Treatment Of Endometriosis-related Pain Research Articles

Advances in approaches to diagnose endometriosis

Endometriosis is a common, underdiagnosed, systemic inflammatory, and endocrine pain disorder that impacts the quality of life of millions of persons with a uterus globally. It is associated with chronic pelvic pain and an increased risk of subfertility. It has also been associated with cardiovascular disease, depression, thyroid and autoimmune disorders, ovarian and breast cancers, and poor pregnancy outcomes. Treatment of endometriosis-related pain and infertility can be medical and/or surgical, although misdiagnosis due to symptoms that overlap with other conditions and reliance on definitive diagnosis by histologic confirmation of endometriosis at surgery have contributed to a prolonged diagnosis-to-treatment timeline. A paradigm shift in endometriosis diagnosis is underway, with greater reliance on clinical and family history, physical examination, and imaging, without surgical confirmation, and then proceeding with medical and/or surgical therapies, although any one diagnostic approach alone is insufficient. Although there are no validated, specific molecular biomarkers for endometriosis, recent candidates have promise for diagnosing the disease and facilitating symptom management. This review presents current and evolving approaches to diagnose endometriosis with the goal of expediting the diagnosis-to-treatment timeframe, so patients can have confidence in a diagnosis for their symptoms, expectations set about disease management across the lifespan, and a patient-centered treatment plan promptly initiated. To provide context, the review begins with a summary of disease characteristics, followed by genetic and environmental risks for developing endometriosis, the central role of estrogen and inflammation in the pathophysiology of pain and infertility relevant to the disease and biomarker discovery, and nonsurgical approaches that are increasingly being acknowledged by professional organizations across the globe to be of value in the diagnosis of this enigmatic disease with diverse manifestations.

Management of Endometriosis: An Integrative Review of National and International Guidelines

Endometriosis is a disease characterized by the presence of endometrial tissue outside the uterus, affecting 2 to 22% of women worldwide, resulting in inferior quality of life as the condition often causes pain (dysmenorrhea, dyspareunia) and infertility. It is notable that clinical practice has changed in the last decade, with endometriosis receiving much more media attention and patients taking a more active role through different disease organizations. Considering these changes and identifying which practices are justified by medical evidence is essential. Using the descriptors: "Treatment", "Endometriosis" and "Guidelines" in the PUBMED, MEDLINE and SciELO databases, a total of 312 articles were found and, subsequently, eight articles were submitted to the selection criteria. Regarding pharmacological therapies associated with endometriosis, most of the guidelines included in this study suggest progestins, either in the form of dienogest or medroxyprogesterone acetate, and combined oral contraceptives as first-line therapy with considerable evidence. GNRH agonists and the levonorgestrel system are used as second-line treatment. Surgery also has a significant role in the treatment of endometriosis-related pain, with the excision of endometrial implants or endometriomas. Handling ovarian tissue as thoroughly as possible is recommended in order to limit the decrease in ovarian reserve. Despite very well-established guidelines, relevant diagnostic tests such as Magnetic Resonance Imaging (MRI) are inaccessible and expensive for most women, as is laparoscopic surgery, hindering the diagnosis and treatment of the disease, especially in underdeveloped countries.

Long-term treatment of endometriosis-related pain among women seeking hormonal contraception

Objective To evaluate the different effects of a progestin-only contraceptive with desogestrel (DSG) vs combined oral contraceptives (COCs) for a first line long-term treatment of endometriosis-related pain among patients seeking hormonal contraception. Methods An observational retrospective cohort study was conducted in collaboration with a local outpatient clinic for endometriosis among a group of nulliparous young women (n = 216) with endometriosis-related pain and seeking contraception. The cohort was subdivided into a group (n = 73) treated as first line by DSG and another group (n = 75) treated by a COC. During the study, clinical symptoms, side effects and possible changes in OC type use were recorded. Results No significant difference was found between the two groups in terms of clinical characteristics and pain scores before treatment. After 6 months both treatments were effective in reducing endometriosis-related pain, and those treated with DSG showed lower levels of dysmenorrhea, dyspareunia and nonmenstrual pelvic pain than COCs group (p < .01). After 12 months, in DSG Group some patients (15%) switched from DSG to a COC for breakthrough bleeding, whereas in COC Group 48% of patients switched to another type of COC for reduced efficacy on pain and/or for side effects. After 3 years of OC treatment, in DSG Group 79% of patients maintained the same therapy, whereas in COC Group only 14% continued the same COC type, 37% switched to another COC and 47% to DSG. Conclusions A progestin-only contraceptive with DSG is a valid option for long term management of endometriosis-related pain in patients seeking hormonal contraception.

Endometriose en pijn: een overzicht met argumentatie voor een individuele en multidisciplinaire aanpak

Endometriosis and pain: an overview with arguments for an individual and multidisciplinary approach This article provides a narrative overview of endometriosis-related pain. Pain due to endometriosis affects quality of life with an impact on professional, social, family and sexual functioning. Both neuropathic and inflammatory mechanisms are at the root of the pain, which is further modulated via central sensitization in the brain. Chronic pain due to endometriosis is associated with morphological changes in pain-processing areas of the central nervous system. These data reinforce the need to frame endometriosis therapy in a much broader sense than just local surgical removal and (hormonal) suppression. Both the diagnosis and the therapy of endometriosis benefit from a multidisciplinary and dedicated team. The literature on the treatment of endometriosis-related pain is characterized by large gaps, there are only a few prospective randomized or placebo-controlled studies. In addition to surgery, estrogestin combinations, progestogens alone, GnRH agonists and antagonists, aromatase inhibitors, selective estrogen and/or progestogen receptor modulators, NSAIDs (non-steroidal anti-inflammatory drugs), psychotherapy and physiotherapy can be used. Except for acupuncture, there are no good comparative studies on alternative treatments, like for example certain nutritional supplements, cannabis, osteopathy and other alternatives. In view of the interdependence of pain complaints in endometriosis patients and its effects on their social and personal experience and functioning, the approach must be based on a patient-oriented program, adapted to the personal needs and preferences of the patient. A multidisciplinary approach with a policy based on the needs and expectations of the patient can be an added value.

Comparison of the Efficacy and Tolerability of Dienogest and Dienogest Plus Ethinylestradiol on Endometriosis Related-Pain

Objective: Endometriosis is a common gynecological condition that affects many women of reproductive age worldwide and is a major cause of pain and infertility. Treatment of endometriosis can be either surgical, aiming to restore normal anatomy by removing endometriotic lesions, or hormonal. Various medical treatments with different doses, formulations, delivery systems, and regimens have been tested. The main objective of this study was to compare the efficacy and tolerability of dienogest and dienogest plus ethinylestradiol on endometriosis-related pain. Additionally, the effects on endometrioma size were examined.Study Design: A total of 81 patients with clinically diagnosed endometrioma, who had chronic pelvic pain, dysmenorrhea, or deep dyspareunia between January 2015 and December 2018 were studied retrospectively. The patients were divided into two main groups: continuous oral dienogest (n=43) (Visanne®, 2 mg/day) and continuous oral dienogest plus ethinylestradiol (n=38) (Dienille®, 2 mg/0.03 mg/day). The intensity of pain symptoms was evaluated before therapy, then after 3 and 6 months of treatment using a 10-point numerical rating scale (0 = no pain and 10 = worst possible pain) (NRS) provided to the patients in advance.Results: The pain scores related to chronic pelvic pain decreased 36% for dienogest and 49% for dienogest plus ethinylestradiol (p&lt;0.05) and scores for dysmenorrhea decreased 38% and 44% respectively (p&lt;0.05) at 6 months, significantly lower than before treatment. At the 6-month follow-up, a 28% decrease in the pain scores related to deep dyspareunia in the dienogest group was statistically significant. Although the dienogest plus ethinylestradiol group also decreased by 20%, the difference was not significant. There was no significant difference in endometrioma size between the two groups at the 6-month follow-up (dienogest and dienogest plus ethinylestradiol; 24.2±17.5 mm vs. 27.5±19.1 mm, respectively; p=0.42).Conclusion: Upon analysis of our 6 months of clinical data, estrogen-progestin and a progestin alone seem to be of similar efficacy for the temporary treatment of endometriosis-related pain. The dienogest plus ethinylestradiol combination was slightly less effective on deep dyspareunia but was still well tolerated. Similarly, the two hormonal regimens posed no superiority over one another with regard to endometrioma size reduction.

Patient preferences for elagolix and leuprolide for treating endometriosis-related pain in the United States

ABSTRACT Introduction We evaluated elagolix and leuprolide from the patient’s perspective for the treatment of endometriosis-related pain. Area covered Preference weights from a published discrete choice experiment were used to evaluate preferences for treatment profiles simulating elagolix (150 mg/day and 200 mg/twice-daily dosages) and leuprolide for the treatment of moderate to severe endometriosis-related pain. Sensitivity analyses were conducted by varying the range of risk for pregnancy-related problems, moderate to severe hot flashes, and bone fracture across scenarios. Expert opinion The 200 mg twice daily dosage of elagolix is more likely to be preferred over leuprolide by patients with moderate to severe endometriosis-related pain in all scenarios explored in the evaluation and sensitivity analyses. The probability that an average respondent would select a treatment was sensitive to increases in risk of moderate to severe hot flashes for leuprolide and possible variations in the risk of pregnancy-related problems for both treatments but was not influenced by an increased risk of bone fracture. Conclusions Patients’ preferences for treatment of endometriosis-related pain should be evaluated using the benefits and risks of each pharmacological option. Respondents were more likely to prefer the treatment profile similar to 200 mg twice daily elagolix over that of leuprolide in all scenarios.

Time to full effect, following treatment with combined oral contraceptives (cyclic versus continuous administration) in patients with endometriosis after laparoscopic surgery: a prospective cohort study

The risk of recurrence after surgery is a major problem in women who are suffering from endometriosis. The prescription oral contraceptives (OCs) in the treatment of endometriosis-related pain, in women who do not desire fertility, is still controversial. The aim of this prospective cohort study is to evaluate the time until the reduction in the mean intensity of dysmenorrhoea and deep dyspareunia takes effect, for patients who use combined OCs in the accepted cyclic manner, versus in the continuous fashion as after the laparoscopic excision of endometriosis. A total of 28 patients diagnosed with endometriosis who underwent surgical treatment were offered at least a 12 months course of oral contraceptives. The intensity of both symptoms was reduced at the end of observational period in both groups. The use of continuous OCs (11 patients) was associated with a more pronounced reduction in the mean intensity of dyspareunia and dysmenorrhoea at 9 (p = 0.004) and 6 (p = 0.003) months respectively as compared to the cyclic group (17 patients).

Relugolix. GnRH (LHRH) receptor antagonist, Treatment of uterine fibroids, Treatment of endometriosis-related pain, Treatment of prostate cancer

Relugolix. GnRH (LHRH) receptor antagonist, Treatment of uterine fibroids, Treatment of endometriosis-related pain, Treatment of prostate cancer

Micronized palmitoylethanolamide/trans-polydatin treatment of endometriosis-related pain: a meta-analysis.

To demonstrate clinical effectiveness of micronized palmitoylethanolamide-trans-polydatin combination in reducing endometriotic chronic pelvic pain. Other endometriotic-pains were also assessed. Systematic reviews of PubMed, SCIELO, Scopus, and AJOL. Randomized trials and observational studies reporting a visual analogue scale for pain or similar in endometriotic patients were reviewed. A mean improvement of visual analogue scale (or visual analogue scale-like) scores at enrollment and at a three-month follow-up was assessed and interpreted clinically. Four studies of poor quality were available. In a heterogeneous sample of endometriotic patients with pain, the administration of micronized palmitoylethanolamide/trans-polydatin (400 mg/40 mg) twice a day for three months provided a clinically relevant improvement of chronic pelvic pain and dysmenorrhea while improving deep dyspareunia to a limited degree. No clinically relevant improvement was found for dyschezia. More studies are warranted for assessing the drugs-related efficacy.

A pilot double-blind, randomized, placebo-controlled trial of the efficacy of trace elements in the treatment of endometriosis-related pain: study design and methodology

Endometriosis is one of the most common benign gynecological disorders, affecting almost 10%-15% of all women of reproductive age and .30% of infertile women. The pathology is associated with various distressing symptoms, particularly pelvic pain, which adversely affect patients' quality of life. It is an estrogen-dependent disease. There is evidence both in animals and in humans that metal ions can activate the estrogen receptors. They are defined as a variety of xenoestrogens, called metalloestrogens, which could act as endocrine disruptors. Therefore, it could be considered to act on this gynecological disorder using food supplements containing trace elements (ie, nutripuncture). The assumption is that they could modulate estrogen receptors and thus influence the tropism and the survival of cells involved in endometriosis. By a modulation of the antioxidant system, they might also interact with various parameters influencing tissue biochemistry. The objective of this article is to describe and discuss the design and methodology of an ongoing double-blind, randomized, placebo-controlled study aiming to evaluate the efficacy of metal trace elements on the reduction of pain and improvement of quality of life, in patients with a revised American Fertility Society Score Stages II-IV endometriosis, combined or not with adenomyosis, during a treatment period of 4 months. Trace elements or placebo is proposed in the absence of any other treatment or as an add-on to current therapies, such as sexual hormones, nonsteroidal anti-inflammatory drugs, and surgery. A placebo run-in period of one menstrual cycle or 30 days for women in amenorrhea has been scheduled to eliminate the patients who are responding too much to the placebo. After a 1:1 ratio randomization on Day 0, the treatment with trace elements or placebo will last for 4 months (120 days).

Efficacy of letrozole in treatment of endometriosis-related pain

To evaluate the efficacy of aromatase inhibitor (letrozole) in the treatment of endometriosis-related pain. A total of 20 women with Stage IV endometriosis presented with endometriosis-related pain refractory to previous treatment or recurrence after such treatment have been included in the study. All women were treated with oral administration of letrozole 2.5 mg in addition to elemental calcium 1000 mg and vitamin D 880 IU daily for a total treatment duration of 6 months. Baseline (pre-treatment), monthly during treatment, at end of treatment and 6 months after completion of treatment; all patients were evaluated for the presence and intensity of pain (including dysmenorrhea, deep dyspareunia and chronic pelvic pain) using a 100 mm visual analog scale (VAS). Mean age was 30.9 years with 80% of patients were NP. Half of patients presented with dysmenorrhea. Patients previously received oral contraceptives (50%), GnRH agonists (25%) and Medroxyprogesterone acetate (25%) or underwent laparotomy with ovarian cystectomy (20%) or exploration 30%). At the end of treatment (6 months after start treatment) mean VAS dropped from 7.65 at start of therapy to 6.1 ( p -value < 0.005). Six months later (12 months after start of therapy), further significant drop of mean VAS has been reported (from 6.1 to 4). Letrozole (aromatase inhibitor) has shown to be effective in the treatment of endometriosis-related pain with substantial improvement of pain with no recurrence of pain for 6 months after completion of treatment.