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Medicine Nov 2023Endometriosis is a common disease of reproductive-age women and an important cause of dysmenorrhea and infertility. Information on endometriosis is complex and there is... (Review)
Review
Endometriosis is a common disease of reproductive-age women and an important cause of dysmenorrhea and infertility. Information on endometriosis is complex and there is a lack of summarization of available results. The study aims to evaluate the overall distribution of publications related to endometriosis to provide a foundation for further research. The Web of Science Core Collection was searched for articles published in the field of endometriosis. Our survey revealed the structure, hotspots, and development trends of endometriosis-related research and publications.
Topics: Humans; Female; Endometriosis; Bibliometrics; Dysmenorrhea; Infertility; Reproduction
PubMed: 38013311
DOI: 10.1097/MD.0000000000035723 -
Human Reproduction (Oxford, England) Aug 2023What are the similarities and differences in the systemic proteomic profiles by endometriosis-associated pain subtypes among adolescents and young adults with...
STUDY QUESTION
What are the similarities and differences in the systemic proteomic profiles by endometriosis-associated pain subtypes among adolescents and young adults with endometriosis?
SUMMARY ANSWER
Endometriosis-associated pain subtypes exhibited distinct plasma proteomic profiles.
WHAT IS KNOWN ALREADY
Endometriosis patients, especially those diagnosed in adolescents and young adults, are often plagued by various pain symptoms. However, it is not clear what biological processes underlie this heterogeneity.
STUDY DESIGN, SIZE, DURATION
We conducted a cross-sectional analysis using data and plasma samples from 142 adolescent or young adult participants of the Women's Health Study: From Adolescence to Adulthood cohort with laparoscopically confirmed endometriosis.
PARTICIPANTS/MATERIALS, SETTING, METHODS
We measured 1305 plasma protein levels by SomaScan. We classified self-reported endometriosis-associated pain into subtypes of dysmenorrhea, acyclic pelvic pain, life impacting pelvic pain, bladder pain, bowel pain, and widespread pain phenotype. We used logistic regression to calculate the odds ratios and 95% confidence intervals for differentially expressed proteins, adjusting for age, BMI, fasting status, and hormone use at blood draw. Ingenuity Pathway Analysis identified enriched biological pathways.
MAIN RESULTS AND THE ROLE OF CHANCE
Our study population consisted mainly of adolescents and young adults (mean age at blood draw = 18 years), with nearly all (97%) scored as rASRM stage I/II at laparoscopic diagnosis of endometriosis, which is a common clinical presentation of endometriosis diagnosed at a younger age. Pain subtypes exhibited distinct plasma proteomic profiles. Multiple cell movement pathways were downregulated in cases with severe dysmenorrhea and life impacting pelvic pain compared to those without (P < 7.5×10-15). Endometriosis cases with acyclic pelvic pain had upregulation of immune cell adhesion pathways (P < 9.0×10-9), while those with bladder pain had upregulation of immune cell migration (P < 3.7×10-8) and those with bowel pain had downregulation (P < 6.5×10-7) of the immune cell migration pathways compared to those without. Having a wide-spread pain phenotype involved downregulation of multiple immune pathways (P < 8.0×10-10).
LIMITATIONS, REASONS FOR CAUTION
Our study was limited by the lack of an independent validation cohort. We were also only able to explore any presence of a pain subtype and could not evaluate multiple combinations by pain subtypes. Further mechanistic studies are warranted to elucidate the differences in pathophysiology by endometriosis-pain subtype.
WIDER IMPLICATIONS OF THE FINDINGS
The observed variation in plasma protein profiles by pain subtypes suggests different underlying molecular mechanisms, highlighting the need for potential consideration of pain subtypes for effectively treating endometriosis patients presenting with various pain symptoms.
STUDY FUNDING/COMPETING INTEREST(S)
This study was supported by the Department of Defense W81XWH1910318 and the 2017 Boston Center for Endometriosis Trainee Award. Financial support for establishment of and data collection within the A2A cohort were provided by the J. Willard and Alice S. Marriott Foundation. N.S., A.F.V., S.A.M., and K.L.T. have received funding from the Marriott Family Foundation. C.B.S. is funded by an R35 MIRA Award from NIGMS (5R35GM142676). S.A.M. and K.L.T. are supported by NICHD R01HD094842. S.A.M. reports serving as an advisory board member for AbbVie and Roche, Field Chief Editor for Frontiers in Reproductive Health, personal fees from Abbott for roundtable participation; none of these are related to this study. Other authors report no conflict of interest.
TRIAL REGISTRATION NUMBER
N/A.
Topics: Female; Humans; Endometriosis; Dysmenorrhea; Cross-Sectional Studies; Proteomics; Pelvic Pain; Abdominal Pain
PubMed: 37196326
DOI: 10.1093/humrep/dead099 -
International Journal of Environmental... Dec 2023Dysmenorrhea is highly prevalent, ranging from 16% to 91% among women, and it can lead to multiple reproductive disorders. However, risk factors associated with...
Dysmenorrhea is highly prevalent, ranging from 16% to 91% among women, and it can lead to multiple reproductive disorders. However, risk factors associated with dysmenorrhea remain unexamined. Cold exposures can significantly disturb blood circulation and prostaglandin production in the uterus, leading to dysmenorrhea. This study investigated the relationship between cold exposures and dysmenorrhea, as well as potential disparities between Asians and Whites and the potential cultural influences on these associations. This was a cross-sectional survey among 197 Asian and 222 non-Asian women recruited from the U.S., with more than 40% from California. We assessed cold exposures, such as the frequency of consumption of cold water/drinks and ice cream, as well as room temperatures at home and public places, for both summer and winter over the past 12 months. The type of cold exposure associated with dysmenorrhea differs between Asian and White women. We found that among Asian women, a higher frequency of ice cream consumption in winter (beta = 1.19, = 0.0002 when comparing high to low categories) was associated with dysmenorrhea; however, among White women, increased consumption of cold water/drinks in winter (beta = 0.49, = 0.04 when comparing high to low categories) was also associated with dysmenorrhea. Higher home room temperatures in winter were associated with reduced severity of dysmenorrhea among White women but not among Asian women. All these associations supported our hypothesis and were stronger among women who lived in states with colder winters. However, there are a few exceptions. For instance, women who drank cold water/drinks less frequently during their menstrual period were more likely to experience more severe dysmenorrhea. In conclusion, this study provides crucial evidence to support the link between cold exposures and dysmenorrhea among Asians and Whites. The associations contradictory to our hypothesis are likely due to reserved causation influenced by Asian cultural practice. This paper sheds light on an understudied area that profoundly affects women's quality of life.
Topics: Humans; Female; Dysmenorrhea; Cross-Sectional Studies; Quality of Life; White; Cold Temperature; Water
PubMed: 38248521
DOI: 10.3390/ijerph21010056 -
Przeglad Menopauzalny = Menopause Review Sep 2023The aim was to assess the relation between primary dysmenorrhea in adolescents and body mass index (BMI).
INTRODUCTION
The aim was to assess the relation between primary dysmenorrhea in adolescents and body mass index (BMI).
MATERIAL AND METHODS
Two-hundred and ten adolescents were recruited for this cross-sectional research. After detailed evaluation, pelvic sonography was performed for the studied adolescents to rule out any pelvic abnormalities and/or lesion(s). The severity of the studied adolescents' dysmenorrhea was assessed by the visual analogue scale (VAS). The studied adolescents were divided into underweight, normal-weight, overweight, and obese adolescent groups based on their BMI (kg/m). Collected data were analyzed using the ANOVA test, and correlation analysis (Pearson's correlation) to assess the relation between primary dysmenorrhea in adolescents and BMI.
RESULTS
The visual analogue scale of dysmenorrhea was statistically higher in the underweight adolescent group (8.7 ±0.8) compared to normal-weight (6.5 ±0.5) ( = 0.000001), and overweight (6.3 ±0.6) ( = 0.000001) adolescent groups. The visual analogue scale of dysmenorrhea was also statistically higher in the obese adolescent group (9.4 ±0.6) compared to underweight (8.7 ±0.8) ( = 0.000001), normal-weight (6.5 ±0.5) ( = 0.000001), and overweight (6.3 ±0.6) ( = 0.000001) adolescent groups.
CONCLUSIONS
The visual analogue scale of dysmenorrhea was statistically higher in the underweight adolescent group compared to normal-weight, and overweight adolescent groups, and there was a strong negative relation between the VAS and BMI in the underweight adolescent group. In addition, the VAS of dysmenorrhea was statistically higher when the obese adolescent group was compared with the overweight, normal-weight and underweight adolescent groups, and there was a moderate positive relation between the VAS and BMI in the obese adolescent group.
PubMed: 37829266
DOI: 10.5114/pm.2023.131314 -
International Journal of Environmental... Aug 2023Endometriosis, i.e., endometrial-like tissue outside the uterus, is a chronic inflammatory condition affecting physical functioning. However, the specific levels of...
BACKGROUND
Endometriosis, i.e., endometrial-like tissue outside the uterus, is a chronic inflammatory condition affecting physical functioning. However, the specific levels of physical activity (PA) in the context of endometriosis and different disease symptoms remain unclear.
METHODS
This multi-center, cross-sectional study compared PA levels and influencing factors in endometriosis patients and non-endometriosis patients. Data were collected through questionnaires. Endometriosis was surgically confirmed. A statistical analysis was performed with appropriate tests.
RESULTS
The study included 460 women with endometriosis and 460 age-matched women without this condition. The two groups did not differ significantly in terms of age, education level, or stable partnership. Women with endometriosis exhibited lower PA levels, practicing fewer hours of sports weekly and climbing fewer stairs daily compared to the control group. These differences remained significant after controlling for confounding factors. Factors such as endometriosis, current dysmenorrhea, and depression were associated with decreased PA.
CONCLUSIONS
These findings suggest that women with endometriosis engage in less PA compared to those without this condition. These results highlight the need for interventions to promote increased PA in endometriosis patients and harness the associated health benefits. Further research is warranted to explore the underlying mechanisms and develop tailored exercise therapies for this population.
Topics: Humans; Female; Cross-Sectional Studies; Exercise; Exercise Therapy; Sports; Control Groups; Endometriosis
PubMed: 37681799
DOI: 10.3390/ijerph20176659 -
Obstetrics and Gynecology Sep 2023The diagnosis of endometriosis, a common gynecologic condition, is characterized by delays of up to 11 years. During this time, women may experience persistent symptoms...
OBJECTIVE
The diagnosis of endometriosis, a common gynecologic condition, is characterized by delays of up to 11 years. During this time, women may experience persistent symptoms that affect their quality of life, productivity, and relationships, and the disease may progress. It is therefore a priority to understand the factors that contribute to this delay to help improve the diagnostic pathway. Our objective was to describe the diagnosis barriers of endometriosis from the patient and health care professional perspectives using a qualitative evidence synthesis.
DATA SOURCES
We searched MEDLINE, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature using combinations of the synonyms of endometriosis, diagnosis, and qualitative research. The search was restricted to English-language articles from database creation until May 2022.
METHODS OF STUDY SELECTION
The initial search yielded 899 articles. Studies were included if they explored the experiences or views of affected women or health care professionals on the diagnosis of endometriosis and used qualitative methods for data collection and data analysis. Risk of bias was assessed with the Critical Appraisal Skills Programme checklist.
TABULATION, INTEGRATION, AND RESULTS
Thirty-seven articles were considered for full review, with 13 eligible articles identified for inclusion. Thematic synthesis was used to identify four key themes: 1) individual factors (n=6), 2) interpersonal influences (n=6), 3) health system factors (n=13), and 4) factors specific to endometriosis (n=13). These encompassed 12 subthemes that represented barriers to the diagnosis of endometriosis: 1) difficulty establishing pathologic symptoms from normal menstruation and the use of self-care techniques; 2) menstrual stigma and the normalization of menstrual pain; 3) attitudes and lack of training for health care professionals, delayed referrals to specialist services, and poor explanation of oral contraceptive pill use in the diagnostic process; and 4) variability in presenting symptoms, overlap with other conditions, lack of a noninvasive method of diagnosis, and concerns about the value of a diagnosis.
CONCLUSION
This review identified barriers to the timely diagnosis of endometriosis from the perspective of affected individuals and health care professionals. It highlights areas for improvement along the diagnostic pathway, which may guide future strategies to reduce delays.
Topics: Humans; Female; Endometriosis; Quality of Life; Menstruation; Dysmenorrhea; Health Personnel
PubMed: 37441792
DOI: 10.1097/AOG.0000000000005255 -
Reproductive Biology and Endocrinology... Oct 2023To determine whether there is a correlation between stiffness measured by strain elastography and the severity of dysmenorrhea and to determine the value of elastography... (Observational Study)
Observational Study
BACKGROUND
To determine whether there is a correlation between stiffness measured by strain elastography and the severity of dysmenorrhea and to determine the value of elastography in evaluating severe dysmenorrhea in patients with adenomyosis.
METHODS
The correlation between tissue stiffness and dysmenorrhea was analyzed by performing elastography on premenopausal women diagnosed with adenomyosis. Expression levels of transforming growth factor-β (TGF-β), α-smooth muscle actin (α-SMA), and protein gene product 9.5 (PGP9.5) were detected by immunohistochemistry; the correlation of TGF-β and α-SMA levels with the tissue stiffness and the degree of fibrosis was further analyzed. Also, the relationship of the PGP9.5 expression level with the tissue stiffness and degree of dysmenorrhea was determined.
RESULTS
The degree of dysmenorrhea was significantly positively correlated with lesion stiffness in patients with adenomyosis but not with the uterine or lesion volume. The cutoff for the strain ratio was > 1.36 between the adenomyosis and control groups, with an area under the curve (AUC) of 0.987. For severe dysmenorrhea, the cutoff for the strain ratio was > 1.65 in patients with adenomyosis, with an AUC of 0.849. TGF-β, α-SMA, and PGP9.5 expression levels were higher in adenomyotic lesions than in the endometrium of the adenomyosis and control groups. Both TGF-β and α-SMA levels were positively correlated with the tissue stiffness and degree of fibrosis. Additionally, the expression level of PGP9.5 showed a positive correlation with the tissue stiffness and degree of dysmenorrhea.
CONCLUSIONS
Elastography can be used to evaluate the degree of dysmenorrhea; the greater the tissue stiffness, the greater the degree of dysmenorrhea. In addition, elastography performed well in the diagnosis of adenomyosis and the evaluation of severe dysmenorrhea in patients with adenomyosis.
Topics: Humans; Female; Adenomyosis; Dysmenorrhea; Elasticity Imaging Techniques; Transforming Growth Factor beta; Fibrosis
PubMed: 37884924
DOI: 10.1186/s12958-023-01145-y -
Frontiers in Pain Research (Lausanne,... 2023
PubMed: 37711988
DOI: 10.3389/fpain.2023.1254682 -
International Journal of Molecular... Sep 2023Endometriosis is a chronic and inflammatory disease associated with pelvic pain. Dietary changes may be therapeutic for chronic inflammatory processes, reducing visceral...
BACKGROUND
Endometriosis is a chronic and inflammatory disease associated with pelvic pain. Dietary changes may be therapeutic for chronic inflammatory processes, reducing visceral input. The aim was to evaluate the role of dietary changes according to the Mediterranean Diet (MD) on pain perception in endometriosis and their relationship with oxidative stress.
METHODS
in this prospective study, we included 35 endometriosis women. At baseline (T0) and after 3 (T1) and 6 (T2) months from the start of the diet, we investigated pain intensity with VAS (Visual Analogue Scale, from 0 to 10), vitamin profile, and oxidative stress.
RESULTS
we found a significant increase in the diet score ( < 0.001). At T1, patients reduced pain in terms of dyspareunia ( = 0.04), non-menstrual pelvic pain ( = 0.06), dysuria ( = 0.04), and dyschezia ( < 0.001). Dyspareunia ( = 0.002) and dyschezia ( < 0.001) were further significantly reduced also at T2. We observed a significant positive correlation between lipid peroxidation and VAS non-menstrual pelvic pain and dysuria and a significant negative correlation between Oxygen radical absorbance capacity and VAS non-menstrual pain and dyschezia.
CONCLUSIONS
our findings show a clear tendency toward a relationship between pain relief in endometriosis and MD. This appears promising to treat endometriosis-related symptoms and could be considered a new effective strategy for chronic pain management in the long term.
Topics: Humans; Female; Endometriosis; Prospective Studies; Diet, Mediterranean; Dyspareunia; Dysuria; Pelvic Pain; Pain Perception; Constipation; Dysmenorrhea
PubMed: 37834048
DOI: 10.3390/ijms241914601 -
Journal of Minimally Invasive Gynecology Aug 2023The evaluation of endometriosis in an adolescent girl is a challenging topic. The initial stage of the disease and the limited diagnostic instrument appropriate for the...
The evaluation of endometriosis in an adolescent girl is a challenging topic. The initial stage of the disease and the limited diagnostic instrument appropriate for the youth age and for its typical features can reduce the ability of the gynecologist. At the same time, missing a prompt diagnosis can delay the beginning of specific and punctual management of endometriosis, which could avoid a postponed diagnosis from 6 to 12 years, typical of adolescent girls complaining of dysmenorrhea. This article aimed to answer all the potential questions around the diagnosis and management of endometriosis in adolescents starting from a clinical case looking at the possible solution that is easily reproducible in the clinical practice.
Topics: Female; Adolescent; Humans; Endometriosis; Dysmenorrhea
PubMed: 37001691
DOI: 10.1016/j.jmig.2023.03.017