Objectives:Endometriosis is an inflammatory disease characterized by a frequent association with gynecologic and systemic comorbidities. Our aim was to evaluate which gynecologic and systemic comorbidities occur in women affected by endometriosis and their impact on quality of life and global health. Mechanism: A literature search of the PubMed, Cochrane Library, Scopus and Web of Science databases was performed to identify the relevant studies published before December 31, 2021. We selected clinical studies, systematic reviews, and meta-analyses in English. Findings in Brief: Endometriosis is strongly associated with gynecologic (adenomyosis, uterine fibroids, polycystic ovarian syndrome-PCOS) and systemic (autoimmune, inflammatory, psychiatric and neurological disorders) comorbidities that impair women quality of life and global health through multiple mechanisms, influencing everyday life and work activities. Conclusions: Endometriosis is a chronic disease, impairing multiple functioning areas and affecting women's health and everyday life. Considering the co-existence of multiple both gynecological and non-gynecological disorders, endometrisois needs a multidisciplinary approach. Thus, specialized referral centres are warranted for a personalized management, focused on patient symptoms and comorbidities.

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BACKGROUNDː The purpose of the present study was to compare the effectiveness of intrathecal injection of morphine, inserted in the protocols of multimodal analgesia, versus intravenous morphine in the control of postoperative pain and course in women undergoing gynecological surgery. METHODSː An observational, single-center, retrospective and case-controlled study was performed. Data were collected in a group of women (N.=80) who underwent to gynecological surgery. Women were divided into two groups: group a (40 patients) laparoscopic hysterectomy and group b (N.=40) performing laparotomic myomectomy. in both groups 20 patients underwent administration of intrathecal morphine (125 mcg in 5 ml) and 20 patients underwent to intravenous morphine (1 mg maximum every 10 minutes). The primary endpoint collected was the mean VAS Score during the first 3 days after surgery, while secondary endpoints were opioid consumed during the same period, nausea, vomitus and pruritus. Among the exploratory objectives, length of hospital stay, canalization and feeding time were collected. RESULTSː In group A, patients performing intrathecal morphine presented a significantly lowest VAS on postoperative day 1 and 3 compared to patients performing intravenous morphine while in group b mean Vas was statistically significant lower only on the first day. The emergence of pruritus was significantly higher in patients performing intrathecal morphine. The day of complete canalization was different in Group A patients in favor of intrathecal morphine as well as the length of stay. CONCLUSIONSː Our present study showed that intrathecal morphine allows to achieve important management goals with minimal side effects and complications, in particular in case of laparoscopic hysterectomy.

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