scholarly journals Pharmacological Treatment for Symptomatic Adenomyosis: A Systematic Review

2019 ◽  
Vol 41 (09) ◽  
pp. 564-574 ◽  
Author(s):  
Cristina Laguna Benetti-Pinto ◽  
Ticiana Aparecida Alves de Mira ◽  
Daniela Angerame Yela ◽  
Cassia Raquel Teatin-Juliato ◽  
Luiz Gustavo Oliveira Brito
Keyword(s):  
Pelvic Pain ◽  
Pharmacological Treatment ◽  
Chronic Pelvic Pain ◽  
Grey Literature ◽  
Abnormal Uterine Bleeding ◽  
Gnrh Analog ◽  
Data Synthesis ◽  
Language Restriction ◽  
Selection Of ◽  
Uterine Volume

Objective To assess the efficacy of non-surgical treatment for adenomyosis. Data Sources A search was performed by two authors in the Pubmed, Scopus, and Scielo databases and in the grey literature from inception to March 2018, with no language restriction. Selection of Studies We have included prospective randomized studies for treating symptomatic women with adenomyosis (abnormal uterine bleeding and/or pelvic pain) diagnosed by ultrasound or magnetic resonance imaging. Data Collection Studies were primarily selected by title and abstract. The articles that were eligible for inclusion were evaluated in their entirety, and their data was extracted for further processing and analysis. Data Synthesis From 567 retrieved records only 5 remained for analysis. The intervention groups were: levonorgestrel intrauterine system (LNG-IUS)(n = 2), dienogest (n = 2), and letrozole (n = 1). Levonorgestrel intrauterine system was effective to control bleeding when compared to hysterectomy or combined oral contraceptives (COCs). One study assessed chronic pelvic pain and reported that LNG-IUS was superior to COC to reduce symptoms. Regarding dienogest, it was efficient to reduce pelvic pain when compared to placebo or goserelin, but less effective to control bleeding than gonadotropin-releasing hormone (GnRH) analog. Letrozole was as efficient as GnRH analog to relieve dysmenorrhea and dyspareunia, but not for chronic pelvic pain. Reduction of uterine volume was seen with aromatase inhibitors, GnRH analog, and LGN-IUD. Conclusion Levonorgestrel intrauterine system and dienogest have significantly improved the control of bleeding and pelvic pain, respectively, in women with adenomyosis. However, there is insufficient data from the retrieved studies to endorse each medication for this disease. Further randomized control tests (RCTs) are needed to address pharmacological treatment of adenomyosis.

Pharmacological Treatment of Chronic Pelvic Pain

2020 ◽  
pp. 945-949
Author(s):  
Ashish Shetty ◽  
Oscar Morice ◽  
Sohier Elneil
Keyword(s):  
Pelvic Pain ◽  
Pharmacological Treatment ◽  
Chronic Pelvic Pain

scholarly journals Treatment of C-section diverticula with hysteroscopic resection in women without childbearing intention: a retrospective cohort study

2019 ◽  
Author(s):  
Hui Shi ◽  
Jingyan He ◽  
Yunhe Gao ◽  
Shuang Qin ◽  
Jiaying Fan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cesarean Section ◽  
Pelvic Pain ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Chronic Pelvic Pain ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Timing Of Surgery ◽  
Hysteroscopic Resection

Abstract Background: Diverticulum, one of the long-term squelae of cesarean section, can cause abnormal uterine bleeding, dysmenorrhea and chronic pelvic pain. Hysteroscopic resection of diverticula is thought to reduce abnormal uterine bleeding and chronic pelvic pain. In this study, we aim to describe the improvement after hysteroscopic resection of cesarean section diverticula hysteroscopic resection of cesarean section diverticula (CSD) in women without childbearing intention, and to explore the variables associated with poor prognosis.Methods: A retrospective cohort study of women aged 25-48 with CSD diagnosis by transvaginal ultrasonography (TVS) and hysteroscopy that were enrolled at Guangzhou Women and Children’s Medical Center between June 2017 and December 2018. A total of 124 women met the inclusion criteria and all patients had undergone hysteroscopic resection and accepted a follow-up interview at the 3rd and 6th months postoperatively to record symptom improvement.Result: The mean of intraoperative blood loss and operative time of hysteroscopic resection were (12.94±12.63) ml and (33.63±6.87) min in 124 patients. Overall observed improvement rates of CSD symptom were 47.2% and 65.6% in the first 3 and 6 months, respectively. Multivariable logistic regression models revealed that timing of surgery <14 days was a good prognostic factor associated with both 3-month improvement (OR, 16.59; 95% CI, 2.62-104.90; P=0.003) and 6-month improvement (OR, 15.51; 95%CI, 1.63-148.00; P=0.02); Patients with numbers of cesarean section(CS) ≥2 had a lower rate of improvement after 6 months of CSD repair surgery compared with patients who underwent one CS(OR, 8.29; 95%CI, 1.05-65.75; P=0.04).Conclusions: A hysteroscopic repair might be an appropriate method for CSD in women who no childbearing intentions. The timing of surgery and the number of CS seems to be factors influencing the postoperative improvement of CSD.

Success of uterus-preserving treatments for abnormal uterine bleeding, chronic pelvic pain, and symptomatic fibroids: age and bridges to menopause

2011 ◽  
Vol 204 (3) ◽  
pp. 272.e1-272.e7 ◽  
Author(s):  
Lee A. Learman ◽  
Sanae Nakagawa ◽  
Steven E. Gregorich ◽  
Rebecca A. Jackson ◽  
Alison Jacoby ◽  
...  
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding

P–299 Efficacy and safety of linzagolix for the treatment of severe adenomyosis: Initial results from a pilot study

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
O Donnez ◽  
J Donnez
Keyword(s):  
Pilot Study ◽  
Pelvic Pain ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Open Label ◽  
Junctional Zone ◽  
Once Daily ◽  
Partial Suppression ◽  
Uterine Volume

Abstract Study question Is a once daily regimen of the GnRH antagonist, linzagolix, high-dose (200mg) for 12 weeks then low-dose (100mg) for 12 weeks, effective in severe adenomyosis? Summary answer After 12 weeks, there was marked shrinkage of uterine volume, regression of adenomyotic lesions and symptom improvement (pain, anemia), 24 weeks data is pending. What is known already Suppression of estradiol using GnRH antagonists has been shown to be an effective treatment for endometriosis and uterine fibroids. Linzagolix is an investigational, oral GnRH receptor antagonist, which dose-dependently reduces E2 levels, providing full suppression (serum E2 &lt; 20 pg/mL) and partial suppression with once daily oral dosing of 200 mg and 100 mg, respectively. We hypothesized that a regimen of full suppression for 12 weeks followed by partial suppression maintenance therapy for 12 weeks could be effective for the treatment of severe adenomyosis. Study design, size, duration This was a single-center, open-label exploratory study in women with symptomatic adenomyosis confirmed by Magnetic Resonance Imaging (MRI) (EudraCT number: 2017–004–042–14). Patients were recruited from a single private clinic and infertility research unit between March 2019 to June 2020. Participants/materials, setting, methods Eligible patients were premenopausal women 18 to 48 years old with symptomatic uterine adenomyosis confirmed by MRI, moderate-to-severe pain and abnormal uterine bleeding. The primary measure of efficacy was the reduction in uterine volume assessed by MRI. Other endpoints included adenomyosis lesion volume, pelvic pain, haemoglobin, uterine bleeding and quality of life (EHP–30 domains: pain, control and powerlessness, emotional well-being, social support and self-image). Main results and the role of chance Eight (3 black and 5 white) enrolled subjects had mean±SD age 42±3 years and weight 75±19 kg. At baseline (day 2 of the cycle) all patients presented with pelvic pain, severe dysmenorrhea and heavy menstrual bleeding. In all cases, MRI showed an enlarged uterus (mean±SD volume 343±253 cm3) with severe adenomyosis characterized by heterogenous myometrium with multiple myometrial cysts. The mean±SD junctional zone was 29.0±14.2 mm. Median serum estradiol was suppressed to 12 pg/mL by 4 weeks and this was maintained up to 12 weeks. After 12 weeks, mean±SD uterine volume was 162±117 cm3, a 57±16% reduction from baseline, with marked regression of adenomyotic lesions and the junctional zone was 21.0±13.4 mm. Mean±SD overall pelvic pain score (0–10 NRS) was reduced from 8.4±1.1 at baseline to 2.4±3.4 (p = 0.0035) and there were also improvements in dysmenorrhea, dyspareunia, non-menstrual pelvic pain and dyschezia scores. No subjects reported uterine bleeding between Weeks 4 to 12. Mean±SD haemoglobin was 12.1±2.0 at baseline and 12.8±1.1 at 12 weeks. Anemia at baseline (≤10g/dL) was resolved by 12 weeks. Substantial improvements were observed on each of the EHP–30 domains. The most common side effect was the expected hypoestrogenic side effects of hot flushes, which were reported by 6/8 subjects. Limitations, reasons for caution This was a single-centre, open-label pilot study in 8 patients with symptomatic adenomyosis. We report the results after the first 12 weeks treatment of a high full suppression dose of linzagolix. Results after 24 weeks will further inform on the potential for a low partial suppression dose to maintain efficacy. Wider implications of the findings: The initial results of this open-label pilot study in women with severe adenomyosis indicate that a high full suppression dose of linzagolix 200 mg is effective in reducing uterine and adenomyosis lesion size, reducing abnormal uterine bleeding and pelvic pain and improving quality of life. Trial registration number EudraCT number: 2017–004–042–14

CA 125 Modifications Throughout Menstrual Cycle and following GnRH-Analog Administration to Diagnose Endometriosis as Cause of Chronic Pelvic Pain. A Prospective Controlled Study

2011 ◽  
Vol 3 (3) ◽  
pp. 151-158
Author(s):  
Roberta Venturella ◽  
Pietro D'Alessandro ◽  
Francesco Gallo ◽  
Michele Morelli ◽  
Fulvio Zullo
Keyword(s):  
Menstrual Cycle ◽  
Diagnostic Accuracy ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Diagnostic Laparoscopy ◽  
Follicular Phase ◽  
Ca 125 ◽  
Gnrh Analog ◽  
Early Follicular Phase ◽  
Group A

Purpose Endometriosis is the leading single cause of chronic pelvic pain (CPP). To date, the gold standard to diagnose this condition is histologic confirmation of lesions obtained by surgery. However, a noninvasive and cheaper tool for early diagnosis is strongly needed. The aim of this study is twofold: first, to assess the diagnostic accuracy to detect endometriosis of serum CA 125 modifications throughout the menstrual cycle, and second, to analyze whether variations in CA 125 levels following one dose of GnRH-analog (GnRH-a) may increase the diagnostic value of the assay. Methods 84 women scheduled for a diagnostic laparoscopy for CPP (group A) and another 12 women scheduled for diagnostic laparoscopy for unexplained infertility (group B) were enrolled as cases and controls. Serum CA125 was determined for each patient at the early follicular and luteal phases. Prior to surgery, patients from group A received one vial of leuprolide acetate depot. Following laparoscopy and histologic examination, cases were sub-grouped into group A1 (subjects with endometriosis) and group A2 (subjects without endometriosis). Results Plasma CA125 levels during the early follicular phase were significantly higher than those recorded in the luteal phase in all groups and they were significantly higher in group A1 in comparison with groups A2 and B. One month after GnRH administration, a significant reduction in plasma CA-125 levels was only observed in group A1. Conclusions The assessment of serum CA 125 modifications throughout the menstrual cycle and following one dose of GnRH-a demonstrated good diagnostic accuracy to detect endometriosis in patients with CPP. Women with endometriosis are characterized by a significant increase in CA125 levels during the early follicular phase and by a significant decrease following GnRH-a administration.

scholarly journals ROLE OF LAPAROSCOPY IN CHRONIC PELVIC PAIN

2020 ◽  
pp. 1-2
Author(s):  
Priya Saxena ◽  
Bharti Maheshwari ◽  
Debarshi Jana
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Diagnostic Laparoscopy ◽  
Proper Selection ◽  
Medical College ◽  
Common Causes ◽  
Ideal Method ◽  
Selection Of ◽  
The Ideal

Background/purpose: The purpose of the present study was to evaluate the role of laparoscopy in diagnosis the cases of chronic pelvic pain. Methods: This prospective study was conducted among 100 women who had been suffering from chronic pelvic pain for ≥6 months at Department of Obstetrics & gynaecology, Muzaffarnagar Medical College, Muzaffarnagar from December 2017 to December 2018. After proper selection of cases, a detailed history followed by general, systemic and pelvic examination, diagnostic laparoscopy of the patient was done and noted as per the following protocol. Diagnostic laparoscopy was performed under general anaesthesia using a 5-mm Karl Stortz 30° angle double port laparoscope. The data was collected and subjected to statistical analysis using SPSS version 22.00 Results: Majority (70%) of patients with CPP were in the age group between 26 – 30 years and 31 – 35 years. Two most common causes of CPP detected clinically were endometriosis and chronic PID which together constituted about 56% of the cases with CPP in our study group. Laparoscopy findings revealed that 90% of patients with CPP have one or more positive findings, the commonest being endometriosis in various pelvic sites with or without endometrioma (34%) Conclusion: It can be concluded that ideally hysteroscopy should be performed simultaneously to identify intrauterine pathologies, which can be associated with CPP and which are missed by laparoscopy. Hence combined laparohysteroscopy is the ideal method for diagnosis of CPP.

scholarly journals The Prevalence of Cesarean Scar Niche and Its Relation to Certain Gynecological and Obstetrical Issues

2021 ◽  
pp. 152-158
Author(s):  
Mazen Mohammed AlRassad ◽  
Mohammed Mohsen ElNamoury ◽  
Mona Khaled Omar ◽  
Manal Mostafa Abdallah
Keyword(s):  
Cesarean Section ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Abnormal Uterine Bleeding ◽  
University Hospital ◽  
Major Surgery ◽  
P Value ◽  
Long Term Effects ◽  
Cross Sectional ◽  
Cesarean Scar

Background: A cesarean section (CS) is a life-saving surgical procedure when certain complications arise during pregnancy and labor. However, it is a major surgery and is associated with immediate maternal and perinatal risks and may have implications for future pregnancies as well as long-term effects that are still being investigated. This study aims at determining the prevalence of isthmocele (niche) among those who gave birth through Cesarean section, and figure out how many of the women diagnosed with scar niche are symptomatic. Methods: This observational cross-sectional study involved 300 women who gave birth by CS at the latest 6 months and they were recruited from the outpatient clinics of obstetrics and gynecology department, Tanta university hospital. Results: The prevalence of the niche was 21.7%. And the most common shapes of niche documented were the semicircular defects followed by the triangular defects. The majority of cases were symptomatic while only 7.7% were asymptomatic and discovered accidentally by routine ultrasound examination. The most common symptoms documented were abnormal uterine bleeding (AUB), chronic pelvic pain, dysmenorrhea, and secondary infertility. There was a positive significant relationship between the number of CS, the size of the niche, and the severity or frequency of the presenting symptom (P value < 0.01). Conclusion: Cesarean scar niche has a strong statistically significant association with symptoms such as AUB (especially inter-menstrual bleeding), chronic pelvic pain, and dysmenorrhea. In our study, the prevalence of cesarean niche was 21.7% and the common niche shapes documented were the semicircular and triangular niches.

scholarly journals Adenomyosis at Hysterectomy: Prevalence, Patient Characteristics, Clinical Profile and Histopatholgical Findings

2012 ◽  
Vol 10 (1) ◽  
pp. 44-47 ◽  
Author(s):  
A Shrestha ◽  
R Shrestha ◽  
LB Sedhai ◽  
U Pandit
Keyword(s):  
Medical Therapy ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Histopathological Examination ◽  
Menopausal Status ◽  
Lower Abdominal Pain ◽  
Abnormal Uterine Bleeding ◽  
Clinical Findings ◽  
Uterine Bleeding ◽  
Clinical Profile

Background Underlying adenomyosis is often the cause of treatment failure for patients undergoing medical therapy for abnormal uterine bleeding and or chronic pelvic pain. Given the limitation of ultrasonography in diagnosing adenomyosis and MRI being unaffordable to most of the patients belonging to developing countries like us, it often remains undiagnosed before a hysterectomy. Objective To find out the clinical profile associated with adenomyosis and to determine the prevalence of adenomyosis in hysterectomy specimens; frequency distribution, as well as to correlate clinical examination with histopathological examination. Methods A total of 60 women who had undergone hysterectomy with histopathologically proven adenomyosis between April 2009 and March 2010 were included . Data were collected on indication for the intervention, age, symptoms, clinical findings, hemoglobin, menopausal status, gross and histopathological findings. Results A total of 256 women were scheduled for hysterectomy. Adenomyosis was diagnosed in 60 of 256 cases (23.4%). Menorrhagia (91.2%), dysmenorrhoea (84.2%), lower abdominal pain (84.2%) beginning later in reproductive life (mean age- 45yrs) is the classic presentation. Adenomyosis was present in 10 of 61 patients (16.3%) with fibroids; 27 of 60 (45%) with abnormal uterine bleeding; 11 of 55 (20%) with prolapse; four of 35 (11.4%) with ovarian mass; five of 25 (20%) with chronic pelvic pain; three of four (75%) with endometriosis. Conclusion Women undergoing hysterectomy with diagnosis of adenomyosis have a distinct symptomatology. The choice of therapy in adenomyosis is hysterectomy for those women who have completed family and had failed medical therapy . KATHMANDU UNIVERSITY MEDICAL JOURNAL  VOL.10 | NO. 1 | ISSUE 37 | JAN - MAR 2012 | 53-56 DOI: http://dx.doi.org/10.3126/kumj.v10i1.6915

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