Prevalence Of Endometriosis Research Articles

The potential of survivin as a non-invasive diagnostic marker for endometriosis in patients with type 1 diabetes mellitus

BACKGROUND: According to international data, about 5-10% of women of reproductive age suffer from this disease, while in women with chronic pelvic pain or infertility the incidence ranges from 35% to 50%. At the same time, women of reproductive age diagnosed with diabetes mellitus type 1 may also suffer from endometriosis, but asymptomatic or atypical in the initial stages of the disease, which varies considerably in duration, may be the cause of untimely diagnosis. Existing diagnostic methods in the form of bimanual examination, ultrasound, MRI, laparoscopic surgery, and even histologic verification do not allow to exclude with certainty the presence of the disease.
 AIM: The aim of this study was to investigate the prevalence and characteristics of endometriosis among patients with type 1 diabetes mellitus to develop a diagnostic prognostic model.
 MATERIALS AND METHODS: We carried out a retrospective analysis of medical records from the Gynecological Unit of the Second Department of Gynecology and Endocrinology and the Scientific Advisory Department of D.O. Ott Research Institute of Obstetrics, Gynecology, and Reproductive Medicine, St. Petersburg, Russia for the period of 2010–2021. The study cohort included cases of endometriosis in patients with type 1 diabetes mellitus recorded in inpatient or outpatient medical histories. Clinical characteristics of the prevalence of endometriosis in women with type 1 diabetes mellitus were based on an analysis of 2316 medical records in this patient group. The prospective cohort of the case-control study included 137 patients and involved the evaluation of survivin levels in serum on days 5–7 of the menstrual cycle in four study groups: type 1 diabetes mellitus in combination with endometriosis, endometriosis, type 1 diabetes mellitus, and healthy women of reproductive age. Additionally, we examined the gynecological history of patients. Statistical processing of the data obtained and predictive modeling were performed using a binary logistic regression analysis.
 RESULTS: The prevalence of endometriosis among patients with type 1 diabetes mellitus was 1.11%. Risk indicators for the presence of endometriosis were determined based on risk factor values for patients with or without type 1 diabetes mellitus. Patient groups with a probability of having endometriosis exceeding 50% were identified, requiring diagnostic and therapeutic measures aimed at timely initiation of therapy.
 CONCLUSIONS: Predicting the likelihood of endometriosis presence will enable timely preventive and therapeutic measures aimed at improving the patient’s quality of life.

Adenomyosis diagnosis among adolescents and young women with dysmenorrhoea and heavy menstrual bleeding

Research questionWhat is the prevalence of adenomyosis at ultrasonography among adolescents and young women reporting dysmenorrhoea and/or heavy menstrual bleeding (HMB)? DesignThis observational cohort study involved adolescents and young women referred for dysmenorrhoea and/or HMB to the Adolescent Medicine Unit at Careggi University Hospital, Italy. Patients with endometriosis and bleeding disorders were excluded. Transvaginal ultrasonography or transrectal sonography using a transvaginal probe was performed. The myometrium was described according to the Morphological Uterus Sonographic Assessment criteria. Details of baseline characteristics, clinical data and symptoms were collected. The presence of sonographic features of adenomyosis and the association between imaging findings and clinical symptoms were evaluated. ResultsThe cohort included 95 patients aged between 13 and 25 years, referred for dysmenorrhoea (88.4%), HMB (23.2%) or both (13.7%). According to the MUSA criteria the sonographic diagnosis of adenomyosis was made in 27.4% of patients, with the diffuse type the most prevalent. Uterine wall asymmetry, hyperechoic intramyometrial islands, translesional vascularity and an interrupted junctional zone were the most common features. Patients with imaging findings of adenomyosis had significantly higher rates of HMB than those with a normal myometrial appearance (38.5% versus 17.4%, P = 0.030). In addition, the coexistence of dysmenorrhoea and HMB was significantly associated with adenomyosis (odds ratio 5.68, 95% confidence interval 1.65–19.5). ConclusionsAdenomyosis may be diagnosed among teenagers and young women referred with dysmenorrhoea and/or HMB. The clinical presentation is relevant for the diagnosis, with HMB alone and HMB plus dysmenorrhoea significantly associated with the sonographic identification of adenomyosis.

Adenomyosis in women undergoing hysterectomy for abnormal uterine bleeding associated with uterine leiomyomas

Background Uterine leiomyomas and adenomyosis are both common and often associated with abnormal uterine bleeding (AUB), including the symptom of heavy menstrual bleeding (HMB). Understanding the prevalence of adenomyosis in women with uterine leiomyomas could inform clinicians and patients in a way that may improve therapeutic approaches. Objective To explore the prevalence of adenomyosis in a group of women who underwent hysterectomy for AUB-L, to determine the prevalence of submucous leiomyomas, and to examine the utility of preoperative ultrasound to detect the presence of adenomyosis. Methods The Kaiser Permanente Hysterectomy Database (KPHD) was searched for women aged 18–52 undergoing hysterectomy for leiomyoma-associated chronic AUB (AUB-L) in 2018 and 2019. A target sample of 400 comprised those with at least 3 years in the Health System. Radiologists evaluated preoperative pelvic ultrasound images to determine leiomyoma size and level 2 FIGO type (submucous or other), and the linked electronic medical record abstracted for clinical features, including histopathological evidence of adenomyosis. Results Of the 370 subjects that met the study criteria, adenomyosis was identified via histopathology in 170 (45.9%). There was no difference in the adenomyosis prevalence with (47.1%) and without (43.0%) at least one submucous leiomyoma. Subgroup analysis of ultrasound images by an expert radiologist for the presence of adenomyosis demonstrated a positive predictive value of 54.0% and a negative predictive value of 43.4%. Conclusions Adenomyosis was present in almost half of this AUB-L cohort undergoing hysterectomy and was equally prevalent in those with and without submucous leiomyomas as determined by sonographic evaluation. The imaging findings are in accord with prior investigators and demonstrate that 2-D ultrasound is insensitive to the presence of adenomyosis when the uterus is affected by leiomyomas. Further research is necessary to determine the impact of various adenomyosis phenotypes on the presence and severity of the symptom of HMB.

Innovative Medical Treatments for Endometriosis

This presentation will focus on the following innovative areas in medical treatments for endometriosis. Where were we, say, a decade ago compared to where we are now? What diagnostic techniques should we employ to define the population we should treat? Does gold standard surgical treatment help patients avoid unwanted medical treatment - or should it now be the other way round? Do we still believe that medical treatment is not indicated for infertility related to endometriosis? What are the genuinely evidence-based innovative medical treatments for endometriosis? Consensus statements and guidelines represent a clear line in the sand of what may be considered gold standard practice of the time – the World Endometriosis Society’s consensus on current management of endometriosis (2013) 1 provides a good perspective on where we were around a decade ago; the ESHRE Guideline (2022) 2 reflects best practice today. There is growing consensus that a laparoscopic (+/- histological) diagnosis is no longer practical, or indeed needed, in most cases to implement the whole gamut of medical treatment, even though the entire evidence base for treating endometriosis hinges on laparoscopic diagnosis. Hence, “in 2023, there is a strong case for treatment of endometriosis to be based on a clinical diagnosis of ‘likely endometriosis’ supported by imaging findings, when appropriate, in lieu of a traditional diagnosis by laparoscopy +/- histology”. Following laparoscopic surgery, those not intending to conceive should consider the levonorgestrel intrauterine system or combined oral contraceptive pill for at least 18-24 months to reduce the recurrence of endometriosis-related pain symptoms; 2 following surgery for either endometriomas or deep endometriosis, long term hormone therapy should be considered to reduce the chance of recurrence.2 Given the respective evidence bases, progestin hormone therapy may be preferable to the combined oral contraceptive pill to turn the tide of increasing prevalence of endometriosis. 3 While medical treatment has not been recommended to improve fertility, indeed a delaying effect on fertility through medical treatment has traditionally been highlighted, innovative analysis methods, including network meta-analysis, have raised the question whether some medical treatments (dydrogesterone and GnRH agonists) might benefit fertility – and this is merit-worthy of further investigation. GnRH antagonists and aromatase inhibitors are the innovative medical treatments that have shifted from ‘showing potential’ to ‘recommended’, so we will delve into the data supporting this to discover that, for aromatase inhibitors, this remains far from convincing, but for GnRH antagonists, these present a genuine innovative medical treatment option for those suffering from endometriosis.

PATHOGENETIC FEATURES OF ADENOMYOSIS DEVELOPMENT IN WOMEN OF REPRODUCTIVE AGE IN THE POST-COVID PERIOD

Purpose. To study the prevalence and forms of adenomyosis for women of reproductive age after COVID-19, to study pathomorphological changes in the uterine tissues of women of reproductive age with adenomyosis after COVID-19.
 Materials and methods. We examined 114 patients of reproductive age who underwent hysterectomy for various pathologies. Of these, 40 patients (35%) in 2019 before the COVID-19 pandemic, and during the pandemic in 2021 - 36 patients (31.6%), in 2022 - 38 (33.4%) patients.
 Results. The study found that the total number of histologically confirmed adenomyosis in patients of reproductive age increased from 55% in 2019 (before the COVID-19 pandemic) to 66.6% and 71% in 2021 and 2022, respectively; the number of diffuse adenomyosis increased significantly from 12.5% in 2019 (before the COVID-19 pandemic) to 41.6% and 47.4% in 2021 and 2022, respectively; the percentage of diffuse adenomyosis in relation to other forms of adenomyosis increased from 22.7% in 2019 (before the COVID-19 pandemic) to 62.5% and 66.6% in 2021 and 2022, respectively. Given the increase in the prevalence of adenomyosis in the post-COVID period compared to the period before the COVID-19 pandemic, we studied pathomorphological changes in the basal layer of the endometrium and the inner layer of the myometrium that correlated with the clinical features of the disease in the patients who participated in the study. The study included cases with histologically confirmed adenomyosis Pathologically detected changes in the endometrium and inner layer of the myometrium in adenomyosis after COVID-19, namely the line of separation between the endometrium and myometrium is unclear, vessels in the form of clusters, thickwalled, narrowed lumen, edema between fibers, edema between fibers and around vessels, thickening of the vessel wall and narrowing of the lumen, pronounced revascularization, the presence of myxomatous edema, foci of hemosiderosis in the interstitial tissue, thrombosis of vessels of different caliber with hemorrhages, and microcirculatory disorders.
 Conclusion. The results obtained indicate that after COVID-19 disease, the total number of histologically detected adenomyosis in women of reproductive age increased, and the number of diffuse adenomyosis increased. Characteristic changes occurred in the uterine tissue at the border of the endometrium and myometrium, which are morphologically confirmed.

PATHOGENETIC SIGNIFICANCE OF THE CHARACTER OF WOMAN’S UROGENITAL INFECTION IN THE DEVELOPMENT OF ADENOMYOSIS

Adenomyosis is one of the important problems of modern gynecology, which leads to impaired reproductive function, reduced work capacity and quality of life of women. The prevalence of endometriosis in the female population ranges from 20-55% in patients of reproductive age. An important role in the occurrence and development of adenomyosis is played by genetic predisposition, hormonal changes and the influence of immunological factors. Of great interest is a new concept regarding the significant role of bacterial contamination of the genital tract in patients with adenomyosis. The study of the influence of microorganisms on the mechanisms of activation of the inflammatory reaction associated with the progression of endometrioid lesions is relevant and requires the search for new approaches to diagnosis and treatment of the disease.
 The purpose of the work is to study the influence of the woman’s urogenital infection in the development of adenomyosis.
 Materials and methods. 85 patients with 1st and 2nd degree adenomyosis and 30 healthy fertile women were examined. The average age of the examined was 27.3±1.6 years. A comprehensive clinical examination, ultrasound, colposcopic, hysteroscopic studies were conducted. Microbial flora analysis included bacterioscopic, bacteriological research methods with determination of sensitivity to antibiotics, and PCR method. The concentration of cytokines in the culture medium (supernatant) was determined by the enzyme immunoassay. Statistical data processing was performed using the Statsoft Statistica v6.0 and Microsoft Excel 97 software packages.
 Results. In the structure of gynecological diseases, 95.6% of patients with adenomyosis had inflammatory diseases of female genital organs, chronic herpes and cytomegalovirus infection was found in almost 93%. In women with adenomyosis, the II-III stage of vaginal cleanliness prevails with an “intermediate” type of biocenosis, which is characterized by a reduced content of lactobacilli, the presence of various types of morphotypes of gram-positive and gram-negative rods and cocci, and dysbiosis (49.4%), when a mixed bacterial flora prevails microflora, a high percentage of the combination of adenomyosis with chronic inflammatory diseases of the pelvic organs justifies the need to use antimicrobial therapy in this category of patients. When studying the cytokine profile of the cervical contents and endometrium, an increase in the concentration of the main proinflammatory cytokines IL-1β, IL-6, TNFα and a factor with chemotoxic properties IL-8 was found. The obtained data indicate that the development of adenomyosis is facilitated by a previous immuneinflammatory reaction, which is accompanied by a violation of the local cytokine balance.
 Conclusions. Microbiological examination of patients with adenomyosis revealed a violation of the microbial landscape of the reproductive tract in most of the examined. The obtained data indicate a high percentage of the combination of adenomyosis with chronic inflammatory diseases of the pelvic reproductive organs. Previous adenomyosis is an immunoinflammatory reaction, accompanied by a violation of the local cytokine balance. Increased cytokine activity and the presence of infectious agents are associated with the spread of adenomyosis.

Association between depression and endometriosis using data from NHANES 2005–2006

Studies on the association between depression and self-reported endometriosis are limited, and further studies are required to investigate this association. Data were collected from the National Health and Nutrition Examination Survey database (2005–2006). Based on the inclusion and exclusion criteria, 100 participants with self-reported endometriosis and 1295 participants without self-reported endometriosis were included, representing a total population of 64,989,430. Depression severity was assessed using the Patient Health Questionnaire 9 (PHQ9). A survey-weighted logistic regression analysis was performed to explore the association between depression and endometriosis. Subgroup analyses were conducted to explore heterogeneity. The prevalence of endometriosis was 7.17%. A significant positive association was found between the PHQ9 score and endometriosis. After adjusting for all covariates, the PHQ9 score positively correlated with endometriosis. Furthermore, compared with the participants without depression, those with moderate depression were more prone to have endometriosis both in unadjusted and fully adjusted model. However, the relationship between severe depression and endometriosis was not significant in all models (P > 0.05). Our findings highlight the influence of depression on the prevalence of self-reported endometriosis. Further studies are required to elucidate the causal relationship between depression and self-reported endometriosis.

Retrospective review of endometriosis surgery at Te Whatu Ora - Capital and Coast.

Endometriosis is an under-researched disease, with Aotearoa-specific data severely lacking. Current estimates of parameters such as rates of endometriosis diagnosis, indication for surgery and sites of disease are based on international data. There is currently no published data on endometriosis surgeries in Aotearoa New Zealand. We aimed to describe the laparoscopic surgeries conducted for suspected endometriosis at Te Whatu Ora - Capital and Coast, including the prevalence of endometriosis in this cohort, indication for surgery, symptoms experienced, endometriosis stage and sites involved, number of repeat laparoscopies, and prevalence of endometriosis at repeat surgery. To conduct this retrospective cross-sectional study, data were extracted from Te Whatu Ora - Capital and Coast systems to identify all records indicating surgery for suspected endometriosis during 2018 and 2019. Variables investigated included age, ethnicity, endometriosis diagnosis (International Classification of Diseases-10 Clinical Modification coding), stage of endometriosis, histological report and endometriosis symptoms (pain and/or fertility). There were 436 surgeries for suspected endometriosis performed during 2018 and 2019, and endometriosis was diagnosed in 68.3% of these surgeries. Pacific and Asian people were under-represented in the study cohort compared to the demographics of the hospital catchment area (Pacific: 3.0% vs 8.4%, Asian: 9.9% vs 12.9%). The most common indication for surgery was pain. There were 76 surgeries performed for suspected recurrence of endometriosis, and endometriosis was identified in 55.6% of these. Endometriosis surgeries in this hospital in Aotearoa show similar presentations and surgical findings to international data. Our findings highlight areas requiring more research in an Aotearoa-specific context.

Attitudes and perceptions of affected women towards endocrine endometriosis therapy: an international survey based on free-word association networks.

What are the attitudes and perceptions towards endocrine endometriosis therapy? Among the study population, endocrine endometriosis therapies are associated with negative mental images and emotions and there seems to be a pre-therapeutic information deficit on the part of physicians. Endocrine therapies, as the current standard of conservative endometriosis treatment, have good efficacy and improve symptoms and quality of life in most patients. Nevertheless, clinical practice repeatedly shows rejection on the part of patients, which may result in reduced compliance and discontinuation of therapy. Cross-sectional study among endometriosis patients using a multilingual questionnaire distributed via the most popular social media channels between November 2020 and February 2021. A total of 3348 women participated in the study. Based on a pilot phase, an international, multilingual online survey was conducted among women affected by endometriosis. The questionnaire included free-word associations and questions about personal medical history, source of information, and demographic data. Mental representations were detected based on modules of the co-occurrence network of associations. Six modules with different dominant emotional labels emerged from the confluence of associations to endocrine endometriosis therapy mentioned by participants. Five modules reflected negative mental associations, with the most frequently mentioned words being 'side effects', 'pain', 'ineffective', 'depression', and 'uncertainty'. Of the 12 most frequently selected emotions, only 'optimistic' was positive. Side effects affecting mental health are the most important reason for deciding against endocrine therapy in our survey population. Twenty-seven percent of respondents reported knowing little about endocrine therapies for endometriosis. Social media are the most frequently used sources of information and were rated as the most useful. By translating the questionnaire, questions might have been understood differently depending on the language. By using social media channels for distribution, digitally literate patients were targeted. The survey population might not be representative as patients who are critical/unhappy with therapy are more likely to seek advice from peer groups. The findings of this study replicate the findings of a recent survey in three European countries. Given the prevalence of endometriosis and the few emerging pharmaceutical alternatives, these data point to a growing need for further research and development of non-hormonal drugs for treating endometriosis. Most endometriosis patients are young and digitally literate, and much information is obtained from alternative sources, such as social media. Careful education before starting therapy should be taken seriously, and patients' concerns should be addressed individually by health care providers. This could help reduce misunderstanding and misinformation and improve treatment adherence and satisfaction. There is no funding or conflict of interest to declare. The trial is not registered at any trial registry.

Women’s health report for Belgium: addressing the information gap

Abstract Issue In the last years, Belgian policy makers have become increasingly concerned about health problems affecting only women (e.g. endometriosis) or affecting women in different ways than men (e.g. cardiovascular diseases). The current monitoring tools on the health status in Belgium routinely present information disaggregated by sex. Nevertheless, there is a need to go further than a mere comparison of men and women and strive for gender-sensitive health reporting. Description of the problem To address the information gap pertaining to the health of girls and women, a women's health report for Belgium was developed. The goal of this report is to identify and highlight health issues specific to women or affecting them differently and possible knowledge and data gaps. Results The report highlighted several data gaps, e.g. prevalence of endometriosis and polycystic ovary syndrome, and several opportunities to fill them. The process also uncovered available but underused data on women-specific issues, including fertility treatments, abortions, and contraception. Among the main results, an analysis on girls (11-18 years old) showed an alarming difference in health status compared to boys, starting from a young age and increasing throughout adolescence. For example, girls reported experiencing more psychosomatic symptoms more often than boys with the difference increasing with age. Girls reported more often a negative perception of their health (22%) compared to boys (15%) and more often depressive symptoms (47%) than boys (31%). Conversely, boys were twice as likely to meet WHO recommendations on physical activity. Lessons This first report on women's health in Belgium highlighted the need to collect better information on women-specific issues and the need to promote the use of existing data. Results showed that gender differences in health emerge and increase during adolescence. We strived to put results into context to produce knowledge and recommendations for policymakers. Key messages • Developing a women’s health report allowed to highlight data gaps and underuse of existing data. • Specific interventions should target teenage girls.

Occupational characteristics and risk factors associated with endometriosis among Korean female workers.

Endometriosis is a chronic and debilitating condition that affects daily working life. Characterization of the factors associated with endometriosis in the working population can facilitate the development of prevention and intervention strategies for those at risk of endometriosis. This population-based retrospective study was conducted using the 2007-2015 National Health Insurance Service-Female Employees database. Overall, 151,386 female workers aged 15-64 years were included in the study. Participants with endometriosis were identified using the diagnosis codes in the claims data. Multivariable Cox regression analyses were used to evaluate the effect of sociodemographic, lifestyle, health, and occupational factors on endometriosis risk. Of the 151,386 participants, 4,457 were diagnosed with endometriosis. The risk of endometriosis was significantly higher in 41-60 years group (HR = 1.47 (95% CI, 1.06-2.04)) and in those with body mass index (BMI) < 18.5 kg/m2 (HR = 1.16 (95% CI, 1.05-1.27)) than 15-20 years group and those with normal BMI, respectively. According to the international standard industrial classification, occupational groups with financial and insurance activities, public administration and defence, compulsory social security, and manufacturing were at a higher risk of endometriosis. Although there was no significant association between the risk of endometriosis and type of work, the cumulative prevalence of endometriosis from 2007 to 2015 continued to rise in office workers, manual workers, and both types of workers together. The risk of endometriosis was closely linked to the occupational characteristics of female workers. This study provides a foundation for developing occupational safety and health guidelines for female workers.

EP26.05: Prevalence of adenomyosis, as diagnosed at transvaginal ultrasound, in infertile women scheduled for their first assisted reproductive treatment

EP26.05: Prevalence of adenomyosis, as diagnosed at transvaginal ultrasound, in infertile women scheduled for their first assisted reproductive treatment

Diagnostic accuracy study of sonography in adenomyosis: A study of current practice.

To estimate diagnostic accuracy of sonography in the diagnosis of adenomyosis in current practice when compared to pathology as a "gold standard". This diagnosis accuracy study was observational and retrospective, including women managed by hysterectomy for benign pathology from January 2015 to November 2018. Preoperative pelvic sonography reports were collected, including details on diagnosis criteria for adenomyosis. Sonographic findings were compared to pathological results of the hysterectomy specimens. Our study initially concerned 510 women; 242 of them had adenomyosis confirmed by a pathological examination. The pathological prevalence of adenomyosis was 47.4% in this study. A preoperative sonography was available for 89.4% of the 242 women, with a suspicion of adenomyosis in 32.7% of them. In this study, Sensitivity is 52%, Specificity 85%, Positive Predictive Value (PPV) 77%, Negative Predictive Value (NPV) 86% and Accuracy 38,1%. Pelvic sonography is the most common non-invasive examination used in gynecology. It is also the first recommended examination for the diagnosis of adenomyosis because of its acceptability and its cost, even if the diagnosis performances are moderate. However, these performances are comparable to MRI (Magnetic Resonance Imaging) performances. The use of a standardized sonographic classification could improve and harmonize the diagnosis of adenomyosis.

Endometriosis and Adolescence: The Impact of Dysmenorrhea.

Endometriosis affects approximately 10% of premenopausal women worldwide. Despite its impact on quality of life, the delay in diagnosing this chronic disease is well known. Many patients with endometriosis report having suffered from dysmenorrhea and chronic pelvic pain in adolescence or at a young age. However, this painful symptom is often highly underestimated and considered a normal and transient symptom in young women. The real prevalence of endometriosis in adolescence remains uncertain. Some authors recently described at least one ultrasound feature of endometriosis in 13.3% of a general population of adolescent girls, which increased to 35.3% in young girls with severe dysmenorrhea. Dysmenorrhea is classified as primary dysmenorrhea or secondary dysmenorrhea. Primary dysmenorrhea is defined as a menstrual pain without organic disease, while secondary dysmenorrhea is defined as a menstrual pain associated with organic pelvic pathology. Since endometriosis represents the main cause of secondary dysmenorrhea in adolescents and young women, it is important to determine whether the patient has primary dysmenorrhea or additional suggestive symptoms related to endometriosis. Endometriosis in adolescent patients is a challenging problem with clinical and pathological differences compared with its presentation in premenopausal women. Adolescents and young women with dysmenorrhea and painful symptoms that suggest endometriosis should be referred to dedicated endometriosis centers for an early diagnosis and appropriate medical and surgical management. This paper aims to describe the role of dysmenorrhea in adolescents and the management of these young patients to confirm or exclude endometriosis.

Adenomyosis and Infertility: A Literature Review.

Background and Objectives: Adenomyosis (the presence of ectopic endometrial glands and stroma below the endometrial-myometrial junction) is a benign condition which is increasingly diagnosed in younger women suffering from infertility. The aim of this narrative review was to study the pathophysiology and prevalence of adenomyosis, the mechanisms causing infertility, treatment options, and reproductive outcomes in infertile women suffering from adenomyosis. Materials and Methods: A literature search for suitable articles published in the English language was performed using PubMed from January 1970 to July 2022. Results: The literature search retrieved 50 articles that met the purpose of this review and summarized the most recent findings regarding the accuracy of diagnostic methods, pathophysiology, and the prevalence of adenomyosis and optimal strategies for the treatment of infertile women with adenomyosis. Conclusions: Adenomyosis is a common gynecological disorder, affecting women of reproductive age. It negatively affects in vitro fertilization, pregnancy and the live birth rate, as well as increases the risk of miscarriage. With the advent of non-invasive diagnoses with MRI and TVUS, the role of adenomyosis in infertility has been better recognized. Overall, more randomized controlled trials (RCTs) are needed to provide strong data on the accuracy of diagnostic methods, the pathophysiology and the prevalence of adenomyosis, the fertility outcomes of patients and the optimal strategy for the treatment.

Urinary cadmium and endometriosis prevalence in a US nationally representative sample: results from NHANES 1999-2006.

Is exposure to toxic metal cadmium associated with increased endometriosis prevalence among a nationally representative sample of the US population? Concentrations of urinary cadmium, a long-term biomarker (10-30 years) of cadmium exposure, were associated with an increased prevalence of endometriosis. Cadmium exhibits estrogenic properties and may increase the risk of endometriosis, a gynecologic condition associated with substantial morbidity, for which estrogen has a central pathogenic role. Previous epidemiological studies of cadmium and endometriosis have yielded mixed results, with null, positive, and inverse associations being reported. We conducted a cross-sectional study using data from four cycles of the National Health and Nutrition Examination Survey (NHANES) 1999-2006. The study population comprised participants aged 20-54 years who had an endometriosis diagnosis, available data on urinary cadmium, and a glomerular filtration rate ≥60 ml/min/1.73 m2 (unweighted n = 1647). Urinary cadmium was measured by inductively coupled plasma-mass spectrometry, and we used urinary creatinine concentrations and covariate-adjusted standardization to account for urinary dilution. Self-reported diagnosis of endometriosis was ascertained by interview. We examined the association between quartiles of urinary cadmium and endometriosis using log-binomial regression to estimate adjusted prevalence ratios (aPRs) and 95% CIs. We observed twice the prevalence of endometriosis for participants with cadmium concentrations in the second quartile (versus the first quartile) (aPR 2.0, 95% CI: 1.1, 3.9) and the third quartile (versus the first quartile) (aPR 2.0, 95% CI: 1.1, 3.7). Our data also suggested a 60% increased prevalence of endometriosis with urinary cadmium concentrations in the fourth quartile (versus the first quartile) (aPR 1.6, 95% CI: 0.8, 3.2). In a sensitivity analysis, restricting the study population to premenopausal participants with an intact uterus and at least one ovary (unweighted n = 1298), stronger associations accompanied by wider CIs were observed. We were limited by the ascertainment of urinary cadmium and endometriosis diagnosis at a single time point, given the cross-sectional study design, and we relied on self-report of endometriosis diagnosis. However, urinary cadmium characterizes long-term exposure and findings from validation studies suggest that misclassification of self-reported endometriosis diagnosis may be minimal. This study suggests that cadmium is associated with an increased endometriosis prevalence. Given the substantial morbidity conferred by endometriosis and that the general population is ubiquitously exposed to cadmium, further research is warranted to confirm our findings. This work was supported by the National Institute of Nursing Research (grant R00NR017191 to K.U.) of the National Institutes of Health. The authors report no conflict of interest. N/A.

Adenomyosis: Current knowledge, Recent Advances and Future Perspective

Aim: Adenomyosis is an abnormal overgrowth of the endometrial tissues within the myometrium causing enlargement of the uterus. This present review will focus on clinical symptoms, diagnostic approach, image findings, complications, and management of Adenomyosis. The goal is also to highlight the recent advances in the topic. Methodology: A total of 15 articles published in various journals have been included to write the current review. PubMed, Research Gate, Scopus, Springer are some of the databases used for the literature search. Results: After reviewing the literature Adenomyosis has been discussed under the following topics 1) epidemiology (known and emerging risk factors) 2) Pathogenetic Theories (recent advances such as sequencing analysis of epithelial cells in Adenomyosis) 3) Clinical Manifestations and impact on women's fertility and pregnancy outcome 4)Diagnostic Approach, Current imaging techniques and classifications 5) Medical Management 6) Surgical Interventions (with recent advances such as UAE) 7) Future Perspective. Conclusion: The prevalence of Adenomyosis is still unknown owing to the lack of a validated standard diagnostic approach. Historically, the standard treatment of adenomyosis has been hysterectomy, but this is not always the best option, especially for women who want to preserve their fertility or for those who are poor surgical candidates.

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

P-636 Euploid blastocysts obtained in advanced maternal age women either in donor or autologous egg cycles showed similar live birth rates: a retrospective cohort study

Abstract Study question Do euploid blastocysts have the same implantation and live birth rate in autologous and donor egg cycles in patients with advanced maternal age (AMA)? Summary answer Euploid blastocysts transferred in AMA patients showed that implantation and live birth rates (LBR) were not significantly different between reproductively younger and older women. What is known already Aneuploidy rates increase steadily with age, reaching &amp;gt;80% in women &amp;gt;42 years old. The high prevalence of aneuploidies may provide an explanation for the low LBR achieved by assisted reproductive treatments, especially for women with AMA. Similarly, among oocyte donors, age is critical to achieving reproductive success independently of the recipients’ age. In donor cycles, recipients using oocytes from older donors had a statistically significantly lower LBR than younger donors. Currently, it still remains unclear whether the LBR differs between young donors versus old infertile patients in the context of euploid blastocyst transfers. Study design, size, duration Multicenter retrospective study with the preimplantation genetic test for aneuploidies (PGT-A) in both autologous and donor oocytes cycles between January 2018 and January 2021 was conducted at three different institutions (IVI-RMA, GeneraLife and Humanitas Fertility Center). 556 patients were included and matched 1:1 for the age of recipients, euploid blastocyst morphological quality, and day of development. In the frozen embryo transfers, endometrial preparation was done using hormonal replacement therapy (HRT) or natural cycles (NC). Participants/materials, setting, methods AMA patients older than 39 years underwent IVF. 556 patients who underwent autologous or donor oocyte cycles with at least one euploid blastocyst transferred were matched for oocyte age, blastocyst morphological quality and day of development. Blastocyst ploidy was assessed by aCGH or NGS analysis. Patients with uterine pathologies reported in the dataset were excluded. The primary outcome was LBR per first euploid blastocyst transfer. Outcomes were adjusted for confounders via logistic regression analyses. Main results and the role of chance 278 single euploid blastocysts tested by PGT-A were transferred in both autologous and donor oocyte cycles. No statistical differences were reported in the maternal age at transfer in the two groups (41.91 ± 2.03 and 41.75 ± 1.98, p = 0.55), endometrial thickness [(8.67, 95%CI: 8.45-8.88) and (8.36, 95%CI: 8.05-8.67)] and type of endometrial preparation (HRT or NC). Implantation rate and pregnancy rate were similar without statical difference in autologous or donor cycles, respectively [57.91%, (95%CI: 51.87-63.78) versus 56.83%, (95%CI: 50.79-62.74); p = 0.99)] and N = 158/278 (56.83%, 95%CI: 50.79-62.74) versus N = 161/278 (57.91%, 95%CI: 51.87-63.78), p = 0.86. The rate of ectopic pregnancy was not statistically different in both arms. Even the miscarriage rate was comparable in autologous N = 46/158, 16.55% (95%CI:12.38-21.45) versus donor group N = 45/161, 16.19%, (95%CI:12.06-21.05); p = 0.98. The LBR was not statistically different in autologous N = 111/278 (39.93%, 95%CI:34.13-45.95) and donor group 114/278 (41.01%, 95%CI:35.17-47.04), p = 0.86. No statistical difference was reported for gestational age and birthweight at delivery. The logistic regression analyzed as putative confounders: oocyte age, number of inseminated MII-oocytes, zygotes and euploid blastocysts, sperm parameters, endometrial preparation and endometrial thickness showed no statistical differences. Limitations, reasons for caution Despite the matched design, the retrospective nature is the major limitation of this study. Also, patients received PGT-A using NGS and CGH arrays technology. The aCGH analysis is less sensitive than more recent NGS technology. Lastly, the prevalence of adenomyosis could be underestimated due to retrospective data collection. Wider implications of the findings The dramatic decline in IVF treatment success is primarily caused by aneuploidies. Euploid blastocysts show LBR largely independent of oocyte age. Our study suggests no uterine effect of aging. The reproductive decline in women is mainly related to meiotic failure, therefore future insights should develop strategies to overcome chromosomal aneuploidies. Trial registration number NA

O-266 Anti-angiogenic therapy as treatment for adenomyosis in mice

Abstract Study question What is the effect of anti-angiogenic therapy on adenomyosis in mice Summary answer Commencing treatment at six weeks with angiogenesis inhibitor axitinib successfully reduced the severity of adenomyosis by approximately 50% at 9 weeks. What is known already Adenomyosis is a gynecological disorder characterized by abnormal uterine bleeding, dysmenorrhea, pelvic pain and subfertility. Increased expression of angiogenic markers, as well as increased microvascular density (MVD) in adenomyosis suggest a pivotal role for angiogenesis in the pathophysiology of adenomyosis, which presents an opportunity for treatment. Study design, size, duration The effect of angiogenesis inhibition was studied in a tamoxifen-induced adenomyosis mouse model. 102 Mice received oral treatment with axitinib 3 mg/kg (‘dose I/AX3 treatment group’, n = 34), axitinib 25 mg/kg (‘dose II/AX25 treatment group’ n = 34), or with vehicle-only (‘placebo group’, n = 34) from week 6 until week 9. After termination of the mice at week 9, all uteri were analyzed for the presence of adenomyosis. Participants/materials, setting, methods The prevalence and severity of adenomyosis were assessed by; (i) grade of adenomyosis (0/1/2/3), based on the depth of endometrial gland infiltration into the myometrium in H&amp;E-stained sections, (ii) percentage of adenomyosis-affected tissue in vimentin-stained sections and (iii) degree of myometrium that is affected in α-SMA-stained sections. The adenomyosis severity index was calculated by multiplying mean grade/mouse with the percentage affected surface area. Changes in angiogenesis-related gene expression were evaluated using real-time quantitative PCR. Main results and the role of chance 101 mice completed adenomyosis induction and could be analyzed. The prevalence of adenomyosis was 30/33 (90.0%) in dose I (3mg/kg), 29/34 (85.3%) in dose II (25mg/kg) and 30/34 (88.2%) in placebo treated mice (p=0.78). The prevalence of high grade (2/3) adenomyosis was significantly lower in mice treated with axitinib dose II (N = 19, 55.9%) than in the placebo group (N = 27, 79.4%, p&amp;lt;0.05). The grade of adenomyosis per mouse after treatment was 0.7 point lower in the groups treated with axitinib dose I and dose II, than in the placebo treated group (dose I and II both median of 1.0 compared to 1.7, p &amp;lt; 0.05). The adenomyosis severity index was reduced by 48% in the axitinib-treated groups (dose I p&amp;lt;0.05). In the placebo-treated group, the myometrium adjacent to the affected site (as a marker for hypertrophy) was thicker in the placebo- than in the axitinib-treated groups. There were no signs of fibrosis. MVD was reduced in myometrium of dose I treated mice by 14% compared with Ax25-treated mice (p&amp;lt;0.05), as well as compared to 6-week-old tamoxifen-treated mice (p&amp;lt;0.05). Expression of angiogenic growth factors and their receptors was markedly reduced in the dose I and II axitinib-treated groups compared to the placebo-treated group. Limitations, reasons for caution Limitations of this study include the uncertainty on the optimal timing to start treatment, and the assessment of the presence and severity of adenomyosis. Further research should focus on commonality among different angiostatic drugs, as well as the method and timing of application. Wider implications of the findings Since there is currently no treatment option for premenopausal women who wish to retain their uterus and their fertility, treatment with an angiogenesis inhibitor might provide a solution. The major requirement in further development of anti-angiogenesis therapy is a safety and side-effect profile tolerable for this population. Trial registration number Not applicable