Past History Of Endometriosis Research Articles

Management of menopausal women with a history of endometriosis

Aim. To formulate a position statement on the management of the menopause in women with a past history of endometriosis from the point of view of evidence-based medicine.
 Materials and methods. Review of domestic and foreign literature, position of IMS and EMAS.
 Results. The article describes the main modes snd ways of introducing MHT and their advantages. The expert position on the management of patients with a history of endometriosis during surgical and natural menopause is highlighted. Information on the prevalence and methods of treatment of postmenopausal endometriosis is given.

Robot-assisted laparoscopic ureteroneocystostomy combined to hysterectomy for intrinsic ureteral and deep pelvic endometriosis: Video presentation

Introduction: We present a case of posterior deep infiltrating endometriosis with intrinsic ureteral involvement in a 43-year-old patient treated by robot-assisted laparoscopic technique. To our knowledge, this is the second case of robot-assisted ureteroneocystostomy with concomitant hysterectomy reported in the literature1–5, yet the first one to be described with a video presentation. Case description: A 43-year-old woman with a past history of endometriosis treated laparoscopically was referred to our clinic for grade II–III left hydronephrosis. Pelvic ultrasound and magnetic resonance imaging demonstrated a 3-cm paracervical endometriotic nodule causing ureteral compression, another 1.6-cm endometriotic nodule at the rectosigmoid junction, an adenomyotic nodule in the anterior uterine wall, and an endometrioma on the right ovary. Given that the patient had an absolute contraindication to hormonal therapy, we opted for robot-assisted laparoscopic complete eradication of endometriosis. The procedure consisted in total hysterectomy with concomitant removal of the rectovaginal nodule, right adnexectomy, left salpingectomy, and left ureteral resection with ureteroneocystostomy. After 8 days, a cystography was accomplished to confirm anastomosis integrity, and the bladder catheter was removed. The patient was discharged on day 8 after a regular postoperative period. One year after the surgery, the patient refers wellbeing. Conclusion: The robotic approach in such a complex procedure as surgical treatment of ureteral and deep infiltrating endometriosis is feasible and safe with acceptable postoperative outcome. Further investigations with larger comparative cohorts that include cost analysis are needed to fully assess the benefits achieved by robotic assistance in patients with ureteral and deep infiltrating endometriosis.

531 - Treatment with Radiofrequency in Patients with Chronic Pelvic Pain and Endometriosis: Pilot Study

Study Objective: Managing chronic pelvic pain in patients with a past history of endometriosis might be a challenge for the gynaecologist.

A Retrospective Study of Recipient-related Predictors of Success in an Oocyte Donation Program

ABSTRACTIntroductionPrior to the era ofin vitrofertilization, no options for conception were available to women with primary ovarian insufficiency, decreased ovarian reserve, or genetically transmittable diseases. Oocyte donation (OD) has been used in such women for almost 30 years. It also offers an opportunity to study the participation of the uterus in the process of human embryo implantation.AimTo identify recipient variables that may have a significant impact on the pregnancy outcome of an OD program.Materials and methodsThe present study was conducted at Madras Medical Mission Hospital, Chennai, India. We retrospectively evaluated 192 patients and 283 embryo transfer cycles as a result of OD over a period of 5 years. Rates of implantation, clinical pregnancy, ongoing pregnancy, miscarriage, and live birth were calculated for different age groups, endometrial thickness (ET), indications of OD, fresh and frozen embryo transfers (FET), type of subfertility, past history of endometriosis, and body mass index (BMI) of the recipients. Data evaluation was mainly done by Chi-square analysis, and receiver operating characteristic (ROC) curves were made for age and ET.ResultsThe results of this study showed a clinical pregnancy rate (CPR) of 37.1%, implantation rate (IR) of 19.3%, miscarriage rate of 20.4%, ongoing pregnancy rate (OPR) of 32.2%, and live birth rate (LBR) of 26.6%. Significant association was seen between age of recipient and OPR (p = 0.014), and also between fresh embryo transfers, CPR, OPR, and LBR (p < 0.05). The ROC curves showed a significant association of LBR with age of recipient.ConclusionAlthough no single or combined recipient variable(s) could be identified as predictor(s) of pregnancy, significant association was found between OPR, LBR, and recipient's age and also between fresh embryo transfers with CPR, OPR, and LBR.How to cite this articlePunhani R, Balasubramanyam S, Shankar K, Varma TR. A Retrospective Study of Recipient-related Predictors of Success in an Oocyte Donation Program. Int J Infertil Fetal Med 2017;8(2):75-82.

Clinical presentation of endometriosis identified at interval laparoscopic tubal sterilization: Prospective series of 465 cases

ObjectivesWomen seeking sterilization are usually parous and have no major complains, such as pelvic pain. This could be a good model to indirectly assess the prevalence of endometriosis in the general population. Prevalence of endometriosis in women undergoing tubal sterilization by laparoscopy has been assessed in 17 published reports. Results indicate a surprising wide variation of prevalence of endometriosis, ranging from 1.4% to 43.3%. This clinical study describes the prevalence and clinical presentations of endometriosis identified at interval laparoscopic tubal sterilization, as a close representation of endometriosis in general population. Material and methodsFrom July 1989 to February 2009, 465 women undergone interval laparoscopic tubal sterilization and were included in this series. Surgery was realised in a non universitary centre of gynecologic surgery. All patients were operated on by the same surgeon. A complete assessement of pelvic organs was achieved with a particular attention paid for endometriotic lesions. Endometriosis when present was staged according to r-AFS classification. Biopsies were sent for pathological examination to assess endometriosis. ResultsMean age of women was 40.7 years (range 15–49 years). 20 women were nulliparous and 12 others had a past history of endometriosis. Endometriosis was visually identified in 55 patients (11.82%), and confirmed by histologic examination in most of cases (50/55: 90.9%). The mean age of women presenting endometriosis at the onset of tubal ligation was 41.27 years. Cases with endometriosis were classified according to the r-AFS. 39,7,8 and 1 cases corresponded to stages I, II, III and IV respectively. In the 20 nulliparous women, the prevalence of endometriosis was 20% (4/20). At the time of laparoscopic sterilization, 91 women presented a painfull condition (dysmenorrhea mainly or dyspareunia). Endometriosis was identified in 16 of them (17.58%). In the group of 360 asymptomatic parous women, the prevalence of endometriosis was 10% (36/360). Nulliparity, associated pelvic pain and retroverted uterus were associated with increased prevalence of endometriosis, without being significant. ConclusionIn our study, the prevalence of endometriosis identified at interval laparoscopic tubal sterilization was 11.82%. In parous asymptomatic women, the prevalence of endometriosis was 10%. The prevalence of endometriosis was slightly increased in nulliparous women, when pain was associated and in women with a retroverted uterus.

Long-term Follow-up of a Patient with Repeated Pneumothorax during Pregnancy and a History of Catamenial Pneumothorax: A Case Report

We report the subsequent course of a previously-reported (Japanese abstract) case of catamenial pneumothorax (CPT) involving seven recurrences of pneumothorax during pregnancy, treated by thoracoscopic surgery and then small thoracotomy segmental resection and pleural covering with polyglycolic acid felt and fibrin glue. The patient took an oral contraceptive (OC) from 6 months postpartum until discontinuation after 2 years to become pregnant. Pregnancy occurred after 1 year and an elective caesarean section was performed in the 37th week of pregnancy. During that period, there was no evidence of recurrence of pneumothorax. Endometriosis-related pneumothorax during pregnancy recurs with high probability following medical management by thoracic drainage. For pneumothorax during pregnancy occurring on the right side followed by early recurrence after medical management by thoracic drainage, endometriosis should be considered to be a possible cause, particularly when there is a past history of endometriosis. In such cases, we recommend early thoracoscopic surgery comprising not only resection of the endometriosis lesions after careful evaluation but also pleurodesis and/or covering with polyglycolic acid felt and fibrin glue. Further studies are needed to clarify and develop appropriate management of pneumothorax in pregnant women with a history of CPT.

Primary umbilical endometrioma: Analyzing the pathogenesis of endometriosis from an unusual localization

ObjectiveThis report presents a rare case of symptomatic primary umbilical endometriosis and reviews the literature on the topic with the aim to clarify some questions on the origin of endometriosis. Case reportA 33-year-old woman with cyclic umbilical bleeding was found to have umbilical endometriosis. She had no history of pelvic or abdominal surgery. There was no past history of endometriosis or endometriosis-associated symptoms. An omphalectomy was performed after explorative laparoscopy to carefully inspect the abdominopelvic cavity and assess any coexisting pelvic endometriotic lesions. Histological examination confirmed the diagnosis of umbilical endometriosis. ConclusionUmbilical endometriosis is a rare but under-recognized phenomenon. Primary lesions are difficult to recognize, but probably represent an independent nosological entity. The possibility of endometriosis must be considered during the evaluation of an umbilical mass despite the absence of previous surgery. Complete excision and successive histology are highly recommended.

Association of endometriosis-related infertility with age at menopause

Objective The influence of past history of infertility, which is closely associated with reproductive factors, on menopause has not been clarified. The purpose of this study was to clarify the association of reproductive factors, including past history of infertility, with menopause in Japanese women. Study design This study was a cross-sectional analysis of the Japan Nurses’ Health Study (JNHS) baseline survey. The JNHS is a nationwide prospective cohort study on the health of Japanese women, and the baseline survey was conducted between 2001 and 2007. Main outcome measure We analyzed data for 24,153 pre- and postmenopausal women who were enrolled in the JNHS at the ages 40–59 years. The main outcome measure was menopause. Results Reproductive factors influencing the onset of natural menopause were past history of infertility [relative risk (RR) (age-adjusted odds ratio and 95% confidence interval): 1.28 (1.10–1.48)], past history of endometriosis: 1.32 (1.07–1.64), age at menarche: 0.919 (0.886–0.953) and number of pregnancies: 0.943 (0.911–0.976). Endometriosis as the cause of infertility was significantly associated with earlier onset of menopause (3.43 [2.17–5.44]) after adjustment for age. The strong association of past history of infertility related to endometriosis was still significant after multivariate adjustment. Conclusion Menopause in women who have a past history of infertility, especially in those who have suffered from endometriosis, is significantly earlier than that in women without such a history.

EMAS position statement: Managing the menopause in women with a past history of endometriosis

Introduction Endometriosis is a common disease in women of reproductive age. The symptoms usually disappear after a natural or a surgical menopause. Estrogen-based hormone therapy is required in women with premature or early menopause until the average age of the natural menopause and should be considered in older women with severe climacteric symptoms. However use of hormone therapy raises concerns about disease recurrence with pain symptoms, need for surgery and possibly malignant transformation of residual endometriosis. Aim To formulate a position statement on the management of the menopause in women with a past history of endometriosis. Materials and methods Literature review and consensus of expert opinion. Results and conclusions The data regarding hormone therapy regimens are limited. However it may be safer to give either continuous combined estrogen–progestogen therapies or tibolone in both hysterectomised and nonhysterectomised women as the risk of recurrence may be reduced. The risk of recurrence with hormone therapy is probably increased in women with residual disease after surgery. Management of potential recurrence is best monitored by responding to recurrence of symptoms. Women not wanting estrogen or those who are advised against should be offered alternative pharmacological treatment for climacteric symptoms or skeletal protection if indicated. Herbal preparations should be avoided as their efficacy is uncertain and some may contain estrogenic compounds.

Intestinal endometriosis-A rare cause of colonic perforation

Endometriosis is the ectopic growth of viable endometrium outside the uterus, affecting approximately 7% of females. It commonly affects pelvic structures including the bowel. Perforation of the colon by endometriosis is very rare and the patients generally present with an asymptomatic or painful pelvic mass, often in the left iliac fossa. Our patient presented acutely unwell and her symptoms were more suggestive of pyelonephritis or diverticulitis. We therefore report an unusual cause of acute abdomen. The purpose of the following case report is to elucidate certain diagnostic and therapeutic problems of the disease, concerning both surgeons and gynaecologists. In summary, intestinal endometriosis should be considered in the differential diagnosis of all post-menarche women with episodic gastrointestinal symptoms. A past history of endometriosis or co-existent gynaecological symptoms should increase the index of suspicion, and laparoscopy prior to formal laparotomy should be considered. Our patient, in retrospect, had a history of mild endometriosis, but we feel that this case serves as a reminder of a rare, but important, differential diagnosis of acute abdomen in females.

The role of hormone replacement therapy in women with a current or past history of endometriosis

Endometriosis is an oestrogen sensitive condition, leading to reluctance to prescribe hormone replacement therapy. Treatment of endometriosis either medically with gonadotrophin releasing hormone analogues or with surgery involving bilateral oophorectomy leads to oestrogen deficiency. While this may lead to vasomotor symptoms, the consequence which has been of most concern is a reduction in bone mass. Repeated courses of gonadotrophin releasing hormone analogues may mean that women with endometriosis enter the menopause with a below average bone density. Thus, there is a place for hormone replacement therapy both as add-back therapy in premenopausal women receiving gonadotrophin releasing hormone analogues, and in postmenopausal women with a past history of endometriosis. Addback therapy with continuous combined regimes and tibolone do not prevent disease resolution in the hypogonadal patient. The evidence regarding the use of hormone replacement therapy in patients with a history of endometriosis is poor, but suggests that we could be less conservative than we have been.