High Prevalence Of Endometriosis Research Articles

The Correlation between Serum and Peritoneal Fluid CA125 Level in Women with Pelvic Endometriosis

Background: Despite a high prevalence of endometriosis, there still exist many challenges in diagnosing the disease. This study aims to evaluate non-invasive and practical diagnostic methods by measuring serum and peritoneal fluid CA 125 levels in patients with endometriosis. A secondary aim is to determine the correlation between these markers with the stage of disease as well as the relationship of the two markers with each other. Materials and Methods: This is a cross-sectional study of 60 women who underwent laparoscopy for benign conditions. Based on laparoscopic findings and biopsy results, patients were divided to two groups; one group included patients with pelvic endometriosis (35 patients) and the second enrolled patients free from endometriosis (25 patients). Serum and peritoneal fluid specimens were provided at the time of laparoscopy and CA125 levels were then assessed by electrochemiluminescence immunoassay. Results: Mean serum and peritoneal fluid CA125 levels were significantly higher in women with endometriosis as compared to the control group (26.42 ± 24.34 IU/ml versus 12.64 ± 6.87 IU/ml in serum and 2203.54 + 993.19 IU/ml versus 1583.42 ± 912.51 IU/ml in peritoneal fluid, p<0.05). CA 125 levels also varied proportionally with the stage of endometriosis; but showed a significant difference only in higher stages of the disease, both in serum and peritoneal fluid. We calculated the cut-off value suggesting a diagnosis of pelvic endometriosis as 14.70 IU/ml for serum and 1286.5 IU/ml for peritoneal fluid CA125. A linear correlation between CA 125 levels in serum and peritoneal fluid in patients with pelvic endometriosis has also been observed. Conclusion: Serum and peritoneal fluid CA 125 levels are simple and non-surgical tools for diagnosing and staging pelvic endometriosis. These markers are of greater diagnostic value in higher stages of the disease.

High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners

To determine the prevalence of histologically proven endometriosis in a subset of infertile women. Retrospective case series with electronic file search and multivariable logistic regression analysis. Tertiary academic fertility center. Two hundred twenty-one infertile women without previous surgical diagnosis for infertility with regular cycles (variation, 21-35 days) whose partners have a normal semen analysis. Diagnostic laparoscopy and, if necessary, operative laparoscopy with CO(2) laser excision. The prevalence of endometriosis and of fertility-reducing nonendometriotic tubal and/or uterine pathology. The prevalence of endometriosis was 47% (104/221), including stage I (39%, 41/104), stage II (24%, 25/104), stage III (14%, 15/104), and stage IV (23%, 23/104) endometriosis, and was comparable in patients with (54%, 61/113) and without (40%, 43/108) pelvic pain. The prevalence of fertility-reducing nonendometriotic tubal and/or uterine pathology was 29% in all patients (15% in women with and 40% in women without endometriosis). A multivariate logistic regression model including pain, ultrasound data, age, duration of infertility, and type of fertility was not or not sufficiently reliable for the prediction of endometriosis according to the revised American Fertility Society (rAFS) classifications I-II and rAFS III-IV, respectively. Reproductive surgery is indicated in infertile women belonging to the study population, regardless of pain symptoms or transvaginal ultrasound results, since half of them have endometriosis and 40% of those without endometriosis have fertility-reducing pelvic pathology.

Laparoscopic Management of Patients with Endometriosis and Chronic Pelvic Pain

Endometriosis has been traditionally included among the most important causes of chronic pelvic pain (CPP) in women of reproductive age. The main clinical manifestations of endometriosis are dysmenorrhea, dyspareunia, and chronic nonmenstrual pain. Despite the high prevalence of endometriosis in women suffering from CPP, controversy still exists regarding the true association between the stage and extent of this peculiar disease and the severity of pain. Over the last decade, advances in endoscopic technology have enabled gynecologic surgeons to recognize many atypical appearances of the endometriotic implants not known to exist before, thus allowing their complete excision or destruction. Laparoscopic surgery may offer considerable relief in patients with endometriosis and CPP. Although cases with advanced endometriosis seem to benefit the most, we also support surgical treatment in patients with early endometriosis diagnosed using laparoscopy, as many will experience improvement in their symptoms.

The potential role of exposure to environmental toxicants in the pathophysiology of endometriosis.

Humans and animals are exposed daily to a complex mixture of polyhalogenated aromatic hydrocarbons (PHAHs). Previous work has shown that exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) is associated with a dose-dependent increase in the incidence and severity of endometriosis in the rhesus monkey. Dioxin-like chemicals can also exert effects in combination with TCDD via the aryl hydrocarbon receptor. Using a rhesus model of chronic TCDD exposure and endometriosis, serum concentrations of TCDD and 19 dioxin-like PHAHs were quantified 13 years after termination of exposure to TCDD. In additional studies, the immune status of TCDD-exposed monkeys was evaluated. For TCDD-exposed and unexposed animals, TCDD exposure correlated with an increased serum TCDD concentration. Furthermore, TCDD exposure and an elevated serum TCDD concentration were associated with increased serum levels of triglycerides, 1,2,3,6,7,8-hexachlorodibenzofuran (HxCDF), PCB77, and PCB126. Importantly, the animals with elevated serum levels of PCB77 and PCB126 and increased total serum TCDD equivalents (TEQs) had a high prevalence of endometriosis, and the severity of disease correlated with the serum concentration of PCB77. In immune studies, TCDD exposure correlated with increased tumor necrosis factor alpha (TNFalpha) production by peripheral blood mononuclear cells (PBMC) in response to stimulation by T cell mitogen and decreased NK cytolytic activity. Elevated serum concentrations of TCDD, 1,2,3,6,7,8-HxCDF, and PCB126 correlated with increased numbers of CD3+/CD25- and CD3-/CD25+ leukocytes and enhanced secretion of TNFalpha by mitogen-stimulated PBMC. This evidence suggests that TCDD exposure and endometriosis in the rhesus monkey may be associated with increased serum concentrations of specific coplanar PCB compounds and long-term alterations in systemic immunity. Furthermore, the data suggest a potential involvement of an increased body burden of PCB compounds in the etiology of endometriosis in the rhesus. Recent advances in the detection and assay of individual PHAH congeners in biological samples have made it possible to assess total PHAH body burden in humans and animals. Future studies are expected to exploit this advance to assess the health impact of PHAH body burdens in both exposed individuals and the general population. Serum PHAH concentrations and TEQs in TCDD-exposed monkeys with endometriosis are similar to or lower than blood levels in the general human population; thus, it is important to consider the implications of these findings for human health and the prevalence of endometriosis in humans. Additional studies are warranted, particularly in human subjects, to explore the potential implications of these data.

Serum levels of TCDD and dioxin-like chemicals in Rhesus monkeys chronically exposed to dioxin: correlation of increased serum PCB levels with endometriosis.

Humans and animals are exposed daily to a complex mixture of polyhalogenated aromatic hydrocarbons (PHAHs). Previous work has shown that exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) is associated with a dose-dependent increase in the incidence and severity of endometriosis in the rhesus monkey. Dioxin-like chemicals can also exert effects in combination with TCDD via the aryl hydrocarbon receptor. This study demonstrates that the serum levels of TCDD and specific dioxin-like PHAH congeners were increased in TCDD-treated animals with endometriosis 13 years after the TCDD exposure. Nine TCDD-exposed and 6 unexposed female rhesus monkeys were evaluated for serum content of relevant compounds and for endometriosis by surgical laparoscopy. Additional studies were done on 4 animals that died 7 to 11 years after exposure to TCDD and 4 lead-treated animals with no history of PHAH treatment. For TCDD-exposed and unexposed animals, TCDD exposure correlated with an increased serum TCDD concentration. Furthermore, TCDD exposure and an elevated serum TCDD concentration were associated with increased serum levels of triglycerides, 1,2,3,6,7,8-hexachlorodibenzofuran, 3,3',4,4'-tetrachlorobiphenyl (TCB) and 3,3'4,4',5-pentachlorobiphenyl (PnCB). Importantly, the animals with elevated serum levels of 3,3',4,4'-TCB, 3,3',4,4',5-PnCB and an increased total serum TEQ had a high prevalence of endometriosis, and the severity of disease correlated with the serum concentration of 3,3,',4,4'-TCB. Increased serum concentrations of coplanar PCBs were also present in lead-treated animals. Implications of these findings for human health and the prevalence of endometriosis in humans will be discussed.

CA-125 in Women with Endometriosis

The serum CA-125 level is elevated in most women with endometriosis. Although tests are readily available to measure the marker, simple modifications of the present assays are required to improve and standardize the quality of the measurements. The serum test has low sensitivity and would not be appropriate for general screening purposes, but in clinical situations that have a relatively high prevalence of endometriosis, CA-125 determinations have acceptable sensitivities and very high specificities. The concentrations of CA-125 correlate with both the severity and the clinical course of the disease. In women with diagnosed endometriosis, use of serial CA-125 determinations to monitor the course of the disease shows much promise in early studies. The changes in the CA-125 levels can offer additional information to the clinician about the status of the endometriosis, but how much this information will assist in the management and improve the outcome of treatment must await the results of prospective studies.