Endometriosis-related Pelvic Pain Research Articles

Pelvic pain in endometriosis: is success of therapy gone in cigarette smoke?

The objective of the study was to assess potential individual factors influencing the efficacy of combined surgical and medical therapy in en-dometriosis patients with pelvic pain. For this purpose we performed a prospective study using a specifically designed questionnaire among patients suffering from persistent pelvic pain and undergoing laparoscopy and further GnRH analogue therapy in a university-based gyne-cologic department. Eighty-one women of re-productive age with histologically confirmed endometriosis were enrolled. A questionnaire gathered information from women on the fol-lowing groups of variables: age, marital status, education, reproductive and medical history including previous pregnancies and parity, knowledge of accompaniing pelvic disorders, concurrent cigarette smoking, as well as general quality of life estimates including self-image. Pelvic pain was scored using a visual analogue scale. Patients filled out the questionnaires before surgery and upon completing medical therapy. Data were statistically evaluated. After cessation of therapy, 53% of patients reported absence of pain. Only 12% of pain-free patients were smokers. This corresponded to slightly more than one third (35%) of all smokers in the study. However, 56% of non-smoker participants reported a positive outcome that proved to be significantly larger than the ratio of pain-free smoker participants (p = 0.02). Improvement in quality of life was reported by 74% of all patients, and only 9% of them were smokers. However, 47% were smokers among patients reporting no change or worsening in quality of life (p < 0.01). Based on our results, we can conclude, that regular smoking might have a disadvantageous impact on the success rate of combined surgical and medical therapy for endometriosis related pelvic pain.

Overexpression of nerve growth factor in peritoneal fluid from women with endometriosis may promote neurite outgrowth in endometriotic lesions

To investigate the role of the nerve growth factor (NGF) in the endometriosis-associated innervation in the development of endometriosis-associated symptoms, 41 peritoneal fluid samples (PF) from patients with surgically and histologically proven endometriosis and 20 PF from patients with other gynecologic conditions were analyzed with Western blot and a novel in vitro model using dorsal root ganglia (DRG) to show neuronal outgrowth; endometrial cells also were analyzed. The results suggest that the PF of endometriosis patients and endometriotic lesions have neurotropic properties, because the Western blot analysis and the cell culture stainings showed NGF expression, and the neurite outgrowth of DRG treated with PF of patients with endometriosis was significantly higher than when treated with PF of patients without endometriosis. Furthermore, blocking NGF with both anti-NGF and K252a leads to a significant decrease in neurite outgrowth.

Treatment of endometriosis and chronic pelvic pain with letrozole and norethindrone acetate

Background: Endometriosis is encountered in 7-10% of actively menstruating women, with a suspected prevalence as high as 22% in asymptomatic women. It is an important cause of chronic pelvic pain. The aim of this study was to evaluate the efficacy and safety of letrozole in combination with norethindrone acetate and calcium in the management of endometriosis associated pelvic pain. Methods: Prospective non-randomized open label study was carried out including 20 patients with endometriosis related pelvic pain that was refractory to previous treatments. Result: In all 14 patients completed the study. All patients showed significant improvement of pain scores and revealed significant improvement of features of endometriosis on being given letrozole in combination with norethindrone acetate and calcium. Conclusion: Letrozole is an effective drug for treatment of endometriosis.

Is the 30-item Endometriosis Health Profile (EHP-30) suitable as a self-report health status instrument for clinical trials?

This prospective study aimed to evaluate the suitability of the Endometriosis Health Profile-30 Questionnaire (EHP-30) as a self-report health status instrument. We compared our results with those from the U.K. and the U.S. and discovered relationships between the EHP-30 and patient characteristics. The results showed that the EHP 30 questionnaire is a user-friendly self-report tool suitable for use in endometriosis-related clinical research.

Japanese-Style Acupuncture for Endometriosis-Related Pelvic Pain in Adolescents and Young Women: Results of a Randomized Sham-Controlled Trial

Study Objective To assess feasibility, and collect preliminary data for a subsequent randomized, sham-controlled trial to evaluate Japanese-style acupuncture for reducing chronic pelvic pain and improving health-related quality of life (HRQOL) in adolescents with endometriosis. Design Randomized, sham-controlled trial. Settings Tertiary-referral hospital. Participants Eighteen young women (13–22y) with laparoscopically-diagnosed endometriosis-related chronic pelvic pain. Interventions A Japanese style of acupuncture and a sham acupuncture control. Sixteen treatments were administered over 8 weeks. Main Outcome Measures Protocol feasibility, recruitment numbers, pain not associated with menses or intercourse, and multiple HRQOL instruments including Endometriosis Health Profile, Pediatric Quality of Life, Perceived Stress, and Activity Limitation. Results Fourteen participants (out of 18 randomized) completed the study per protocol. Participants in the active acupuncture group (n = 9) experienced an average 4.8 (SD = 2.4) point reduction on a 11 point scale (62%) in pain after 4 weeks, which differed significantly from the control group's (n = 5) average reduction of 1.4 (SD = 2.1) points ( P = 0.004). Reduction in pain in the active group persisted through a 6-month assessment; however, after 4 weeks, differences between the active and control group decreased and were not statistically significant. All HRQOL measures indicated greater improvements in the active acupuncture group compared to the control; however, the majority of these trends were not statistically significant. No serious adverse events were reported. Conclusion Preliminary estimates indicate that Japanese-style acupuncture may be an effective, safe, and well-tolerated adjunct therapy for endometriosis-related pelvic pain in adolescents. A more definitive trial evaluating Japanese-style acupuncture in this population is both feasible and warranted.

Development of Protocols for Randomized Sham-Controlled Trials of Complex Treatment Interventions: Japanese Acupuncture for Endometriosis-Related Pelvic Pain

Very little research has been conducted in the West to evaluate the clinical efficacy of Japanese acupuncture (JA). The characteristics that define and differentiate JA from Chinese acupuncture styles add specific challenges to the operationalization of treatment protocols for use in clinical trials. To develop an ecologically valid and viable multimodal treatment intervention, including active and sham protocols, for use in a pilot randomized sham-controlled trial of a style of JA in treating endometriosis-related chronic pelvic pain in adolescents and young women. A focus group format was used to systematize the diagnostic framework, operationalize the intake, design the treatment protocols, and develop a viable and effective sham acupuncture intervention using the Streitberger device and sham moxibustion. Implementation of the treatment protocol employed the manualization process to provide flexibility of treatment while assuring replicability and standardization. The Japanese Acupuncture Department at the New England School of Acupuncture in Newton, MA. Completed study visit forms indicated good compliance of study practitioners with active and sham treatment protocols. The specific JA protocols used in our pilot study were well tolerated by the adolescent girls who participated in the trial. No serious adverse events were reported by any participants. Our protocols were successful in maintaining patient blinding and minimizing differences in outcome expectations between treatment groups. Manualization provided a viable method for conforming to the interactive nature of JA treatments, yet facilitated compliance with a replicable treatment protocol. Sham controls of complex, multicomponent JA interventions pose unique challenges. The modified Streitberger needle in conjunction with sham moxibustion showed promise as a viable control in clinical trails of JA; both components of this sham protocol require further validation.

Pelvic denervation procedures: A current reappraisal

The introduction of minimally invasive techniques over recent years has led to the resurgence of pelvic denervation procedures such as presacral neurectomy and uterine nerve ablation being performed for women with dysmenorrhea and pelvic pain. Women who have failed medical therapy with persistent and debilitating symptoms may certainly benefit from these procedures. However, presacral neurectomy and uterine nerve ablation are distinct procedures that require appropriate patient selection in order to optimize pain relief. Whereas presacral neurectomy may be effective for both primary dysmenorrhea and endometriosis-related pelvic pain, the role of uterine nerve ablation should be reserved for patients with primary dysmenorrhea only, as evidenced by several randomized trials.

Adolescent Endometriosis-Related Pelvic Pain Treated with Acupuncture: Two Case Reports

Chronic pelvic pain in adolescents accounts for 10% of outpatient gynecology visits, and 70% of adolescent patients whose pelvic pain is unresponsive to initial therapy have endometriosis. To date, there has been no published research investigating the use of acupuncture for adolescents with chronic pelvic pain and/or endometriosis. This paper presents two case reports describing the impact of a course of acupuncture on adolescent girls with endometriosis-related chronic pelvic pain of more than 1 year. Both patients, undergoing between 9 and 15 treatments over a 7- to 12-week period, experienced modest improvement in pain as measured by oral self-reports of pain on a scale from 1 to 10, as well as self or family-reported improvement in headaches, nausea and fatigue. No adverse effects were reported. These case reports provide preliminary evidence that acupuncture may be an acceptable and safe adjunct treatment therapy for some adolescents with endometriosis-related pelvic pain refractory to standard antiendometriosis therapies. These observations suggest that a prospective, randomized controlled trial of the safety and efficacy of acupuncture for this population may be warranted.

A danazol-loaded intrauterine device decreases dysmenorrhea, pelvic pain, and dyspareunia associated with endometriosis

A danazol-loaded intrauterine device (IUD) containing 300–400 mg of danazol was inserted for 6 months in a group of women (n = 18) (median age 36.6 years; age range: 30 to 46 years) with a histologic diagnosis of endometriosis, referred for recurrent pelvic pain. Dysmenorrhea, dyspareunia, and pelvic pain significantly decreased after the first month, with a persistent effect during the 6 months of IUD insertion. These results show that a danazol-loaded IUD is an effective conservative therapy for patients with endometriosis-related pelvic pain.

Endometriosis-related pelvic pain: what is the evidence?

Endometriosis-related pelvic pain: what is the evidence?

Estroprogestin vs. gonadotrophin agonists plus estroprogestin in the treatment of endometriosis-related pelvic pain: a randomized trial

Objective: This is a randomized clinical trial comparing estroprogestin (E/P) pill given for 12 months vs. gonadotrophin releasing hormone agonist (GNRHa) given for 4 months followed by E/P pill treatment for 8 months in the relief of endometriosis-related pelvic pain. Methods: Eligible for the study were women with laparoscopically confirmed endometriosis and pelvic pain lasting 3–12 months after diagnosis. Eligible women were randomly assigned to treatment with E/P pill (gestroden 0.75 mg and ethynlestradiol 0.03 mg) for 12 months (47 patients) vs. tryptorelin 3.75 mg slow release every 28 days for 4 months followed by E/P pill for 8 months (55 patients). Results: At baseline, dysmenorrhea was reported in 46 women allocated to E/P pill only (97.9%), and in all the 55 women allocated to GNRHa+E/P pill. The corresponding value at the 12 months follow-up visit was 14 subjects (35.9%) and 16 subjects (34.8%). The baseline median values of the multidimensional and analog scale were for dysmenorrhea 4 and 6 in the EP only and 3 and 6 in the GNRHa+E/P group. The corresponding value at the 12 months follow-up visit were 2 and 6 and 0 and 5. Non-menstrual pain was reported, respectively, at baseline and 12 month visit by 46 (97.9%) and 15 (38.5%) subjects in the E/P pill group and 49 (89.1%) and 17 (37.0%) of the GNRHa+E/P pill one. The baseline median values of the multidimensional and analog scale were for non-menstrual pain 3 and 5 in the E/P only and 2 and 6 in the GNRHa+E/P group. The corresponding values at the 12 month follow-up visit were 0 and 4 and 0 and 4. These differences between the two groups were not statistically significant. Conclusions: 1 year after randomization, the two treatment schedules show similar relief of pelvic pain in women with endometriosis.

Reproductive outcome after treatment of mild endometriosis with laparoscopic excision and electrocoagulation

Objective: To compare the pregnancy rates (PRs) of infertile women with mild endometriosis treated laparoscopically by surgical excision and by electrocoagulation. Laparoscopic treatment of minimal and mild endometriosis usually is done by laser or electrocoagulation. Whether surgical excision is associated with similar results is unknown. Design: Retrospective study with a historical control. Setting: University teaching hospitals. Patient(s): One hundred one infertile women undergoing laparoscopic treatment of mild endometriosis. Intervention(s): Forty-eight women were treated with electrosurgery (historical control) and 53 women were treated with excision. Main Outcome Measure(s): The PRs of the two groups of women were evaluated using life-table calculations and the Mantel-Cox test. Result(s): Of the total 24 pregnancies (PR: 57.1%) in the electrosurgery group, there were 3 spontaneous abortions (12.5%) and 1 ectopic pregnancy (4.2%). The total PR in the excision group was 53.5%, the abortion rate was 17.4% (4 of 23), and the ectopic PR was 8.7% (2 of 23). The median interval between surgery and conception was 10.7 months in the electrosurgery group and 13.3 months in the excision group. There was no statistically significant difference in the probability of conception between the two groups of women (Mantel-Cox test: z = 0.24). Using the Cox proportional-hazards model, the effects of age and duration of infertility were evaluated and were found not to be associated with a decreased PR. Conclusion(s): There is no difference in the PRs of infertile women with mild endometriosis treated laparoscopically by surgical excision and by electrocoagulation. The difference between these two modalities in women with endometriosis-related pelvic pain remains to be determined.

Correction to: "Friedman AJ, Hornstein MD: Gonadotropin-releasing hormone agonist plus estrogen-progestin "add-back" therapy for endometriosis-related pelvic pain. Fertil Steril 1993;60:236-41"

Correction to: "Friedman AJ, Hornstein MD: Gonadotropin-releasing hormone agonist plus estrogen-progestin "add-back" therapy for endometriosis-related pelvic pain. Fertil Steril 1993;60:236-41"