Endometriosis-related Symptoms Research Articles

Long-Term Follow-Up Regarding Pain Relief, Fertility, and Re-Operation after Surgery for Deep Endometriosis.

Background: Endometriosis is known to be a common chronic disease that often affects the quality of life of patients. Especially for deep endometriosis (DE), the most challenging form of the disease, surgery remains an important component of treatment. However, long-term outcomes after surgery are poorly studied. Therefore, we aimed to evaluate the postoperative clinical course of women with DE who underwent surgery, particularly with regard to pain relief, fertility, and re-operations. Methods: Thus, women who underwent surgical treatment for DE between 2005 and 2015 were included in this retrospective questionnaire-based analysis. Results: A total of 87.0% of the patients who underwent surgery for pain reported a postoperative relief of their complaints. Moreover, 44.6% even stated that they were free of pain at the time of the questionnaire. Patients who underwent surgery for infertility and tried to become pregnant postoperatively gave birth to a child in 45.9% of cases. Approximately one-third of the patients had to undergo another surgery because of endometriosis-related symptoms. The main reasons for re-operation were pain and infertility. The median time to re-operation was 2.1 years. Conclusions: In this extraordinarily long follow-up with a remarkable response rate, we show that surgical treatment of DE leads to pain relief and improved fertility in most cases. However, the risk of recurrence and the need for re-operation remains remarkable.

Comparing the treatment of endometriosis-related pain by excision of endometriosis or hysterectomy: A multicentre prospective cohort study.

To compare the effectiveness of endometriosis excision alone to excision plus hysterectomy, with and without bilateral oophorectomy, for endometriosis-related symptoms. Multicentre prospective cohort. Eighty-six specialist endometriosis centres. Women undergoing rectovaginal endometriosis surgery between 2009 and 2021. We performed multivariable regression with random effects for patient and centre, controlling for age, BMI, smoking, laparoscopic versus open approach and type of bowel surgery performed, with sensitivity analysis for loss to follow-up. Pain scores, bowel symptoms and quality-of-life measures. Compared to endometriosis excision alone, women undergoing hysterectomy with conservation of ovaries had greater improvement in non-cyclical pain (MD: 1.41/10, 95% CI: 1.03-1.78, p < 0.001), dyspareunia (MD: 1.12/10, 95% CI: 0.71-1.53, p < 0.001), back pain (MD: 1.29/10, 95% CI: 0.92-1.67, p < 0.001) and quality-of-life scores (MD: 8.77/100, 95% CI: 5.79-11.75, p < 0.001) at 24 months post-operatively. Women undergoing hysterectomy with bilateral oophorectomy also had greater improvement in non-cyclical pelvic pain (MD: 2.22/10, 95% CI: 1.80-2.63, p < 0.001), dyspareunia (MD: 1.05/10, 95% CI: 0.59-1.52, p < 0.001), back pain (MD: 1.18/10, 95% CI: 0.77-1.59, p < 0.001) and quality of life (MD: 12.41/100, 95% CI: 9.07-15.74, p < 0.001) at 24 months compared to endometriosis excision alone. Compared to hysterectomy with ovarian conservation, hysterectomy with bilateral oophorectomy was associated with greater improvement in non-cyclical pelvic pain (MD: 0.81/10, 95% CI: 0.32-1.30, p = 0.001) at 24 months and quality of life (MD: 3.74/100, 95% CI: 0.56-6.92, p = 0.021) at 12 months, although this result was sensitive to loss to follow-up. Patients who undergo endometriosis excision plus hysterectomy experience greater improvement in pain and quality of life compared to those who have endometriosis excision alone. There are additional benefits of bilateral oophorectomy with hysterectomy, although its value is less clear due to loss of follow-up.

P-743 Laparoscopic radical excision of deep endometriosis: A positive impact of fertility outcome

Abstract Study question Does laparoscopic radical excision of deep endometriosis (DE) and endometrioma enucleation impact fertility outcomes and recurrence rates when compared to partial excision group? Summary answer In stage IV endometriosis, laparoscopic radical surgery significantly reduced the recurrence rates.The laparoscopic radical excision group tended to have a higher rate of natural conception. What is known already Endometriosis-related symptoms can be significantly improved through surgery, leading to better pregnancy rates. However, the optimal surgical approach can vary due to the complexity of DE. As a result, the recurrence of postoperative symptoms and pregnancy rates can differ due to the lack of randomized trials comparing primary surgery with first-line IVF studies. Thus, the ESHRE stated that there was no evidence supporting surgical management of DE prior to ART to improve pregnancy rates. However, the higher probability of postoperative spontaneous conception in patients undergoing radical resection versus conservative treatment of DE has been reported. Study design, size, duration study design: Retrospective cohort study in a tertiary referral center. size: 77 patients diagnosed with moderate or severe endometriosis and DE. duration: between 2018 and 2020 Participants/materials, setting, methods 77 patients underwent laparoscopic surgery for dysmenorrhea or infertility. Group 1 (n = 22) underwent conservative treatment through partial excision of endometriosis, indicating incomplete resection. Group 2 (n = 55) underwent radical excision of endometriosis and restoration of pelvic anatomy, indicating complete resection. We compared the baseline characteristics, peri-operative data, and follow-up outcomes, aiming to investigate whether radical excision yields superior results in terms of recurrence rate, re-intervention, and pregnancy rate. Main results and the role of chance Main results: Group 2 showed significantly higher surgical complexity with higher revised American Fertility Society classification scores, a greater proportion of severe endometriosis, multiple sites with endometriotic lesions, and longer operation times. Both groups had comparable pregnancy, recurrence, and re-intervention outcomes during the follow-up period of 28.2±16.4 months. While Group 2 tended to have a higher pregnancy rate (84% versus 67%, p = 0.56) and higher live birth rates (80% versus 67%, p = 0.59) when compared with group 1. In the population with stage IV endometriosis, group 2 significantly reduced the recurrence rates (9% versus 50%, p = 0.04) when compared to group 1. Conclusions: The group that underwent laparoscopic endometrioma enucleation with radical excision of extra-ovarian endometriosis exhibited significantly higher surgical complexity. In the population with stage IV endometriosis, radical surgery significantly reduced the recurrence rates. Surgical excision of ovarian endometriosis and extra-ovarian disease is advisable to limit disease progression and ensure complete symptom resolution. Additionally, the laparoscopic radical excision group tended to have a higher rate of natural conception, indicating potential benefits for fertility in patients who have moderate and severe endometriosis with DE. Limitations, reasons for caution The main limitations were the small sample size and recall bias. But, additionally, the limited cases in the research group might have influenced the results and restricted the extrapolation of related conclusions. Further studies with larger sample sizes are needed in the future. Wider implications of the findings We believe that a standardized surgical technique outlining a step-by-step method to delineate all important structures and address altered planes as in endometriosis, with the aim of restoring normal pelvic anatomy, ensures the avoidance of high complication rates, leads to lower recurrence rates and positive impact on fertility outcomes. Trial registration number not applicable

The impact of vitamin D treatment on pregnancy rate among endometriosis patients: a systematic review and meta-analysis.

Vitamin D supplementation is supposed to have an important role in the management of several endometriosis-related aspects, offering potential relief to affected individuals. Herein, the authors aim to evaluate the impact of vitamin D on pregnancy rates and clinical symptoms in women with endometriosis. The authors extensively searched PubMed, Cochrane Library, EMBASE, Ovid MEDLINE, and CINAHL from their inception to 20 July 2023. Three randomized controlled trials involving 167 patients were included in this meta-analysis. The findings demonstrated that vitamin D supplementation exhibits efficacy in alleviating dysmenorrhea associated with endometriosis, as evidenced by a meta-analysis showing a significant reduction in dysmenorrhea (mean difference -1.41, 95% CI -2.61 to -0.22, P = 0.02). However, the impact on dyspareunia was inconclusive, with a non-significant mean difference of -0.2 (95% CI -1.62 to 1.22, P = 0.78). In contrast, dyschezia significantly decreased with vitamin D supplementation (mean difference -1.10, 95% CI -2.22 to 0.02, P = 0.05 However, the meta-analysis did not show a significant effect of vitamin D on chronic pelvic pain associated with endometriosis. While antioxidant vitamin D supplementation demonstrates general effectiveness in alleviating endometriosis symptoms, such as dysmenorrhea, dyspareunia, and dyschezia, the existing literature lacks direct investigations into the specific impact of vitamin D on enhancing pregnancy rates among endometriosis patients. This observation prompts various hypotheses, suggesting that the positive effects of vitamin D supplementation on endometriosis-related symptoms may indirectly contribute to improved pregnancy outcomes and enhanced fertility.

Exercise and endometriosis-is there a promising future? A narrative review.

Endometriosis is the leading cause of chronic pelvic pain in women of reproductive age with debilitating effects on quality of life, yet no cure exists. Exercise yields the potential in providing women with a non-invasive, non-pharmacological method of symptom control. Present up-to-date knowledge regarding how exercise may contribute to the management of endometriosis-related symptoms. Discuss: 1. The pathophysiology surrounding exercise and endometriosis. 2. The role of exercise in endometriosis symptom control. Scientific literature has alluded to exercise being a favourable factor in the management of endometriosis-related symptoms. Moreover, current clinical guidelines for endometriosis fail to reflect the aforementioned benefits of exercise. A search strategy using the terms 'endometriosis', 'endometriomas', 'exercise', and 'physical activity' was devised. Pubmed, Medline, Cochrane reviews, and Embase were reviewed. Interventional studies, within-subjects studies, randomised-control trials, systematic reviews, meta-analysis, cohort studies, publication since 2000. Non-English publications, non-human studies. Numerous studies have suggested positive effects for endometriosis patients who performed exercise exclusively or in conjunction with other therapies. Improvements in pain levels, quality of life, anxiety, and depression were noted. Current research outlines promise regarding the potential benefit of exercise prescribing in patients with endometriosis as well as a synergy between exercise and hormonal therapies for the management of endometriosis-related symptoms. However, the current paucity of high-quality robust studies investigating these aspects of endometriosis management is an apparent obstacle to progression in this area. For clinicians to incorporate exercise in managing endometriosis, clear recommendations regarding advice and benefits are needed.

A gluten-free diet for endometriosis patients lacks evidence to recommend it

Endometriosis, an estrogen-dependent chronic disease that is characterized by the presence of endometrium-like tissue outside the uterus, is often associated with symptoms like dysmenorrhea, dysuria, dyschezia, chronic pelvic pain and infertility. Women diagnosed with endometriosis can also report gastro-intestinal symptoms, including bloating, constipation or diarrhea and abdominal cramping, that can be associated with Irritable Bowel Syndrome (IBS) and can result in misdiagnosing endometriosis as IBS at first. Treatment usually involves hormonal therapy, pain management, surgery and/or assisted reproductive techniques in case of infertility. Nonetheless, these treatment methods can be insufficient in alleviating symptoms, or can cause unacceptable side effects leading to non-compliance. Therefore, women often apply self-management strategies including dietary interventions. One of the diets frequently suggested as a tool to manage endometriosis-related symptoms on social media and patient forums, is a gluten-free diet. While a gluten-free diet has been proven effective in managing non-celiac wheat sensitivity or celiac disease, its effectiveness for endometriosis remains uncertain. The Nurses’ Health study II found it unlikely that gluten intake was a strong factor in endometriosis etiology and symptomatology. The most frequently cited and sole published intervention study, to our knowledge, on the efficacy of a gluten-free diet for endometriosis has several important limiting factors, including the absence of a control group. Additionally, gluten consumption is highly susceptible to a placebo- and nocebo effect, where women might experience symptom relief when eliminating gluten, and return of symptoms when they consume gluten again, solely because they believe gluten are bad for them. Despite the inverse association between BMI and endometriosis and between a gluten-free diet and increased BMI, this is an association and no causality was proven. Other factors should be taken into account. Finally, a gluten-free diet is expensive with a limited availability, has a great impact on Quality of Life and without proper dietary guidance may adversely affect the gastro-intestinal microbiome. Therefore, a scientifically substantiated advice regarding the use of a gluten-free diet for endometriosis-related symptoms is currently not available and a gluten-free diet should therefore be discouraged unless there is an additional diagnosis of non-celiac wheat sensitivity or celiac disease.

Postmenopausal endometriosis: a challenging condition beyond menopause.

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. 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. 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.

Neonatal uterine bleeding: Risk factors and its association with endometriosis-related symptoms later in life

ObjectiveWe examined the prevalence and risk factors in association with neonatal uterine bleeding (NUB) by retrospective search of contemporary and historical medical records and investigated the possible association between the history of NUB at birth and endometriosis-related symptoms later in life who are now young women. Study designThis was a retrospective case-controlled cohort study and prospective evaluation of web-based questionnaire survey on symptoms related to endometriosis among young women born with and without NUB. Multiple regression analysis was performed incorporating various confounding variables that may influence the occurrence of NUB or the reporting of endometriosis symptoms later in life. ResultsAmong the 1093 female neonates born between 1996 and 2000, 105 of them had NUB, yielding with a prevalence of 9.6 %. Of the 807 female babies born between 2013 and 2017, 25 (3.1 %) had NUB. Multiple Logistic regression analysis indicated that younger age of the mother [odds ratio (OR) = 0.92, 95 % confidence interval (CI) = 0.85–1.00, P = 0.048] and longer gestational age of 39 weeks (OR = 3.04, 95 % CI = 1.43–6.45, P = 0.004) and of ≥ 40 weeks (OR = 4.54, 95 % CI = 2.20–9.39, P < 0.0001) of gestation were significantly associated with the occurrence of NUB. While the possibility of recall bias cannot be ruled out, newborn females who had a history of NUB appeared to complain of various endometriosis-related symptoms later in life during adulthood. ConclusionsWe confirmed the validity of the reported prevalence and risk factors of NUB. NUB indeed occurs with a prevalence of 3–10% during the historical and contemporary period. Longer gestational age and younger maternal age may be considered as high-risk factors for the occurrence of NUB. The clinical relevance of our findings remains to be elucidated. Future prospective studies, preferably with larger sample sizes and the inclusion of NUB cases after discharge from the hospital, may further illuminate some unresolved issues. We also need to confirm the endometriosis-related symptoms in women with and without history of NUB via more definitive diagnosis such as imaging and histology.

Mediterranean Diet and Oxidative Stress: A Relationship with Pain Perception in Endometriosis.

Endometriosis is a chronic and inflammatory disease associated with pelvic pain. Dietary changes may be therapeutic for chronic inflammatory processes, reducing visceral input. The aim was to evaluate the role of dietary changes according to the Mediterranean Diet (MD) on pain perception in endometriosis and their relationship with oxidative stress. in this prospective study, we included 35 endometriosis women. At baseline (T0) and after 3 (T1) and 6 (T2) months from the start of the diet, we investigated pain intensity with VAS (Visual Analogue Scale, from 0 to 10), vitamin profile, and oxidative stress. we found a significant increase in the diet score (p < 0.001). At T1, patients reduced pain in terms of dyspareunia (p = 0.04), non-menstrual pelvic pain (p = 0.06), dysuria (p = 0.04), and dyschezia (p < 0.001). Dyspareunia (p = 0.002) and dyschezia (p < 0.001) were further significantly reduced also at T2. We observed a significant positive correlation between lipid peroxidation and VAS non-menstrual pelvic pain and dysuria and a significant negative correlation between Oxygen radical absorbance capacity and VAS non-menstrual pain and dyschezia. our findings show a clear tendency toward a relationship between pain relief in endometriosis and MD. This appears promising to treat endometriosis-related symptoms and could be considered a new effective strategy for chronic pain management in the long term.

Diet associations in endometriosis: a critical narrative assessment with special reference to gluten.

Endometriosis is characterized by the presence of endometrium-like tissue outside the uterus. The etiology remains largely unknown. Despite adequate treatment, patients can still experience symptoms or side effects resulting in therapy incompliance and in self-management strategies such as dietary measures is increasing. A gluten free diet is thought to be contributory in reducing endometriosis-related pain, thereby optimizing quality of life. However, data is conflicting and currently provides no evidence for causality. This narrative review aims to put the effect of dietary self-management strategies on endometriosis in a balanced perspective, especially the effect of gluten and a gluten free diet. Several studies have found a strong overlap in symptoms, metabolic and immune responses associated with endometriosis and those associated with celiac disease, ulcerative colitis, Crohn's disease, irritable bowel syndrome and non-celiac wheat sensitivity. However, it remains unclear whether these diseases and/or disorders are causal to an increased risk of endometriosis. Some studies have found a positive effect on the risk of endometriosis, endometriosis-related symptoms and quality of life (QoL) when women either avoided certain nutrients or foods, or applied a specific nutrient supplementation. This includes the avoidance of red meat and omega-3, an increasing intake of foods rich in anti-oxidants, micronutrients and dietary fibers (e.g., fruit, vegetables) and the appliance of a gluten free diet. However, data from the available studies were generally graded of low quality and it was noted that placebo and/or nocebo effects influenced the reported positive effects. In addition, such effects were no longer seen when adjusting for confounders such as overweight, when a translation was made from in vitro to in vivo, or when the nutrients were not supplemented as isolated sources but as part of a mixed daily diet. Finally, some studies showed that long-term adherence to a gluten free diet is often associated with an impaired diet quality and nutrient intake, leading to negative health outcomes and reduced QoL. Concluding, scientific evidence on the efficacy of dietary interventions on well-defined clinical endpoints of endometriosis is lacking and recommending a gluten free diet to women solely diagnosed with endometriosis should therefore not be advised.

Challenges in diagnosing and managing endometriosis in general practice: A Western Australian qualitative study.

To reduce diagnostic delay for women with endometriosis-related symptoms, we need to understand general practitioners' (GPs) perspectives on the challenges they face in diagnosing and managing endometriosis. Qualitative interviews were conducted with nine Western Australian GPs to explore their knowledge, experiences andchallenges with the diagnosis and management of endometriosis. Three themes were identified as challenges: eliciting symptoms, with subthemes of multiple and complex symptoms, clinician experience and awareness, time constraints and screening opportunities; delivering patient-centred care, with subthemes of cultural factors and health literary, perceived gender biases and women's choices and priorities; and system and service, which included learning on the job, clearer diagnostic pathways, access to services and collaborative care models. GPs can be better supported in dealing with endometriosis through raising awareness and education; recognition ofendometriosis as a complex chronic condition; and the development of pragmatic guidelines, with increased access to local centres for excellent andcollaborative care.

P-318 Epidemiologic analysis of endometriosis awareness in Turkey

Abstract Study question What is the prevalence of endometriosis in Turkey, and what are the impacts of endometriosis-related symptoms on social, occupational, medical, and daily life activities? Summary answer Endometriosis is a debilitating disease that affects 18% of Turkish women of reproductive age. Social, occupational, and psychological functioning are all negatively impacted. What is known already Endometriosis is a chronic, inflammatory disease. It affects about 6–10 percent of women worldwide. It can alter the quality of life, mental health, relationships, and sexuality of the carriers. The delay in the diagnosis of endometriosis causes a loss of workforce, a decrease in productivity, and, most importantly, excessive finances. Previous studies from developed countries show endometriosis carriers have lower annual incomes and higher short or long-term workforce loss. Due to the difficulty of diagnosing most cases, the actual incidence of endometriosis in the population, including in developed countries, is unknown. Study design, size, duration This study used a web-based survey to identify the prevalence of symptoms and endometriosis-diagnosed women. For this purpose, the World Endometriosis Research Foundation (WERF) EndoCost tool was utilized and altered by the Turkish demographic and healthcare background. Between September 15, 2022, and November 2022, the survey was accessible. In this process, 16304 surveys were completed, with 15673 being counted. Participants/materials, setting, methods The survey's applicants were reached through social media platforms (Facebook and Instagram), which included social media accounts of influencers with followers from all over the country, reports of authors and women's support organizations, countywide student clubs of universities, and nurses working on family medicine in all parts of the country delivering to regions of responsibility. The ethical committee approval have been taken from an university hospital ethical commission (E-10840098-772.02-4247). Main results and the role of chance Our study showed that the prevalence of endometriosis in developing countries was not insignificant. This survey had 15673 participants, and 2880 (18.3%) were diagnosed with endometriosis. There was a significant difference in the impact of endometriosis-related symptoms on social, occupational, medical, and daily life between the participants with endometriosis and the non-endometriosis participants. The percentage of participants with endometriosis (1.3%) who reported quitting work/school due to pain was statistically higher than the non-endometriosis population (0.6%) (P = 0.001). Also, 21.2% of endometriosis participants reported feeling socially isolated related to their condition (P = 0.001). One thousand one hundred fifty-two individuals with endometriosis reported work/school difficulties (28.3%), and 224 respondents could not attend class/work due to endometriosis-related symptoms (7.4%). In addition, most respondents with endometriosis (46.0%) reported problems in a personal relationship, and interestingly, according to 1820 (63.2%) participants with endometriosis, people did not believe their pain or symptoms. There is also this to consider: our data shows that the average number of physician visits before diagnosis was four. Limitations, reasons for caution The study is limited by self-reported patient responses that were not confirmed by medical records or other complementary data. Wider implications of the findings Our findings can be used to increase awareness of the prevalence and challenges of endometriosis carriers, which may help develop future prevention programs. Since most participants with endometriosis experience financial difficulties due to their treatment, health policies can be designed to improve this issue. Trial registration number not applicable

The efficacy of GnRH-a followed by SanJieZhenTong capsules in long-term management of endometriosis: Study protocol for a multicenter, double-blinded, double-dummy randomized clinical trial

BackgroundEndometriosis is a common benign gynecological disorder with high risk of recurrence and adverse impact on fertility-sparing. This study aims to evaluate the effectiveness and safety of SanJieZhenTong Capsules, a traditional Chinese medicine, in the long-term management of endometriosis postoperatively. Methodsand analysis: A prospective, double-blinded, double-dummy parallel-group randomized controlled trial will be conducted at three university-based medical centers in China. A total of 600 patients with rAFS III-IV endometriosis diagnosed by laparoscopy will be enrolled. After fundamental treatment (gonadotropin-releasing hormone agonists injection starts on the first day of menstruation postoperatively, and repeats 3 times every 28 days), participants will be randomly allocated to the oral contraceptive group (oral contraceptive + dummy A) or SanJieZhenTong Capsules group (SanJieZhenTong Capsules + dummy B) in a 1:1 ratio. All participants will be treated and followed up for 52 weeks. The primary outcome is a recurrence rate based on endometriosis-related symptoms, physical examination, and/or ultrasound/MRI findings. The secondary outcome includes changes in quality of life and organic function outcome via the 36-item Short-Form scores and gastrointestinal function score. ConclusionThe current trial could provide rigorous evidence on SanJieZhenTong Capsules application in the long-term management of advanced-stage endometriosis.

Endometriosis Symptoms and Their Impacts on the Daily Lives of US Women: Results from an Interview Study.

This interview study sought to capture patients' experiences and perceptions of endometriosis symptoms and their impacts on daily life, as described by women in their own words. Using open-ended questions and a concept-elicitation approach, this study assessed the signs and symptoms of endometriosis and their impacts on different aspects of quality of life, including daily activities, functioning, and well-being. This interview study included US women with moderate-to-severe endometriosis-associated pain who completed one of two Phase 3, randomized, double-blind, placebo-controlled trials (SPIRIT 1 or SPIRIT 2; ClinicalTrials.gov identifiers: NCT03204318, NCT03204331). Interviews were conducted via a web/Internet-based video platform or telephone by trained interviewers, using open-ended questions in a concept-elicitation approach, and probes as needed to obtain additional feedback on the burden of endometriosis. Qualitative data from the interviews were analyzed, and emerging concepts were coded by independent coders. Concept saturation was evaluated to determine if all endometriosis-related symptoms and impacts had been described by the sample of women interviewed. Forty women participated in this study. In total, 18 unique symptoms of endometriosis emerged from the interviews; pelvic pain (92.5%), dyspareunia (80.0%), and heavy bleeding (75.0%) were the most commonly reported endometriosis symptoms. A total of 33 unique impacts of endometriosis symptoms were identified across 11 concepts: physical impacts, impacts on activities of daily living, social impacts, sleep impacts, emotional impacts, appearance impacts, financial impacts, sex-related impacts, work/school-related impacts, fertility impacts, and cognitive impacts. Concept saturation was achieved for both symptoms and impacts of endometriosis. This interview study provides substantive qualitative data on the burden of endometriosis, from the perspective of affected women in the US. The findings demonstrate the debilitating effect of endometriosis symptoms, which limit and adversely impact women's daily lives.

A Prospective Pilot Study of the Safety and Effectiveness of Uterine Artery Embolization for the Treatment of Endometriosis: The UAE-E Study

Abstract Purpose Uterine artery embolization (UAE) evidence is increasing in the setting of adenomyosis, which shares pathological similarities to endometriosis. Endometriosis is characterized by the presence of endometrium-like tissue outside of the uterus, and the retrograde menstruation hypothesis may account for disease development. In women where fertility is no longer desired, hysterectomy can be offered to improve pain-related symptoms. The authors hypothesize that this cohort of patients may similarly respond to UAE. The aim of this pilot study is to assess the safety and effectiveness of UAE in the management of endometriosis-related symptoms. Methods Six-patient prospective single-arm pilot study in female, premenopausal patients over 40 years with symptoms of endometriosis. Institutional review board approval was obtained.Inclusion criteria include completed family, premenopausal, pelvic endometriosis as confirmed by laparoscopy within the last 5 years, and symptoms of endometriosis impacting quality of life as evidenced by the British Society of Gynaecological Endoscopy pelvic pain and Short Form-36 questionnaires. Results The primary endpoint will be safety, as assessed by the composite number of procedural and postprocedural complications during procedure, predischarge, and at 6 weeks, 3 months, 6 months, and 12 months. Secondary endpoints will include technical success, clinical success, and durability. Discussion This study will be a novel application of UAE in the setting of endometriosis and has the potential to improve patient quality of life. This pilot study will assess safety and allow the investigators to design a prospective randomized controlled study.

A Systematic Review of Systematic Reviews on the Use of Aromatase Inhibitors for the Treatment of Endometriosis: The Evidence to Date.

Endometriosis is a chronic gynecologic condition that affects around 6-10% of reproductive age women. This clinical entity is characterized with pelvic pain, dysmenorrhea, dyspareunia, and infertility which are the most often presenting symptoms. Aromatase P450 is the key enzyme for ovarian estrogen biosynthesis and there is evidence that endometriotic lesions express aromatase and are able to synthesize their own estrogens. Aromatase inhibitors (AIs) are potent drugs that suppress the estrogen synthesis via suppression of aromatase. We performed a systematic review of systematic reviews and narrative reviews on the use of aromatase inhibitors in the medical management of endometriosis. We searched: PubMed (1950-2022), Google Scholar (2004-2022), Cochrane Library (2010-2022) and Researchgate (2010-2022). The search included the following medical subject headings (MeSH) or keywords: "Aromatase Inhibitors" AND "Endometriosis" AND "Systematic reviews" OR "Systematic review" AND "Reviews" OR "Reviews" AND "Endometriosis". The electronic database search yielded initially 12,106 studies from the different databases. Further assessment of the studies resulted in exclusion of (n = 12,015) studies due to duplicates and irrelevance; Finally, 24 studies were selected for inclusion, 5 were Systematic reviews and 19 were Narrative reviews. The 5 systematic reviews were assessed by AMSTAR-2 criteria and were found to have low quality. Narrative reviews were assessed with SANRA criteria and were found to have high-quality aromatase inhibitors are potent drugs that can manage the endometriosis-related symptoms in cases where initial medical management has failed to show positive results. However, their use is limited by the adverse effects that are linked with menopausal symptoms. aromatase inhibitors can be administered as an alternative treatment in patients. Future studies with randomized design are required to reach safer conclusions and further investigation. These studies should define the therapeutic dose, new add-back therapy modalities. Future directions should examine the most-appropriate way of administration and the duration of therapy.

Epidemiology of Endometriosis Awareness in Turkey.

Endometriosis is a chronic painful disease that affects the daily quality of life of individuals. Estimated rates show one in 10 women has endometriosis, although the actual prevalence is unknown. In this study, the impact of endometriosis prevalence and symptoms on women's lives in Turkey was questioned through a web-based questionnaire. We utilized a version of the World Endometriosis Research Foundation (WERF) EndoCost tool, which was sent to applicants via social media. Data from women aged 18-50 years were analyzed. The results of 15,673 participants have been analyzed, and 2880 (18.3%) participants had endometriosis. Respondents with endometriosis reported urinary, neurological, and gastrointestinal disorders at statistically higher rates when compared to individuals without endometriosis diagnosis (54.2%, 84.5%, and 89.9% vs. 37.2%, 75.5%, and 81.1%, respectively; p = 0.001). Most respondents with endometriosis (80.1%) reported persistent fatigue and 21.2% of endometriosis participants reported feeling socially isolated related to their condition (p = 0.001). Of the participants with endometriosis,63.2% mentioned that people did not believe their pain or symptoms and 77.9% experienced financial difficulties due to the cost of therapy. Of the participants with endometriosis, 46.0% reported that they had problems in their personal relationships, 28.3% had difficulties at work/school, and 7.4% were unable to attend class/work due to endometriosis-related symptoms. Endometriosis is a chronic, underestimated disease that affects 18% of Turkish women of reproductive age. There is a need for guidelines to inform healthcare providers, population professionals, and patients. Societies and governmental health authorities must work together to resolve this public health issue.

Efficacy of Dienogest on Pelvic Pain and Dyspareunia: Comprehensive Meta-Analysis and Systematic Review

Introduction: Endometriosis is a severe disorder marked by endometrial tissue outside the uterus and linked to infertility, although typically manifesting as discomfort in the form of dysmenorrhea, dyspareunia, and pelvic pain. Dienogest is indicated as a first-line hormone treatment for endometriosis-related discomfort. The aim of this study is to analyze the efficacy of Dienogest on treating pelvic pain and dyspareunia compared to placebo or combined oral contraceptives (COC) in women with endometriosis. Methods: A systematic search is conducted in PubMed, ScienceDirect, and Google Scholar. The PRISMA 2020 rules were used to screen the articles that were obtained. For the review, studies that examined how using dienogest in improving endometriosis were exposed to were taken into consideration. In a meta-analysis utilizing a random-effects model, odds ratios with their 95% confidence intervals (CI) were provided. Results: Five studies that met the criteria for inclusion were determined to be pertinent to the association between using dienogest in improving endometriosis (n=711). The Dienogest group had substantially improve pelvic pain with a mean difference of 1.01 (95% CI 1.2, 0.82; p&lt;0.00001) and dyspareunia with a mean difference of 0.58 (95% CI 1.09, 0.08; p=0.02) compared to placebo. Compared to combined oral contraceptives, COC had substantially improves dyspareunia with a mean difference of 0.99 (95% CI 0.62, 1.37; p&lt;0.00001) and pelvic pain with a mean difference of 1.15 (95% CI 0.23, 0.83; p=0.01). Conclusion: Dienogest should be considered as an alternate treatment for endometriosis-related symptoms. In double-blind research, DNG efficacy was compared to placebo.

Psychological interventions improve quality of life despite persistent pain in endometriosis: results of a 3-armed randomized controlled trial

PurposeDespite standard medical treatment endometriosis is often associated with disabling pain and poor quality of life (QoL). Studies indicate that psychological interventions (PIs) may improve pain and QoL, yet studies on the effects of PIs for women with endometriosis are sparse and limited by low-quality study designs. Therefore, this study aimed, in a rigorous three-armed design, to evaluate the effect of PIs on chronic pelvic pain (CPP) and QoL in women with endometriosis.MethodsThis three-armed parallel, multi-center randomized controlled trial included fifty-eight endometriosis patients reporting severe CPP [≥ 5 for pain intensity measured on a 0–10-point numeric rating scale (NRS)]. Patients were randomly assigned to (1) Specific mindfulness- and acceptance-based psychological intervention (MY-ENDO), (2) Carefully matched non-specific psychological intervention (Non-specific), or (3) A wait-list control group (WL). The primary outcome was pelvic pain intensity/unpleasantness measured on NRS. Secondary outcomes included endometriosis-related quality of life, workability, pain acceptance, and endometriosis-related symptoms. Differences in outcomes between groups at post-treatment follow-up were analyzed using mixed linear models. Analyses were performed on an intention-to-treat basis.ResultsCompared to WL, psychological intervention (MY-ENDO + Non-specific) did not significantly reduce pain. However, psychological intervention did significantly improve the QoL-subscales ‘control and powerlessness’, ‘emotional well-being’, and ‘social support’ as well as the endometriosis-related symptoms ‘dyschezia’ and ‘constipation’. MY-ENDO was not superior to Non-specific.ConclusionsWomen with endometriosis may have significant and large effects of psychological intervention on QoL despite an ongoing experience of severe CPP.Trial registration12 April 2016, clinicaltrials.gov (NCT02761382), retrospectively registered.

Endometriosis Symptomatology, Dyspareunia, and Sexual Distress Are Related to Avoidance of Sex and Negative Impacts on the Sex Lives of Women with Endometriosis

Endometriosis affects approximately 10% of women and is associated with a range of symptoms including pelvic pain, abnormal bleeding, and painful sexual intercourse. However, very little is known about the relationship between endometriosis-related symptoms and sex. Women with a diagnosis of endometriosis (n = 2060; mean age = 30 years) completed a questionnaire measuring the frequency of endometriosis symptoms, dyspareunia, sexual distress, avoidance of sex, and the perceived negative impact of endometriosis symptoms on sex life. In bivariate and multivariate logistic regression models with avoidance of sex and perceived negative impact of endometriosis symptoms on sex life as DVs, higher endometriosis symptom frequency, dyspareunia, and sexual distress were associated with greater avoidance of sex and higher perceived negative impact of endometriosis symptoms on sex life. With a two- and three-fold increase in the odds of avoiding sex and reporting a negative impact of endometriosis on sex lives, respectively, for each point increase in dyspareunia. Similarly, there was a 7% to 11% increase in avoidance of sex and the negative impact of endometriosis on sex lives, per one-point increase in symptom frequency and sexual distress. The results highlight the considerable impacts of endometriosis symptomatology on women's sex lives and wellbeing. Better medical and counselling services may be needed to ameliorate the negative impact of endometriosis on women's sex lives.