A stepped-care approach to symptomatic endometriosis management: a participatory research initiative

Vercellini, Paolo; Donati, Agnese; Ottolini, Federica; Frassineti, Annalisa; Fiorini, Jessica; Nebuloni, Vanessa; Frattaruolo, Maria Pina; Roberto, Anna; Mosconi, Paola; Somigliana, Edgardo

doi:10.1016/j.fertnstert.2018.01.037

Cited by 26 publications

(19 citation statements)

References 86 publications

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“…A prospective study followed a cohort of 157 patients with endometriosis through a self-elected, stepwise management pathway where surgery represented the final step [36]. Although they did not specifically aim to identify reasons for self-electing surgical management, pain and lack of efficacy of medical management as well as intolerance of adverse effects were noted to be reasons for those who escalated to surgery.…”

Section: Patient Preferencementioning

confidence: 99%

“…Although they did not specifically aim to identify reasons for self-electing surgical management, pain and lack of efficacy of medical management as well as intolerance of adverse effects were noted to be reasons for those who escalated to surgery. However, it was noted in their discussion that of the 38 patients who stated they were dissatisfied with medical management, only 2 elected to proceed to surgery, with the majority preferring to tolerate the reduced but persistent pain and symptoms or adverse effects [36]. Another study examined a group of women who were initially referred for surgical intervention for endometriosis involving colorectal disease (generally planned as a laparotomy and bowel resection), of whom half elected for medical management after counseling in the shared decisionmaking model [37].…”

Section: Patient Preferencementioning

confidence: 99%

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When to Do Surgery and When Not to Do Surgery for Endometriosis: A Systematic Review and Meta-analysis

Leonardi¹,

Gibbons²,

Armour³

et al. 2020

Journal of Minimally Invasive Gynecology

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We performed a systematic review and meta-analysis with the aim to answer whether operative laparoscopy is an effective treatment in a woman with demonstrated endometriosis compared with alternative treatments. Moreover, we aimed to assess the risks of operative laparoscopy compared with those of alternatives. In addition, we aimed to systematically review the literature on the impact of patient preference on decision making around surgery. Data Sources: We searched MEDLINE, Embase, PsycINFO, ClinicalTrials.gov, CINAHL, Scopus, OpenGrey, and Web of Science from inception through May 2019. In addition, a manual search of reference lists of relevant studies was conducted. Methods of Study Selection: Published and unpublished randomized controlled trials (RCTs) in any language describing a comparison between surgery and any other intervention were included, with particular reference to timing and its impact on pain and fertility. Studies reporting on keywords including, but not limited to, endometriosis, laparoscopy, pelvic pain, and infertility were included. In the anticipated absence of RCTs on patient preference, all original research on this topic was considered eligible. Tabulation, Integration, and Results: In total, 1990 studies were reviewed. Twelve studies were identified as being eligible for inclusion to assess outcomes of pain (n = 6), fertility (n = 7), quality of life (n = 1), and disease progression (n = 3). Seven studies of interest were identified to evaluate patient preferences. There is evidence that operative laparoscopy may improve overall pain levels at 6 months compared with diagnostic laparoscopy (risk ratio [RR], 2.65; 95% confidence interval [CI], 1.61−4.34; p <.001; 2 RCTs, 102 participants; low-quality evidence). Because the quality of the evidence was very low, it is uncertain if operative laparoscopy improves live birth rates. Operative laparoscopy probably yields little or no difference regarding clinical pregnancy rates compared with diagnostic laparoscopy (RR, 1.29; 95% CI, 0.99−1.92; p = .06; 4 RCTs, 624 participants; moderate-quality evidence). It is uncertain if operative laparoscopy yields a difference in adverse outcomes when compared with diagnostic laparoscopy (RR, 1.98; 95% CI, 0.84−4.65; p = .12; 5 RCTs, 554 participants; very-low-quality evidence). No studies reported on the progression of endometriosis to a symptomatic state or progression of extent of disease in terms of volume of lesions and locations in asymptomatic women with endometriosis. We Ben W. Mol reports consultancy for OvsEva, Guerbet, and Merck; grant support from Merck; travel support from Guerbet; and holds a Practitioner Fellowship from National Health and Medical Research Council. Tal Z. Jacobson reports a minor shareholding in, and clinical service fees from, Virtus Health. Neil P. Johnson reports consultancy for Myovant Sciences, Vifor Pharma, and Guerbet and research funding from AbbVie and Myovant Sciences. All remaining authors declare they have no conflict of interest.

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Section: Patient Preferencementioning

confidence: 99%

Section: Patient Preferencementioning

confidence: 99%

When to Do Surgery and When Not to Do Surgery for Endometriosis: A Systematic Review and Meta-analysis

Leonardi¹,

Gibbons²,

Armour³

et al. 2020

Journal of Minimally Invasive Gynecology

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“…During the long time of progestins usage it was reported a good rate of patient adherence and satisfaction [104,105]. There are few direct comparisons between different types of progestins in endometriosis clinical studies, with the scarce evidence suggesting that when given by the same route and the same regimen, the effectiveness may be similar [7].…”

Section: "Old" Hormone Therapies Still Active In Endometriosismentioning

confidence: 99%

Potential Therapeutic Options and Perspectives for Alleviation of Endometrial Estrogen Dominance and Progesterone Resistance in Endometriosis

Russu¹

2022

Endometriosis - Recent Advances, New Perspectives and Treatments

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Endometriosis is a chronic disease, influenced by internal and external environment, with long duration from intrauterine life with acme during childbearing, when it is associated to chronic pelvic pains, and infertility/subfertility. DNA hypermethylation of endometrial promoter PRs Hox genes and DNA hypomethylation of promoter ERβ gene is a possible explanation of estrogen dominance, progressive loss of progesterone signaling, followed by progesterone resistance in ectopic, and progesterone attenuance in eutopic endometrium, for failure of hormone therapy (HT), repeated recurrences after surgery, cancers after long time evolution. Animal models, human trials demonstrated progesterone (P4) and progestins influences over progression of disease pathological characteristics, associated to endometrial ER, PR aberrant expressions: ERα loss, and abnormal PRB/PRA ratio. P4 supplementation before mice induced-endometriosis protected from PRs depletion, action that can be translated in women according to the difference of 7 to 12 years between histologic onset and clinical symptoms/signs, parallel to progressive loss of PRs and PR-mediated signaling in ectopic and eutopic endometria. The animal studies have shown that a DNA methylation inhibitor alleviates lesion growth, and induces PRs target gene expression restoration. Continuous/extended contraceptives, dienogest- a new progestin, GnRH agonists/antagonists, aromatase inhibitors, SERM, SPRM, combinated molecules are therapeutic options/perspectives aiming restoration endometrial estrogen-progesterone balance, without disease’s cure. HT may be active alone, or surgery associated.

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“…The officially recommended gold standard in many guidelines for diagnosing endometriosis is laparoscopy with tissue biopsy 7 , 8 . Despite this, most gynecological societies advocate empiric medical treatment before tissue diagnosis 9 , 10 .…”

Section: Preoperative Imaging Assessment In Endometriosis and Related Pelvic Conditionsmentioning

confidence: 99%

Recent advances in benign gynecological laparoscopic surgery

Levy¹,

Tsaltas²

2021

Fac Rev

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Minimally invasive surgery continues to transform the field of gynecological surgery and is now the standard of care for the surgical treatment of many diseases in gynecology. Owing to minimally invasive surgery’s clear advantages, new advances in technology are being employed rapidly and enabling even the most complicated procedures to be performed less invasively. We examine recent literature on minimally invasive surgical innovations, advances, and common practices in benign gynecology that, from our point of view, made an impact on the way laparoscopic surgery is performed and managed in the last decade.

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A stepped-care approach to symptomatic endometriosis management: a participatory research initiative

Abstract: Most women with endometriosis-associated pelvic pain who chose a stepped-care approach were satisfied with OC and a low-cost progestin for the treatment of their symptoms. The need to step up to an expensive progestin or surgery was marginal.

Cited by 26 publications

References 86 publications

When to Do Surgery and When Not to Do Surgery for Endometriosis: A Systematic Review and Meta-analysis

When to Do Surgery and When Not to Do Surgery for Endometriosis: A Systematic Review and Meta-analysis

Potential Therapeutic Options and Perspectives for Alleviation of Endometrial Estrogen Dominance and Progesterone Resistance in Endometriosis

Recent advances in benign gynecological laparoscopic surgery

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