Pre- and postsurgical medical therapy for endometriosis surgery

Chen, Innie; Veth, Veerle B; Choudhry, Abdul Jamil; Murji, Ally; Zakhari, Andrew; Agarpao, Carmina; Maas, Jacques W.M.

doi:10.1002/14651858.cd003678.pub3

Cited by 41 publications

(42 citation statements)

References 50 publications

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“…In this study, 324 patients received postoperative pharmacological therapy. In some centers, oral contraceptives or progesterone pills are first-line postoperative therapy to prevent endometriosis recurrence ( 37 , 38 ). We noticed that GnRHa was the most commonly used postoperative treatment in our center for both patients with and without dysmenorrhea.…”

Section: Discussionmentioning

confidence: 99%

Does Dysmenorrhea Affect Clinical Features and Long-Term Surgical Outcomes of Patients With Ovarian Endometriosis? A 12-Year Retrospective Observational Cohort Study

Dai

et al. 2022

Front. Med.

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BackgroundTo examine and compare the differences in clinical characteristics and long-term postoperative outcomes of ovarian endometriomas (OMA) patients with and without dysmenorrhea, including data from at least 8 years of postoperative follow-up examinations.MethodsRetrospective analysis of 334 OMA patients, including their demographic and clinical data. Long-term follow-up record was also collected. All laparoscopic cystectomy procedures were performed by the same surgeon at Peking Union Medical College Hospital between January 2009 and April 2013. Patients were divided into the dysmenorrhea and non-dysmenorrhea groups to perform the analysis of their preoperative characteristics, relevant surgical findings, and postoperative outcomes at the follow-up.ResultsOut of 334 OMA patients, 257 (76.9%) patients were allocated to the dysmenorrhea group, while the rest 77 (23.1%) patients were included in the non-dysmenorrhea group. Compared with the dysmenorrhea group, the non-dysmenorrhea group exhibited a reduced proportion of chronic pelvic pain (CPP) (P = 0.003), dyspareunia (P < 0.001), tenesmus (P < 0.001), concurrency of deep infiltrating endometriosis (DIE) (P < 0.001), and adenomyosis (P = 0.032). Preoperative infertility was significantly higher in the dysmenorrhea group (P = 0.001). The mean operating time in the dysmenorrhea vs. the non-dysmenorrhea group was 68.0 vs. 56.0 min (P < 0.001). According to the revised American Fertility Society (rAFS) scoring system, the mean scores of the two groups were 52.1 vs. 44.6 (P = 0.033). During follow-up, the dysmenorrhea group showed a higher rate of disease relapse (P < 0.001). A minimum postoperative follow-up period of 8 years was required to evaluate the pregnancy outcomes. Successful pregnancies were identified in 97/257 (37.7%) cases in the dysmenorrhea group and 36/77(46.8%) cases in the non-dysmenorrhea group (P = 0.157), respectively. Though the dysmenorrhea group had a higher rate of postoperative infertility, differences were not significant between the two groups.ConclusionsCompared with the dysmenorrhea group, OMA patients without dysmenorrhea exhibited lower proportions of CPP, dyspareunia, tenesmus, lower concurrency of DIE and adenomyosis, shorter mean operating time, lower mean rAFS scores, and lower infertility rates. During the long-term follow-up, a lower recurrence rate was observed in the non-dysmenorrhea group. Regarding fertility outcomes, non-dysmenorrhea patients had a higher likelihood of successful pregnancy after surgery. Postoperative management needs to be evaluated separately according to dysmenorrhea pathology.

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Section: Discussionmentioning

confidence: 99%

Does Dysmenorrhea Affect Clinical Features and Long-Term Surgical Outcomes of Patients With Ovarian Endometriosis? A 12-Year Retrospective Observational Cohort Study

Dai

et al. 2022

Front. Med.

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“…Despite the wide range of research on nonsurgical detection of endometriosis, neither a single nor combined tool has been dedicated as a highly sensitive and specific diagnostic marker [ 1 ]. According to the above, new methods are constantly sought, and each new report regarding the pathogenesis of endometriosis [ 43 , 56 , 57 , 58 ] provides the opportunity for effective identification of women with endometriosis or other significant pelvic pathology and safe causal treatment.…”

Section: Discussionmentioning

confidence: 99%

Fibronectin Molecular Status in Plasma of Women with Endometriosis and Fertility Disorders

Lis-Kuberka

Kubik

Chrobak

et al. 2021

IJMS

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The diagnosis of endometriosis and fertility disorders is difficult; therefore, it is necessary to look for reliable biomarkers. Analysis of the molecular status of fibronectin as a key player in repair and wound healing processes, as well as in coagulation and fibrinolysis pathways, is justified. ELISA and SDS-agarose immunoblotting were applied to determine the fibronectin concentration and presence and occurrence of soluble FN-fibrin complexes in the blood plasma of women with endometriosis (n = 38), fertility disorders (n = 28) and the healthy group (n = 25). The concentration of fibronectin in the blood plasma of women with endometriosis (292.61 ± 96.17 mg/L) and fertility disorders (287.53 ± 122.68 mg/L) was significantly higher than in the normal group (226.55 ± 91.98 mg/L). The presence of FN-fibrin complexes of 750, 1000, 1300, 1600 and 1900 kDa in the plasma of women with endometriosis and fertility disorders was shown. The presence of FN-fibrin complexes with a molecular mass of more than 1300 kDa in women with endometriosis and infertility and the complete absence of these complexes in healthy women may indicate an increased and chronic activation of coagulation mechanisms in these patients. The presence of complexes of high molecular mass may be one of the biomarkers of fertility disorders in women.

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“…Recurrence rate after surgery or medication discontinuation was recorded up to 45% after 5 years [82] and recently one discusses the translation from adjuvant therapy to tertiary endometriosis prevention in postoperative medical care [83]. The moment of medical therapy associated to surgery-before, after, or both before and after surgery is much analyzed, to maximize treatment response, but literature data is still inconclusive [84]. The HT goal is to induce atrophy of endometriotic lesions, even if one missis the ability to predict which medication each individual patient will respond to, being many attempts to find one or more predictive markers [85] to score HT, as it is the immunohistochemical Histo (H) -score on the PRs status, and CYP19A1 expression for the response to progestins, respectively for the need to block estrogen signaling [60].…”

Section: Potential Therapeutic Options To Maintain/restore Endometrial Normal Estrogen-progesterone Signaling 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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Pre- and postsurgical medical therapy for endometriosis surgery

Cited by 41 publications

References 50 publications

Does Dysmenorrhea Affect Clinical Features and Long-Term Surgical Outcomes of Patients With Ovarian Endometriosis? A 12-Year Retrospective Observational Cohort Study

Does Dysmenorrhea Affect Clinical Features and Long-Term Surgical Outcomes of Patients With Ovarian Endometriosis? A 12-Year Retrospective Observational Cohort Study

Fibronectin Molecular Status in Plasma of Women with Endometriosis and Fertility Disorders

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

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