March is endometriosis month
Endometriosis is a common disease where tissue similar to the lining of the womb grows outside it in other parts of the body. More than 830,000 (more than 11%) of Australian women, girls, and those who are gender diverse suffer from endometriosis at some point in their life with the disease often starting in teenagers. Endometriosis Australia
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Articles
Diagnosis
Endometriosis
What you need to know
BMJ 28 November 2021
Pathophysiology, diagnosis, and management of endometriosis
This review discusses the potential genetic, hormonal, and immunologic factors that lead to endometriosis, with a focus on current diagnostic and management strategies for gynecologists, general practitioners, and clinicians specializing in conditions for which patients with endometriosis are at higher risk. BMJ 14 November 2022
When pain is not the whole story: Presenting symptoms of women with endometriosis
Although pelvic pain is not a good predictor for a diagnosis of endometriosis, it remains a common symptom among women with the disease. However, more than one in three patients with Grade IV endometriosis presented without mention of pain symptoms, encouraging clinicians to adopt a broader approach to the presenting symptoms of endometriosis. ANZ journal of obstetrics and gynecology 29 January 2022
How to improve non-invasive diagnosis of Endometriosis with advanced statistical methods
Advanced statistical methods are crucial when creating non-invasive tests for endometriosis. An algorithm based on three easy features, including painful menses, BMI level, and CA125 concentration could have an important place in the non-invasive diagnosis of endometriosis. If confirmed in a prospective study, implementing such an algorithm in populations with a high risk of endometriosis will allow us to cover patients suspected of endometriosis with proper treatment. Medicina 3 March 2023
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Research
Endometriosis and the workplace: Lessons from Australia’s response to COVID-19
Endometriosis is known to impact work productivity. The COVID-19 pandemic resulted in a shift in working practices for many, with an increase in working from home and/or flexible working hours. The aim of this online cross-sectional study was to determine if these changes resulted in changes in symptom management and productivity in Australian people with endometriosis. Three hundred and eighty-nine people responded to the survey. The majority of respondents found that their endometriosis symptoms were much easier to manage, and they were more productive. A key factor was flexibility in work hours and the increased ability to self-manage their time. ANZ journal of obstetrics and gynecology 22 November 2021
Endometriosis and adenomyosis: shared pathophysiology
Endometriosis and adenomyosis are closely related disorders. Their pathophysiologies are extremely similar. Both tissues originate from eutopically located intracavitary endometrium. Oligoclones of endometrial glandular epithelial cells with somatic mutations and attached stromal cells may give rise to endometriosis if they travel to peritoneal surfaces or the ovary via retrograde menstruation and/or may be entrapped in myometrium to give rise to adenomyosis. Fertility and sterility 15 March 2023
Epidemiologic and genetic associations of endometriosis with depression, anxiety, and eating disorders
These findings highlight that endometriosis is associated with women’s mental health through pleiotropic mechanisms. To our knowledge, this is the first large-scale study to provide genetic and phenotypic evidence of the processes underlying the psychiatric comorbidities of endometriosis. JAMA 18 January 2023
Association between laparoscopically confirmed endometriosis and risk of early natural menopause
This cohort study found a risk for early natural menopause (ENM) in women with laparoscopically confirmed endometriosis. These women compared with those without endometriosis may be at a higher risk for shortened reproductive duration, particularly those who were nulliparous or never used oral contraceptives. JAMA 21 January 2022
Recurrence, reoperation, pregnancy rates, and risk factors for recurrence after ovarian endometrioma surgery: Long-term follow-up of 756 women
Considering that longer postoperative hormonal treatment is the sole modifiable factor for recurrent endometrioma, the authors recommend long-term hormonal treatment until subsequent pregnancy, especially in younger women. Yonsei medical journal 13 February 2023
Psychological interventions improve quality of life despite persistent pain in endometriosis: results of a 3-armed randomized controlled trial
Women with endometriosis may have significant and large effects of psychological intervention on QoL despite an ongoing experience of severe chronic pelvic pain (CPP). Quality of life research 17 February 2023
Surgical scar endometriosis: An emerging enigma
Cesarean section is an obvious risk factor for surgical scar endometriosis. Clinicians should have a high index of suspicion for surgical scar endometriosis in women presenting with cyclic pain at the scar site. Ultrasound is accurate in diagnosing scar endometriosis. Surgical management by wide local excision with a clear margin with or without mesh repair is the treatment of choice. Cureus 16 February 2023
Nutritional practices and dietetic provision in the endometriosis population, with a focus on functional gut symptoms
Key points
Journal of human nutrition and dietetics 16 February 2023
The role of social media in management of individuals with endometriosis: A cross-sectional study
In this cohort, a high number of people with endometriosis are using SM for health. These individuals are more likely to suffer both physical and psychosocial impacts from endometriosis. Hospitals and health organisations may consider support of the endometriosis community through SM. ANZ journal of obstetrics and gynecology 18 April 2022
Chronic endometritis increases the recurrence of endometrial polyps in premenopausal women after hysteroscopic polypectomy
Chronic endometritis (CE) was a harmful factor for the recurrence of endometrial polyps (Eps) in premenopausal women after hysteroscopic polypectomy. Thus, routine screening for CE during hysteroscopic polypectomy was needed. Frequent monitoring was needed for multiple EPs as the number of EPs also contributed to polyp recurrence. BMC Women's Health 25 February 2023
Impact of hormone replacement therapy on risk of Ovarian Cancer in postmenopausal women with De Novo Endometriosis or a history of Endometriosis
Endometriosis is a risk factor for ovarian cancer. Meta and pooled analyses have shown hormone replacement therapy (HRT) is significantly associated with an increased risk of ovarian cancer. A combination of estrogen and progesterone is currently recommended to improve menopausal symptoms in women with a history of endometriosis. However, the effect of HRT on the malignant transformation of postmenopausal endometriosis remains unclear. Therefore, this study investigated the impact of HRT on ovarian cancer occurrence in 20,608 postmenopausal women with de novo endometriosis or a history of endometriosis using the nationwide cohort study. With the exception of HRT using estrogen alone, HRT did not increase the risk of ovarian cancer in postmenopausal women with de novo endometriosis or a history of endometriosis. HRT, but not estrogen alone, can be used to improve the quality of life in symptomatic women with postmenopausal endometriosis. Cancers 10 March 2023
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Treatment
Clinical and sonographic impact of oral contraception in patients with deep endometriosis and adenomyosis at 2 years of follow-up
This prospective study suggests a clinical and sonographic improvement after a flexible extended combined oral contraceptives (COC) regimen in deep endometriosis (DE) and adenomyosis (AD) patients, which was significant at 12 months of follow-up. The improvement was more evident in AD and OEs compared with DE. Further research with a longer follow-up, larger sample size and comparison with other treatments is needed. Scientific reports 4 February 2023
Pelvic pain: What are the symptoms and predictors for surgery, endometriosis and endometriosis severity
Gynaecology unit and pain intensity were key predictors of undergoing laparoscopy; however, pain severity did not predict endometriosis diagnosis or staging. These findings indicate the need to review current frameworks guiding practice toward surgery for pelvic pain. ANZ journal of obstetrics and gynecology 24 May 2021
Cannabis for endometriosis-related pain and symptoms: It's high time that we see this as a legitimate treatment
Current pain management strategies have shortcomings and substantive addictive potential. Significant proportions of those with endometriosis cease pharmaceutical treatments due to ineffectiveness (15.6–26.1%) or side effects (10–43.5%). Opioid analgesics are not recommended for persistent or chronic pain due to both a lack of efficacy and safety concerns. However, despite this they continue to be commonly prescribed; women with endometriosis having a four times greater odds of chronic opioid use compared to women without, and opioids are often prescribed alongside benzodiazepines. Both opioids and benzodiazepines can negatively impact cognition and daily activities such as driving, with potential for addiction and severe withdrawal symptoms; in combination these drugs significantly increase the risk of overdose. Hence novel, effective analgesic options with a low risk of addictive potential are considered an urgent research priority in endometriosis. ANZ journal of obstetrics and gynecology 24 January 2023
Comparison of the efficacy of dienogest and GnRH-a after endometriosis surgery
In the comparison of postoperative efficacy of the two drugs on patients with endometriosis, dienogest is better than GnRH-a adjuvant drug in postoperative recurrence, and has a good improvement and application, which is worthy of further promotion in clinical practice. BMC women’s health 24 February 2023
Conservative vs radical bowel surgery for endometriosis: A systematic analysis of complications
Conservative shaving or discoid excision surgery is associated with reduced complications. Previous studies demonstrated a trend toward this finding, but suffered from relatively low participant numbers, increasing the risk of type one statistical error. Our results allow surgeons to make informed choices about potential complications when deciding how to approach bowel endometriosis. The results also allow patients to have more information about the risks. However, outcomes in the studies analysed are heterogenous and are from low-quality evidence. ANZ journal of obstetrics and gynecology 1 February 2021
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