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PubMed2005

Treatment of pelvic endometriosis with etonogestrel subdermal implant (Implanon).

BACKGROUND: Endometriosis is one of the commonest benign gynaecological disorders and has a peak incidence between 30 and 45 years of age. Treatment options are medical or surgical, depending on the location and extent of the disease and the woman's childbearing aspirations or need for contraception. Over the past five decades several formulations of progestogen have been used to treat endometriosis. METHODS: Our study was not planned research but a series of case studies of women with severe symptoms of endometriosis treated in an innovative way with a new long-acting progestogen contraceptive system (etonogestrel subdermal implant) which could reasonably have been expected to have a favourable effect on their disease and its symptoms. RESULTS: Five women with severe pelvic endometriosis were treated. Two of them were nulliparous and wished to become pregnant in due course; the other three had completed their childbearing and were contemplating hysterectomy. One of the five women had relief of pelvic pain but requested removal of the implant after 3 months because of side effects; the other four remained very satisfied with their treatment for the symptoms of pelvic endometriosis. Two of the four very satisfied women have had their implant replaced and the other two are expected to have their implant replaced when necessary. CONCLUSION: Etonogestrel subdermal implants are an additional treatment option in women with symptoms related to pelvic endometriosis.

Adult↗

PubMed2006

Endometriosis: harmful survival of an ectopic tissue.

Endometriosis results from implantation of endometrial tissue outside the uterine cavity. Endometriosis might remain asymptomatic and discovered accidentally. However, it may cause symptoms, which include chronic pelvic pain, bleeding, infertility, and increases susceptibility to development of adenocarcinoma. The most prevailing hypothesis is that endometriosis results from implantation of endometrial tissue that gains access to peritoneal cavity by retrograde flow during menstruation. The factors contributing to the establishment and persistence of the endometriotic lesions (plaques) most probably include abnormalities of the genital tract, genetic predisposition, hormonal imbalance, altered immune surveillance, inflammatory response and abnormal regulation of the endometrial cells. The mediators that contribute to survival and progression of endometriosis are likely involved in the development of the symptoms of this process. Genomic studies have started to delineate the wide array of mediators involved and the complex genetic background required in the development of endometriosis. This review summarizes our current knowledge regarding the pathogenesis of endometriosis, including progress made with transgenic animals, and a clinical perspective on the diagnosis and management of this common process.

Animals↗

PubMed1984

Regression of endometriosis following shorter treatment with, or lower dose of danazol. Comparison of pre- and post-treatment laparoscopic findings in the Scandinavian multi-center study.

One hundred and sixteen patients with laparoscopically confirmed primary or recurrent endometriosis were treated with danazol, either 600 mg daily for 4 months (group A, n = 76) or 600 mg daily for the first 2 months, followed by 400 mg daily for an additional 4 months (group B, n = 40). The only surgery performed before treatment was biopsies, resection of endometriomas greater than or equal to 3 cm and/or adhesiolysis. The extent of endometriosis before and after treatment was established laparoscopically and recorded by means of a modified AFSrecord as mean additive diameter of implants (mean ADI) in millimeters. This provided a uniform and reproducible quantitative registration for each type and location of endometriotic implant. Both treatment schemes resulted in a highly significant (p less than 0.001) reduction of endometriosis, by 79 and 89% in groups A and B, respectively. However, the reduction in mean ADI was significantly greater (p less than 0.025) in group B which had been treated for a longer period. Moreover, the proportion of patients with extensive pre-treatment lesions (mean ADI greater than or equal to 40 mm) was significantly greater in this group. Active residual endometriosis was found in 21 and 17.5% in groups A and B, respectively. These patients had significantly more extensive endometriosis before treatment. The regression of endometriotic implants was independent of type and/or location, i.e. superficial or scarred; peritoneal, ovarian, or tubal. There was no apparent correlation between the quantitative reduction of endometriosis and amenorrhea versus occasional spotting and/or irregular menstruations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1987

Endometriosis in women at interval sterilization.

The prevalence of endometriosis was investigated in 108 Norwegian women admitted for interval tubal sterilization. The mean age of the patients was 37 years. Endometriosis was detected in 19 (18%) of the women. About one-half of these had no symptoms from the disease. A positive correlation was found between a retroversion of the uterus and endometriosis. The women with endometriosis showed a longer period of uninterrupted menstrual cycles prior to the time of sterilization, when compared with the controls (89 unaffected women). Sisters and mothers of patients with endometriosis displayed a higher frequency of benign gynecological disorders than the corresponding relatives of the control group. The prevalence of endometriosis appeared to be independent of the following clinical parameters: onset of menarche, age at first pregnancy, number of pregnancies, previous use of hormonal contraceptives or IUD, and actual age at the time of sterilization.

Adult↗

PubMed1989

Eicosanoids in primary dysmenorrhea, endometriosis and menstrual migraine.

This paper summarizes what has been learned over the years about the role of eicosanoids in the pathogenesis of primary dysmenorrhea, endometriosis and menstrual migraine. The role of prostaglandins (PGs) in the pathogenesis of primary dysmenorrhea is inferred from four main observations: firstly, the clinical symptoms of primary dysmenorrhea are similar to those induced by the administration of PGF2 alpha and PGE2 for the induction of labour; secondly, the increased production of PGs by the endometrium during the luteal and menstrual phases of ovulatory cycles is consistent with the occurrence of primary dysmenorrhea mainly in ovulatory cycles; thirdly, the concentrations of PGF2 alpha and PGE2 in the endometrium and menstrual fluid of dysmenorrheic women are significantly higher than in controls; fourthly, certain PG inhibitors have been proved to be effective in the treatment of dysmenorrhea. The change in PG production can explain the major symptoms of primary dysmenorrhea, including the increased uterine contractility, uterine ischemia and the lowering of the pain threshold to chemical and physical stimuli in the pelvic nerve terminals. Moreover, recent experimental data suggest that leukotrienes (LTs) might be among the alternative pathogenetic causes of primary dysmenorrhea. The data which support a relationship between eicosanoids and endometriosis are as follows: endometriotic tissue produces PGs; the peritoneal fluid concentration of PGF2 alpha increases significantly after the induction of endometriosis in laboratory animals; the concentration of PGs in peritoneal fluid of some patients with endometriosis is greater than in controls and, finally, the number and activation of pelvic macrophages which are able to synthesize eicosanoids increase in patients with endometriosis. Possible roles for eicosanoids in the pathogenesis of infertility and secondary dysmenorrhea induced by endometriosis have been suggested. Eicosanoids are probably also involved in the pathogenesis of menstrual migraine. Different types of PGs might play a role both in the initial vasoconstriction during the prodromal phase of migraine and in the vasodilation and sensitization to pain typical of the pain phase.

Dysmenorrhea↗

PubMed1994

Serum CA-125 concentration in endometriosis patients: role of pelvic and peritoneal irritation.

Serum CA-125 concentrations were investigated preoperatively in 91 consecutive women undergoing laparoscopy for infertility, pelvic pain and/or annexial cysts. The presence and extent of endometriosis were carefully assessed, including the American Fertility Society stage of disease, and implant and adhesion scores. Postoperative CA-125 measurements were obtained in 32 of 53 endometriosis patients and evaluated with respect to clinical evolution of the disease. Serum levels of CA-125 were significantly increased in patients with endometriosis (46.5 +/- 39.5 vs. 13.5 +/- 7.3 U/ml in controls, p < 0.001) and correlated with the severity of disease. A positive correlation (r = 0.7, p < 0.001) was observed between adhesion score and CA-125 levels, while the relationship with implant score was not significant (r = 0.3, p = 0.07). CA-125 level was also significantly increased in women with peritoneal endometriosis (70.7 +/- 47.3 vs. 33.5 +/- 25.6 U/ml for those with ovarian endometriosis), and in these patients the post-operative CA-125 level was significantly related to the clinical evolution of the disease, being higher in patients whose disease recurred compared to those with negative follow-up, irrespective of the adhesion score. We conclude that in endometriosis patients, serum CA-125 level is directly related to the adhesion score and peritoneal involvement, suggesting a central role of pelvic and peritoneal irritation in the increased level of this serum marker.

Adolescent↗

PubMed2003

[Potential links between endocrine disrupting compounds and endometriosis].

There is an increasing awareness of potential links between human health and environmental pollution. Endocrine disrupting compounds(EDCs), such as dioxins, are exogenous chemicals that either imitate endogenous hormones, interfere with pharmacokinetics or act by other mechanisms. It is generally assumed that the number of patients with endometriosis have been increasing. Endometriosis is estimated to occur in approximately 7-10% of reproductive age women. Recently, much more attention has been paid to the relationship between endometriosis and EDCs, especially dioxins. Endometriosis is a common disease that can affect any menstruating woman, but the pathogenesis and pathophysiology are still poorly understood and there is no strategy for prevention. However, there are some new studies that have investigated biological activity and consequences of exposure to EDCs. Endometriosis is the disease in which genetic and environmental factors act together to produce the phenotypes. Findings for environmental factors as well as genetic variants have been reviewed, but the issue remains controversial. The findings of these studies would be a great help to understand the mechanisms of endometriosis.

Animals↗

PubMed1999

[Clinical presentation and natural history of endometriosis].

Natural history of endometriosis is unpredictable. Some recent data show that endometriosis is a progressive disease. Minimal lesions are transient and peritoneal implants are reorganized continuously. So, minimal endometriosis could be considered like a transient statement close to physiology. In favourable statement such as the decreased activation of NK cells, the variable secretions of cytokines, pelvic macrophages and growth factors, the peritoneal implants evoluted like a progressive disease until severe endometriosis. Endometriosis is a frequent cause of pelvic pain with dysmenorrhea, dyspareunia, chronic pelvic pain and infertility. The diagnosis can be suspected by a clinical examination preferentially during menstruation with fixed uterine retroversion peritoneal infiltration, retraction of the rectum and retrovaginal endometriosis, and adnexal cyst.

Adnexal Diseases↗

PubMedDate not supplied

Endometriosis externa and interna: endoscopic diagnosis.

Endometriosis is defined as the presence of the endometrium outside the endometrial cavity. If the ectopic mucosa is located within the endometrium, the disease is defined as endometriosis interna, or adenomyosis, whereas the localization of the endometrium outside the uterus is defined as endometriosis externa, or pelvic endometriosis. The diagnosis of pelvic endometriosis requires invasive techniques, such as laparoscopy or laparotomy, with histologic confirmation on the surgical specimen. The diagnosis of adenomyosis should be based on histology of hysterectomy specimen, since the endoscopic diagnosis is still too inaccurate. Laparoscopy allows the visualization of the different aspects of pelvic endometriosis, i.e. superficial implants, deep lesions, and associated adhesions. Staging is based on a score attributed to each location in order to establish a prognosis in terms of the patient's reproductive performance.

Endometriosis↗

PubMedDate not supplied

Magnetic resonance imaging of pelvic endometriosis.

Endometriosis is a multifocal disease involving multiple pelvic sites. Although laparoscopy is the elective exam in the study of patients with clinically suspected endometriosis, MR imaging represents a valid noninvasive procedure for the study of areas unapproachable with laparoscopy. On MR imaging, areas of endometriosis over 1 cm in size appear homogeneously hyperintense in T1-weighted images and hypointense in T2-weighted images, while areas of endometriosis less than 1 cm in size appear hyperintense in T1-weighted images and with variable signal in T2-weighted images. Endometriosis may also appear as small cystic lesions, hyperintense in T1-weighted images. While MR imaging has some limitations in the visualization of small endometriotic implants and adhesions, it has the ability to characterize the lesions, to study extraperitoneal locations and the contents of pelvic masses. The reliability of MR imaging findings of endometriosis and the assessment of pelvic organ involvement is important for guiding subsequent laparoscopy.

Adult↗

PubMed1999

Immune abnormalities in endometriosis compromising fertility in IVF-ET patients.

OBJECTIVE: To evaluate the incidence of immune abnormalities in patients with endometriosis and primary or secondary infertility. STUDY DESIGN: This study analyzed the incidence of alloantibodies and autoantibodies in 100 women with endometriosis and 62 patients with unexplained infertility without endometriosis who enrolled in an assisted reproduction program at the Colombian Fertility and Sterility Center from January 1, 1996, to May 30, 1997. The alloimmune status of the women was determined by testing for the presence or absence of antileukocyte antibodies. The autoimmune studies included antinuclear antibodies, antiphospholipid antibodies and lupus anticoagulant antibody. RESULTS: Negative titers of IgG antipaternal antibodies were identified in 34% of patients with primary infertility and in 34% of women with secondary infertility and a history of pregnancy losses. Positive titers of antinuclear antibodies were found in 27% (27/100) of the group of patients with endometriosis; of them, 30% (15/50) had primary infertility and 24% (12/50), secondary infertility. The average titer was 1/80. Forty-eight percent of the infertile patients (48/100) showed titers of antiphospholipid antibodies for IgG and IgM; 46% of these patients had primary infertility (23/50) and 50% (25/50), secondary infertility. This was significantly higher than in controls (P < .05). Two patients were positive for lupus anticoagulant antibody. In the group of patients with unexplained infertility without endometriosis, the incidence of antinuclear antibodies was 17.7% and of antiphospholipid antibodies, 30.6%. CONCLUSION: For women with endometriosis, alloimmune and autoimmune evaluation is recommended prior to their undergoing assisted reproduction in order to provide appropriate therapy for each case.

Adult↗

PubMed1999

Impact of nafarelin and leuprolide for endometriosis on quality of life and subjective clinical measures.

OBJECTIVE: To examine the impact of treating endometriosis with nafarelin or leuprolide acetate depot on patient quality of life (QOL) and subjective clinical measures. STUDY DESIGN: A randomized, multicenter study was conducted on 192 women with endometriosis. Patients received nafarelin or leuprolide for six months and were followed for up to six months after treatment. QOL was defined by seven items, including symptom severity, daily activities, pain medication use and need for bed rest. RESULTS: No significant differences were found at baseline between treatments for patients with mild, moderate or no endometriosis symptoms. Those with severe symptoms of endometriosis at baseline and taking nafarelin had a significantly greater improvement in QOL at the last posttreatment visit than those receiving leuprolide (P < .01). Nafarelin was associated with significantly fewer days with moderate or severe hot flashes than leuprolide during treatment (P < .05) and with significantly fewer moderate or severe hypoestrogenic symptoms overall at three months of treatment (P < .05). Additionally, poorer QOL was significantly associated with hypoestrogenic and endometriosis symptoms. CONCLUSION: Treatment of endometriosis with nafarelin was associated with fewer days of moderate or severe hot flashes as compared to leuprolide and with greater improvement in QOL after treatment in patients with severe symptoms at baseline.

Adult↗

PubMedDate not supplied

[Ileal endometriosis. A clinical case and a review of the literature].

Ileal localization of intestinal endometriosis is not extremely rare, but there are always problems related to the preoperative diagnosis. Symptoms of intestinal endometriosis offer often problems to the surgeon in the differential diagnosis with many more pregnant illnesses like appendicitis, diverticulitis, inflammatory bowel diseases and abdominal neoplasms. The authors report a case of endometriosis of the ileum clinically mimicking Crohn's disease. Crohn's disease of the ileum is the most frequently reported illness that is considered in the differential diagnosis. The review of the literature shows that a correct preoperative diagnosis of endometriosis of the ileum is very seldom done. All common diagnostic tools are not able to resolve diagnostic doubts. Also during explorative surgery the diagnosis of endometriosis is not easy. The authors conclude that endometriosis of the ileum has to be more often considered as possible cause of common intestinal symptoms mimicking inflammatory bowel disease and that this illness induces to reevaluate the importance for a correct diagnosis of an accurate clinical history.

Adult↗

PubMed2000

[Hormone replacement therapy in women with surgical treatment of endometriosis and adenomyosis: prospective and follow-up study. Part I].

OBJECTIVE: To determine whether the initiation of estrogen replacement therapy (ERT) in the postoperative period increases the incidence of symptom recurrence following laparoscopic hysterectomy (LH) and/without bilateral salpingo-oophorectomy (BSO) for the treatment of endometriosis and adenomyosis. DESIGN: Prospective partially randomized patient preference follow up trial (PRPPT). SETTING: Department of Gynaecology, Endoscopic Training Centre, Kladno Hospital. METHODS: Chart review of 286 consecutive patients who underwent LH and/or without BSO for endometriosis or adenomyosis between April 1994 and June 1999 and who subsequently received ERT. The methods of second phase of trial was prepared. The symptoms of recurrence in patients who started ERT after surgery and in those who did not start ERT (control group) will be compared and adjusted. RESULTS: Seventy-three percent had preoperative pelvic pain. One hundred thirty two women (46.2%) had only endometriosis. Of the cases of endometriosis, 35.4% was stage I and 64.4% was stage II.-IV. One hundred fifty four women had adenomyosis, 60 with endometriosis. CONCLUSION: In the first phase of follow study the collection of clinical data was performed. Preliminary results from the PRPPT demonstrate that laparoscopic approach to surgery for endometriosis increased significantly the number of this disease.

Endometriosis↗

PubMed1997

[Diagnosis and treatment of rectal and sigmoid endometriosis].

From October 1989 to September 1994 six resections of the bowel were performed for colorectal endometriosis. Five of, the patients, with a mean age of 32 years, presented clinical features. In all cases, colonoscopy showed a normal mucosa. All patients treated by hormonetherapy relapsed. The resection was segmental with immediate end-to-end anastomosis in 5 cases and partial in 1 case. In three cases, endometriosis of the genital tract was associated and treated during the initial laparotomy. One low rectosigmoid anastomosis fistulised. Rectosigmoid endometriosis accounts for 70% of bowel localisations and genital endometriosis is associated in 80% of cases. Deep and clinical rectosigmoid endometriosis does not respond to hormonetherapy and requires bowel resection. The pelvis should be explored and genital tract endometriosis treated. Postoperative hormonetherapy should be considered after initial surgery.

Anastomosis, Surgical↗

PubMed2000

[Endometriosis as an unexpected finding during laparoscopy on sterile women].

OBJECTIVES: Assessment of the laparoscopy as endoscope method at diagnosing as unsuspected finding at sterile women. MATERIALS AND METHODS: Studying is retrospective and includes 20 years period of time (1976-1996). We have examined the documentation of 912 patients on whom performed laparoscopy. 678 from them have been primary and 234 have been with secondary sterility. RESULTS: We have established the following findings: cases only with endometriosis--164 patients; endometriosis and polycystic disease of the ovaries--11 patients; endometriosis and tubal sterility--42 patients; endometriosis and pelvic inflammatory disease (PID)--56 patients; endometriosis and uterus myomatosus--6 patients. DISCUSSION: Diagnosis of endometriosis by laparoscopy effectively helps in the further treatment of sterile women.

Adnexal Diseases↗

PubMed1999

[Investigation of erythrocyte immune function of patients with endometriosis].

OBJECTIVE: To study erythrocyte immune function of patients with endometriosis and explore the pathogenesis of endometriosis. METHODS: 38 patients with endometriosis diagnosed by laparoscopy or laparotomy and 21 normal women as the control were studied. The patients were divided into three groups by revised American Fertility Society (RAFS) classification: group one (stage I, II; n = 13), group two(stage III, n = 15), and group three(stage IV, n = 10). Using rosette formation test and polyethyleneglycol sedimentation methods, the erythrocyte immune function including C3b receptor rosette rate (C3bRR), immune complex rosette rate(ICR), erythrocyte rosette forming enhancing rate (RFER) and inhibitory rate (RFIR), and circulatory immune complex (CIC) was determined. RESULTS: The C3bRR, ICR, and RFER of group one, two, and three were decreased (P < 0.05 or P < 0.01), and RFIR and CIC of group one, two, and three were increased (P < 0.05) when compared with those of the control. All parameters had no significant difference among group one, two and three. In addition, these parameters had no significant difference in infertile groups of endometriosis as compared with those of fertile group. CONCLUSION: The erythrocyte immune function of patients with endometriosis is depressed, resulting from decreased erythrocyte immune adherence enhancer and increased inhibitor. These changes of erythrocyte immune function may be related to the pathogenesis of endometriosis.

Adult↗

PubMed2001

[Ovarian cancer and endometriosis].

Endometriosis is a relatively common condition found in up to 29% of women undergoing laparotomies. The authors suggest that endometriosis could have undergone malignant change. They propose the criteria used to establish that a malignant tumor has develop in endometriosis: clear evidence of endometriosis should be found close to the tumor, the histopathological appearance should be such that origin of the tumor from endometriosis is plausible, no other primary site should be found. The authors consider that atypical endometriosis possesses a precancerous potential or is most frequently associated with endometrioid and clear cell carcinomas.

Adenocarcinoma, Clear Cell↗