scholarly journals CHC for pelvic pain in women with endometriosis: ineffectiveness or discontinuation due to side-effects

2020 ◽  
Vol 2020 (2) ◽  
Author(s):  
Paul J Yong ◽  
Najla Alsowayan ◽  
Heather Noga ◽  
Christina Williams ◽  
Catherine Allaire ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Pelvic Floor ◽  
Pelvic Pain ◽  
Health Research ◽  
Reproductive Age ◽  
Surgical Data ◽  
History Of ◽  
Pelvic Floor Myalgia

Abstract STUDY QUESTION What are the use patterns and factors associated with combined hormonal contraception (CHC) ineffectiveness or discontinuation due to side-effects in patients with endometriosis and pelvic pain? SUMMARY ANSWER Worse chronic pelvic pain (CPP) severity and pelvic floor myalgia were associated with continuous CHC ineffectiveness, while poorer quality-of-life was associated with continuous CHC discontinuation due to side-effects. WHAT IS KNOWN ALREADY CHC is a first line of therapy for endometriosis-associated pelvic pain in women. However, some patients state that CHC is ineffective for their pain, while others have to discontinue CHC due to side-effects. STUDY DESIGN, SIZE, DURATION Analysis of a prospective patient database from a tertiary care referral center for patients with endometriosis and pelvic pain between December 2013 and April 2015 was carried out. PARTICIPANTS/MATERIALS, SETTING AND METHODS A total of 373 patients of reproductive age with endometriosis from the database were included in the study. Data included patient self-reported questionnaires, physical examination findings and validated instruments. There were four variables of interest: history of cyclical CHC ineffectiveness (yes/no), history of cyclical CHC discontinuation due to side-effects (yes/no), history of continuous CHC ineffectiveness (yes/no) and history of continuous CHC discontinuation due to side-effects (yes/no). The primary outcome was CPP severity for the past 3 months (score of 0–10), and secondary outcomes were other pelvic pain scores, quality-of-life on the Endometriosis Health Profile 30 (EHP-30) and underlying conditions including irritable bowel syndrome, painful bladder syndrome, abdominal wall pain, pelvic floor myalgia and depression, anxiety and pain catastrophizing. MAIN RESULTS AND THE ROLE OF CHANCE Among the 373 cases in the dataset, prior cyclical CHC use was reported by 228 (61.1%) women, of which 103 (27.6%) stated it was ineffective for their pain and 94 (25.2%) stated they discontinued CHC due to side-effects. Previous continuous CHC use was reported by 175 (46.9%) women, of which 67 (18.0%) stated it was ineffective and 59 (15.8%) stated they discontinued due to side-effects. Worse CPP severity in the last 3 months was associated with a history of continuous CHC ineffectiveness (P < 0.001). Poorer quality-of-life was present in women who reported a history of continuous CHC discontinuation due to side-effects (P = 0.005). Among the underlying conditions, pelvic floor tenderness (as a marker of pelvic floor myalgia) was associated with CHC ineffectiveness. LIMITATIONS AND REASONS FOR CAUTION This study involved patient recall and no longitudinal follow-up. Also, we do not have data on the type of side-effect that led to discontinuation. Medication ineffectiveness was reported subjectively by the patient rather than using standardized criteria. Finally, the diagnosis of endometriosis was based on previous surgery or a current nodule or endometrioma on examination/ultrasound; without prospective surgical data on all the patients, it was not possible to do a sub-analysis by current surgical features (e.g. stage). WIDER IMPLICATIONS OF THE FINDINGS In women with endometriosis, CHC ineffectiveness was associated with worse CPP and pelvic floor myalgia, which suggests myofascial or nervous system contributors to CPP that does not respond to hormonal suppression. A tender pelvic floor, as a sign of pelvic floor myalgia, may be a clinical marker of patients with endometriosis who are less likely to have an optimal response to hormonal suppression. For women who discontinue CHC due to side-effects, research is needed to help alleviate these side-effects as these patients report worse quality-of-life. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by a Canadian Institutes of Health Research (CIHR) Transitional Open Operating Grant (MOP-142273) as well as BC Women’s Hospital and the Women’s Health Research Institute. PY is also supported by a Health Professional Investigator Award from the Michael Smith Foundation for Health Research. MB/CA has financial affiliations with Abbvie and Allergan; the other authors have no conflicts of interest.

scholarly journals MODERN METHODS OF COMPLEX CORRECTION OF PSYCHOSOMATIC DISORDERS IN PATIENTS WITH EXTERNAL GENITAL ENDOMETRIOSIS

2020 ◽  
Vol 73 (12) ◽  
pp. 2623-2626
Author(s):  
Nikolay A. Shcherbina ◽  
Liliya V Potapova ◽  
Irina N. Shcherbina ◽  
Oksana P. Lipko ◽  
Olga V. Mertsalova ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pelvic Pain ◽  
Pain Syndrome ◽  
Reproductive Age ◽  
Quality Analysis ◽  
Psychological State ◽  
Pelvic Pain Syndrome ◽  
Psychosomatic Disorders ◽  
Pain Mechanisms

The aim: About 10% of socially active women of reproductive age suffer from endometriosis, is determined by the frequent occurrence of menstrual and reproductive functions disorders, and pelvic pain syndrome in patients. The difficulties of therapeutic treatment of chronic pain syndrome in external genital endometriosis (EGE) are associated with polymorphism of pain mechanisms, and delayed diagnosis and treatment. The aim of the study is to improve the effectiveness of the treatment of external genital endometriosis. Material and methods: We examined 60 female patients of reproductive age, 40 – with histologically verified diagnosis of external genital endometriosis and 20 healthy women. We used the following methods of examination: general clinical, instrumental, endoscopic, morphological, the Visual Analogue Scale (VAS) to quantify pain, the Beck Depression Scale and the SF-36 questionnaire. Results: Before the treatment of patients with EGE, VAS scale scores indicated pain in 100% of patients, the indicators of depression and level of anxiety go beyond the normative. The results of the pre-treatment questionnaire indicated lower quality of life scores on the scales of physical and mental health components. As a result of treatment there was significant decrease in the manifestations of pain, depression and anxiety, with women receiving complex therapy (hormone therapy got antidepressants and non-drug correction methods). Сonclusions: Chronic pelvic pain syndrome associated with EGE and accompanied by an unfavorable psychological state, depressive states, anxiety symptoms, and psychosomatic disorders. New approaches to the treatment of clinical manifestations of EGE are needed, taking into account patients’ psycho-emotional status and the life quality analysis. We pathogenetically justified the use of drugs that affect the psychosomatic status of patients with EGE and showed that they could significantly improve the quality of life.

scholarly journals Chronic Pelvic Pain and Associated Clinical Characteristics among Women in a Tertiary Care Center in Indonesia

2017 ◽  
pp. 154
Author(s):  
Kanadi Sumapradja ◽  
Thomas Chayadi
Keyword(s):  
Quality Of Life ◽  
Pelvic Pain ◽  
Clinical Characteristics ◽  
Chronic Pelvic Pain ◽  
Reproductive Age ◽  
Domain Score ◽  
Health Clinic ◽  
Common Diagnosis ◽  
Hs Crp

Objective: To determine the prevalence and various aspects associated with female chronic pelvic pain. Methods: During the period of January to March 2016, a crosssectional study was conducted at the Women’s Health Clinic of Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Subjects were female who complained of pelvic pain for more than 6 months. We performed history taking, physical examination, and laboratory investigations including hs-CRP serum examination. We calculate the prevalence and describe the clinical characteristics and diagnosis of the patient. Quality of life and levels of hs-CRP were compared between the group of mild and severe pain. Results: In this study, the prevalence of CPP was 9.78%. We found 96.9% of gynecological disorders, 1% of urological disorders, and 2.1% of musculo-skeletal disorders. The most common diagnosis is endometriosis. The Clinical characteristics of patients were found 62.9% suffer for 6 months - 1 year with the intensity of pain (VAS) 7-10 as much as 51.5%. Levels of hs-CRP serum was around 1.99 (0.00 - 404, 53). We found a decreased in the quality of life of the patient. The physical domain score was 56 (38-81); the psychology domain score was 56 (31-100); the domain of social relationships was 59 (25-75); and the environmental domain score was 56 (31-94). Conclusion: Endometriosis is the most common diagnosis in female chronic pelvic pain of reproductive age. The pain causes a decreased in quality of life who suffer from it. [Indones J Obstet Gynecol 2017; 5-3: 154-159] Keywords: chronic pelvic pain, hs- CRP, intensity of pain, quality of life

scholarly journals Bleeding

2020 ◽  
Author(s):  
Kizito Omona
Keyword(s):  
Quality Of Life ◽  
At Risk ◽  
Abdominal Pain ◽  
Sexual Intercourse ◽  
Pelvic Pain ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
Abnormal Bleeding ◽  
Monthly Period

Fibroid, also called leiomyomas, is common tumor of the uterus. Usually, women of reproductive age are at risk of getting it. However, majority of these women develop fibroid (s) by the age of 50 years. This condition usually causes painful and unpleasant symptoms such as; heavy bleeding, prolonged periods, inter-menstrual bleeding, abdominal pain and cramps, anemia, pelvic pain and pain during sexual intercourse, among others. Abnormal bleeding, such as bleeding that occurs with fibroids and heavy periods, often lasts more than 10 days per month. This fibroid symptom involves persistent bleeding between cycles, which can severely impact one’s quality of life. Abnormal bleeding, especially in fibroids, can be taken as missing three or more periods in a woman who had been having regular monthly period, or periods that last less than 21 days or more than 35 days apart from each other. Another indication of an abnormal period is bleeding through multiple pads and tampons in a short amount of time.

scholarly journals Clinical picture and diagnosis of genital endometriosis

2016 ◽  
Vol 65 (5) ◽  
pp. 4-21 ◽  
Author(s):  
Maria I Yarmolinskaya ◽  
Elena I Rusina ◽  
Armine R Khachaturyan ◽  
Margarita S Florova
Keyword(s):  
Quality Of Life ◽  
Mental Disorders ◽  
Pelvic Pain ◽  
Clinical Picture ◽  
Chronic Pelvic Pain ◽  
Reproductive Age ◽  
Working Capacity ◽  
Costs Of Treatment ◽  
Gynecological Disease

Endometriosis is a widespread gynecological disease which affects every tenth woman of reproductive age. The main symptoms of disease are chronic pelvic pain, sterility and miscarriage, that leads to a reliable decline in quality of life and working capacity, mental disorders. Timely and complete diagnostics of endometriosis allows choosing the best option of treatment and minimizes the costs of treatment. This article describes in detail the existing methods of diagnosis of endometriosis. Modern literature and the results of own studies are summarized in the text.

scholarly journals A Case of Gallstones Causing Pelvic Pain

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Aizat Drahman ◽  
Kaushi Arulpragasam ◽  
Lilach Leibenson ◽  
Frank Sardelic
Keyword(s):  
Abdominal Pain ◽  
Pelvic Pain ◽  
Diagnostic Laparoscopy ◽  
Reproductive Age ◽  
Gallbladder Perforation ◽  
Pelvic Cavity ◽  
Surgical History ◽  
History Of ◽  
History Presentation

Introduction. Assessing abdominal pain, particularly in women of reproductive age, requires thorough history taking, clinical examination, and investigations to obtain an accurate diagnosis. Both surgical and gynecological causes need to be considered, particularly previous relevant surgical history. Presentation of case. We report a case of pelvic pain secondary to multiple gallstones found within the pelvic cavity postlaparoscopic cholecystectomy. Thorough investigations have been conducted without any obvious cause found. The pain was debilitating and largely affecting the patient’s quality of life. Therefore, decision to perform diagnostic laparoscopy and gallstones was found all over pelvic cavity and retrieved. Her pain resolved post operatively. Conclusions. Gallbladder perforation and stone spillage are the most common complications of laparoscopic cholecystectomy that arise during the removal and dissection of gallbladder and can cause significant morbidity if not managed early, especially retrieval of the stones intraoperatively. Therefore, patient with history of previous cholecystectomy with stone spillage presenting with undifferentiated abdominal pain and early diagnostic laparoscopy should be considered.

Endometriosis-related chronic pelvic pain: A mini review on pathophysiology and impact on mental health

2020 ◽  
Vol 12 (1) ◽  
pp. 35-40
Author(s):  
Thomas Vrekoussis ◽  
Vassiliki Siafaka ◽  
Alexandra Tsitou ◽  
Orestis Tsonis ◽  
Iordanis Navrozoglou ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Central Nervous System ◽  
Nervous System ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Pain Perception ◽  
Reproductive Age ◽  
Current Evidence

Endometriosis-related chronic pelvic pain is a major component of the disease that affects quality of life in women of reproductive age suffering from endometriosis. The present review summarizes current evidence upon pathophysiology and its impact on mental health. It seems that endometriosis-related chronic pelvic pain is the result of chronic stress on the central nervous system as a consequence of chronic pelvic inflammation. Mental health issues may rise as a result of central nervous system derangement and further aggravate pain perception and therefore quality of life. Further properly designed studies are needed in order to elucidate the connection between mental disorders and endometriosis-related chronic pelvic pain.

scholarly journals Pain syndromes in endometriosis: an integrated approach to the problem management

2020 ◽  
pp. 271-273
Author(s):  
T.F. Tatarchuk
Keyword(s):  
Quality Of Life ◽  
Oxidative Stress ◽  
Pelvic Pain ◽  
Standard Treatment ◽  
Reproductive Age ◽  
Alternative Methods ◽  
Endometrial Cells ◽  
Group 2 ◽  
Group 1

Background. Endometriosis affects 10 % of women of reproductive age. Endometriosis is often accompanied by the following symptoms: dyspareunia, pelvic pain, and dysmenorrhea. Pain is a leading symptom of endometriosis and often persists despite treatment. Objective. To elucidate the basics of pathogenesis and treatment of pain in endometriosis. Materials and methods. Analysis of literature data on this topic; own study involving 64 women with endometriosis. Group 1 was given dienogest (2 mg per day) for 3 months, and group 2 was given dienogest in combination with Tivortin (5 intravenous infusions of 100 ml each other day with the switch to Tivortin aspartate (“Yuria-Pharm”) orally). Results and discussion. Pain in endometriosis includes several pathophysiological mechanisms: increased nociception, inflammation, and changes in the recognition of pain in the nervous system. Significant pelvic vascularization promotes the rapid transmission of pain signals from this area to the brain. The severity of pain noted by women poorly correlates with the degree of disease detected during surgery. According to the recommendations of NICE (2017), one or more of the following symptoms are sufficient for suspected endometriosis: chronic pelvic pain (>6 months), dysmenorrhea, which adversely affects quality of life and daily activity, dyspareunia, gastrointestinal disorders and urinary system symptoms associated with menstruation, and infertility in combination with one or more of the above symptoms. Endometriosis requires flexible adaptation of management and the constant choice of treatment tactics depending on the symptoms and life situation of the patient. The basic goals of treatment inlude elimination of symptoms, restoration of quality of life and fertility, prevention of recurrences and repeated surgical intervention. Analgesics, neuromodulators and hormonal agents are used for pharmacological pain management. Additional and alternative methods include reflexology, manual therapy, osteopathy, exercise, dietary changes, and sleep hygiene. Elimination of the oxidation imbalance is one of the methods to treat pain in endometriosis. The uterus is a highly vascularized organ and its cells are constantly affected by high concentrations of oxygen. In settings of hypoxia, steroidogenesis, angiogenesis, inflammation and metabolic transition occur in endometrial cells. In women with endometriosis, there is an increase in markers of oxidative stress in the blood. Intrauterine oxidative stress can be eliminated with the powerful antioxidant L-arginine (Tivortin, “Yuria-Pharm”). In our own study, it was shown that the inclusion of Tivortin into the treatment allowed to decrease the intensity of intermenstrual endometriosis-associated pelvic pain more markedly than the standard treatment. The initial pain level was 61.32±3.2 according to the visual-analog scale in group 1 and 64.2±2.8 in group 2 (Tivortin). A month later, the indicators were 36.5±2.6 and 27.2±2.2, respectively. It should be noted that the effect of Tivortin is stable. In the standard treatment group, the intensity of pain increased again after the end of therapy, and in the Tivortin group remained at a low level. Evaluation of the McGill questionnaire results showed that in Tivortin group pain decreased not only due to the actual strength of the pain, but also due to a decrease in its sensory and emotional characteristics. After treatment, in group 1 the intensity of menstrual bleeding also increased more markedly. Conclusions. 1. The goals of endometriosis treatment are to eliminate symptoms, restore quality of life and fertility, prevent recurrence and repeated surgeries. 2. The effectiveness of L-arginine (Tivortin) in the treatment of endometriosis was ensured by normalizing vascular tone in the pelvic organs, reducing oxidative stress, psychostabilizing effect, increasing the antibacterial activity of neutrophils. 3. The use of Tivortin is a promising area for the treatment of endometriosis and prevention of its recurrence.

scholarly journals Management of Stress Urinary Incontinence With Surface Electromyography–Assisted Biofeedback in Women of Reproductive Age

2007 ◽  
Vol 87 (2) ◽  
pp. 136-142 ◽  
Author(s):  
Mariana T Rett ◽  
Jose A Simoes ◽  
Viviane Herrmann ◽  
Cristina LB Pinto ◽  
Andrea A Marques ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Muscle Strength ◽  
Pelvic Floor ◽  
Pelvic Floor Muscle ◽  
Premenopausal Women ◽  
Reproductive Age ◽  
Pelvic Floor Muscle Strength

Background and Purpose Although surgery has been widely accepted as the treatment of choice for stress urinary incontinence (SUI), there has recently been an increased interest in the conservative management of this condition. The aims of this study were to test the ability of a biofeedback-assisted pelvic-floor muscle exercise (PFME) program to affect symptoms of SUI in premenopausal women and to evaluate a training program that might lead to successful outcomes in a relatively limited number of sessions. Subjects Twenty-six women with SUI were treated with PFME with surface electromyography (sEMG)–assisted biofeedback. All participants were of reproductive age and were treated individually for 12 sessions. Methods Results were evaluated with a 7-day voiding diary, a 1-hour pad test, pelvic-floor muscle strength measurements, sEMG amplitudes, a leakage index, and a quality-of-life questionnaire. These variables were compared before and after the intervention. Results The frequency of urine loss, the occurrence of nocturia, and the number of pads required decreased significantly after the intervention. Objective cure was found in 61.5% of women. There was a significant improvement in the quality of life, in pelvic-floor muscle strength, and in the sEMG amplitudes of all contractions throughout the intervention. Discussion and Conclusion A relatively short-term intervention of PFME with sEMG-assisted biofeedback appeared to be helpful in relieving symptoms of SUI in premenopausal women and represents a reasonable conservative management option.

scholarly journals PHYSIOTHERAPEUTIC ACTIVITY IN THE TREATMENT OF PENETRAL GENE PAIN / PENETRATION WITH A FOCUS ON THE MANUAL THERAPY APPROACH IN WOMEN AT MENACME

2021 ◽  
Author(s):  
Caroline Sant’Anna Cunha
Keyword(s):  
Quality Of Life ◽  
Sexual Function ◽  
Pelvic Floor ◽  
Pelvic Pain ◽  
Manual Therapy ◽  
Pelvic Floor Muscles ◽  
World Health ◽  
Short Period

Genital-pelvic pain / penetration disorder (DGPP) includes vaginismus, dyspareunia and vulvodynia, where the following symptoms are present: Presence of fear or anxiety related to vulvovaginal or pelvic pain in anticipation, during or as a result of vaginal penetration, in addition to the presence of tension or hardening of the pelvic floor muscles during the attempt of vaginal penetration. Adequate sexual function is considered an important factor for quality of life, being recognized by WHO (World Health Organization) regarding the presence of sexual dysfunction as a public health problem, recommending its investigation for causing important changes in quality of life and in the relationship with your partner. It is identified that the role of the physiotherapist becomes relevant in the process of identification and rehabilitation of genito-pelvic pain, justifying the importance of studies on this topic. In order to analyze the role of the physiotherapist in the treatment of pelvic genital pain / penetration with a focus on the approach of manual therapy in women at menacme, a narrative review of the literature was carried out, where 17 articles were used as a basis for research and data collection. During the analysis of the articles, it was defined that DSFs tend to appear in the female fertile phase, causing pain and discomfort. In the reviews covered in this study, it was analyzed that DGPP is a complex syndrome in which the sensation and intensity of pain are felt in different places. With this the diagnosis becomes difficult taking into account the shame and / or blocking of the woman in reporting a sexual complaint. Through a physical therapy assessment, in order to check the tone and function of the pelvic floor muscles, the existence and location of tender points, as well as the understanding of voluntary contractions and rests of these muscles, a therapeutic planning with the use of interventions is outlined. specific measures in self-relaxation and anxiety control techniques, improving body awareness. It is concluded that there is effectiveness in exploring self-knowledge to improve the quality of life of women who suffer from this problem, providing positive results in a short period, thus contributing to the improvement of the sexual function of women with DSFs (Female Sexual Dysfunctions).

Symptom and Quality of Life Improvements After Pelvic Floor Physical Therapy in a Clinical Population of Women With Pelvic Pain and Other Symptoms

2019 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Kim A. Killinger ◽  
Jacob L. Henrichsen ◽  
Esther Han ◽  
Yi Ling Dai ◽  
Laura Nguyen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Therapy ◽  
Pelvic Floor ◽  
Pelvic Pain ◽  
Clinical Population ◽  
Pelvic Floor Physical Therapy
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