriosis may be of value.

Effects of dysregulated glucose metabolism on the occurrence and ART outcome of endometriosis

BackgroundEndometriosis is associated with systemic metabolic indicators, including body mass index (BMI), glucose metabolism and lipid metabolism, while the association between metabolic indexes and the occurrence and assisted reproductive technology (ART) outcome of endometriosis is unclear. We aimed to evaluate the characteristics of systemic metabolic indexes of endometriosis patients with infertility and their effects on pregnancy outcome after ART treatment.MethodsA retrospective cohort study involve 412 endometriosis patients and 1551 controls was conducted. Primary outcome was metabolic indexes, and secondary measures consisted of the influence of metabolic indexes on the number of retrieved oocytes and ART outcomes.ResultsEndometriosis patients had higher insulin (INS) [6.90(5.10–9.50) vs 6.50(4.80–8.90) μU/mL, P = 0.005]. A prediction model for endometriosis combining the number of previous pregnancies, CA125, fasting blood glucose (Glu) and INS, had a sensitivity of 73.9%, specificity of 67.8% and area under curve (AUC) of 0.77. There were no significant differences in ART outcomes and complications during pregnancy. The serum levels of Glu before pregnancy were associated with GDM both in endometriosis group (aOR 12.95, 95% CI 1.69–99.42, P = 0.014) and in control group (aOR 4.15, 95% CI 1.50–11.53, P = 0.006).ConclusionsWe found serum Glu is related to the number of retrieved oocytes in control group, serum INS is related to the number of retrieved oocytes in endometriosis group, while serum Glu and INS before pregnancy are related to the occurrence of GDM in two groups. A prediction model based on metabolic indexes was established, representing a promising non-invasive method to predict endometriosis patients with known pregnancy history.

MRI markers of adenomyosis severity associated with worse IVF/ICSI outcomes

Study objective: The aim of this study was to characterise the severity of adenomyosis on MRI in infertile women, and to assess if MRI characteristics of adenomyosis severity are associated with worse IVF/ICSI pregnancy outcomes versus male infertility controls. Materials and methods: This single-centre retrospective study was carried out at Catharina Hospital in Eindhoven, The Netherlands. The MRIs of 124 infertile women undergoing their first, fresh embryo transfer during IVF/ICSI, diagnosed with adenomyosis only ( N = 31), or combined adenomyosis and endometriosis ( N = 93) were assessed. Measurements of MRI adenomyosis features were performed by two independent investigators. IVF/ICSI outcomes (biochemical pregnancy (BP), ongoing pregnancy (OP) and live birth (LB)) of adenomyosis patients were compared to those of 889 male infertility controls. Results: Patients with adenomyosis had significantly worse IVF/ICSI outcomes compared to male infertility controls. When assessing individual MRI parameters, adenomyosis patients with a mean junctional zone (JZ) of &gt;12 mm, a JZ/Myometrium ratio of &gt;40%, presence of myometrial cysts and presence of endometriosis (specifically deep invasive endometriosis(DIE)) showed statistically significantly worse outcomes compared to patients with milder disease. Conclusion: The results of this retrospective study suggest that individual MRI markers for severe adenomyosis (mean JZ &gt; 12 mm, myometrial cysts), especially when combined with (severe) endometriosis, may be associated with fewer pregnancies during IVF/ICSI when compared to male infertility controls. Future prospective studies should investigate the prognostic potential of these markers for prediction of IVF/ICSI success.

Holistic treatment of endometriosis

The pain phenomena caused by endometriosis are manifold. In addition to nociceptive pain there is also anociplastic reaction with central sensitization. Atypical symptoms, such as acyclic lower abdominal pain, radiating pain, nonspecific bladder and intestinal complaints or even depression increasingly occur in addition to the classical cyclic complaints, such as severe dysmenorrhea, cyclic lower abdominal pain, dyspareunia, dysuria and dyschezia. Due to the diffuse range of symptoms, affected patients often consult not just gynecologists but also specialists from other disciplines (internal medicine, gastroenterology, orthopedics, pain therapy, psychology etc.). The complexity of endometriosis is presented. The resulting approaches to multimodal interdisciplinary holistic treatment are described. Interdisciplinary concepts should be involved in the optimal treatment of endometriosis patients along with hormonal and surgical treatment, mostly under the supervision of agynecologist and pain management, dietary changes, psychological support and physiotherapeutic management should also be included. This article provides an overview of possible treatment strategies for chronic symptomatic endometriosis. Based on multimodal treatment strategies and regarding the complex pathophysiological alterations of this disease, the complex complaints that significantly impair the quality of life of endometriosis patients can be greatly improved.

Evaluation of the efficacy of GnRH-a pretreatment before total hysterectomy for adenomyosis patients: a propensity score matching analysis

Objective: To evaluate the efficacy of gonadotropin-releasing hormone agonist (GnRH-a) pretreatment before total hysterectomy for adenomyosis patients with uterine volume ≥12 gestational weeks and moderate or severe anemia. Methods: From January 2018 to March 2023, 689 patients who underwent total hysterectomy for adenomyosis in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. According to the preoperative medication, they were divided into study group (127 cases) and control group (562 cases). Patients in the study group underwent GnRH-a pretreatment for 3 cycles before surgery, and the control group received operation directly. SPSS 26.0 software was used to perform 1∶1 matching for the two groups of patients through the propensity score matching method. Matching variables included age, body mass index, gravidity, parity, history of pelvic and abdominal surgery, menstrual cycle, menstrual period, dysmenorrhea score, initial diagnosis of cancer antigen 125 (CA125), uterine volume and hemoglobin value. The dysmenorrhea score, uterine volume, hemoglobin value and CA125 level before and after GnRH-a pretreatment in the study group were compared. And the duration of operation, intraoperative blood loss, postoperative white blood cell count, perioperative blood transfusion cases, postoperative disease rate, duration of hospitalization, total hospitalization cost between the two groups were compared. Results: With propensity score matching, 119 patients in the study group and 119 patients in the control group were finally enrolled in this study. In the study group, before and after the treatment with GnRH-a, the dysmenorrhea score (7.4±1.7 vs 5.6±1.8), uterine volume [(362±160) vs (233±126) cm3], hemoglobin value [(74.1±10.7) vs (102.5±13.5) g/L], and CA125 level [(104±76) vs (64±51) kU/L] were statistically different (all P<0.05). There were statistical differences of operation time [(86±18) vs (116±31) minutes], intraoperative blood loss [(24±9) vs (43±22) ml], white blood cell count after 1 day of operation [(9.80±0.10)×109/L vs (9.90±0.10)×109/L], number of perioperative blood transfusion case [5.9% (7/119) vs 61.3% (73/119)], postoperative disease rate [5.0% (6/119) vs 16.0% (19/119)], hospitalization duration [(7.1±1.6) vs (7.9±1.6) days], and total hospitalization cost [(35 323±5 275) vs (37 159±5 640) yuan] between the study group and the control group (all P<0.05). Conclusion: The pretreatment of using GnRH-a before total hysterectomy for adenomyosis patients with uterine volume ≥12 gestational weeks and moderate or severe anemia is not only conducive to improving dysmenorrhea, signs of anemia, reducing uterine volume, but also conducive to the implementation of surgery, reducing intraoperative and postoperative complications, and reducing hospital costs.

Retrospective Review of Outcomes in Patients with Endometriosis and Colonic Segmental Resection (CSR) or Low Anterior Resection (LAR)

Objective: To further the understanding of long-term outcomes of endometriosis patients requiring colonic segmental resection (CSR) or low anterior resection (LAR). To improve counseling of patients with bowel endometriosis. Methods: Retrospective chart review at a single academic institution between 2000-2018 with 3-year follow-up of patients with CSR/LAR for endometriosis. 21 patients aged 18-45 at single academic institution between 1/1/2000 and 12/31/2018 with ICD9&amp;10 codes of endometriosis AND CSR/LAR were included; 9 met criteria for endometriosis as indication for CSR/LAR were reviewed. Results: Pre- and post-operative symptoms were categorized into GI (hematochezia, dyschezia, tenesmus, incontinence, incomplete evacuation of bowel, and pre-operative colonoscopy), GYN (dysmenorrhea, dyspareunia, pelvic pain, and infertility), and GU (dysuria, frequency, urgency, incontinence, and incomplete emptying).

Circulating miR-3613-5p but not miR-125b-5p, miR-199a-3p, and miR-451a are biomarkers of endometriosis

ObjectiveThis study aimed to assess the utility of circulating miR-125b-5p, miR-199a-3p, miR-451a, and miR-3613-5p as biomarkers of endometriosis. Study designPatients with stage III or IV of endometriosis according to the revised American Society of Reproductive Medicine (rASRM) staging classification, as well as control women, were recruited. We created a prospective study conducted on a group of 48 patients (n = 25 controls, n = 24 endometriosis) who had laparoscopic surgery. Blood samples were taken and plasma miRNA levels were measured by quantitative real-time polymerase chain reaction (RT-qPCR) and assessed with AUC and ROC curves. ResultsMiR-451a and miR-3613-5p were significantly decreased in the plasma of endometriosis patients. miR-451a had a receiver-operating characteristic (ROC) area under the curve 0.8283 and miR-3613-5p had a ROC area under the curve 0.7617. The concentration of circulating miR-125b-5p and miR-199-3p did not differ between endometriosis patients and controls. Plasma miRNA levels did not change with BMI, smoking status, fertility problems, or menstrual pain according to the VAS scale (p > 0.05). ConclusionCirculating miR-451a and miR-3613-5p levels significantly differed between endometriosis and controls. However, the levels of miR-451a were discordant with previous studies. Therefore, miR-3613-5p may have better potential as the endometriosis biomarker. Circulating miR-125b-5p and miR-199a-3p cannot be used as reliable markers of endometriosis.