scholarly journals Medical management of deeply infiltrating endometriosis - 7 year experience in a tertiary endometriosis centre in London

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Marianne Wild ◽  
Tariq Miskry ◽  
Asmaa Al-Kufaishi ◽  
Gillian Rose ◽  
Mary Crofton
Keyword(s):  
Medical Management ◽  
Obstructive Uropathy ◽  
Intrauterine Device ◽  
Secondary Analysis ◽  
Surgical Excision ◽  
Hormonal Contraceptive ◽  
Reproductive Age ◽  
Deeply Infiltrating Endometriosis ◽  
Hormonal Therapies ◽  
Infiltrating Endometriosis

Abstract Background Deeply infiltrating endometriosis has an estimated prevalence of 1% in women of reproductive age. Ninety percent have rectovaginal lesions but disease may also include the bowel, bladder and ureters. Current practice often favours minimally invasive surgical excision; however, there is increasing evidence that medical management can be as effective as long as obstructive uropathy and bowel stenosis are excluded. Our objective was to establish the proportion of women with deeply infiltrating endometriosis successfully managed with hormonal therapies within our tertiary endometriosis centre in West London. Secondary analysis was performed on anonymised data from the Trust’s endometriosis database. Results One hundred fifty-two women with deeply infiltrating endometriosis were discussed at our endometriosis multidisciplinary meeting between January 2010 and December 2016. Seventy-five percent of women underwent a trial of medical management. Of these, 44.7% did not require any surgical intervention during the study period, and 7.9% were symptomatically content but required interventions to optimise their fertility prospects. Another 7.0% were successfully medically managed for at least 12 months, but ultimately required surgery as their symptoms deteriorated. 26.5% took combined oral contraceptives, 14.7% oral progestogens, 1.5% progestogen implant, 13.2% levonorgestrel intrauterine device, 22.1% gonadotrophin-releasing hormone analogues, and 22.1% had analogues for 3–6 months then stepped down to another hormonal contraceptive. All women who underwent serial imaging demonstrated improvement or stable disease on MRI or ultrasound. Conclusions Medical treatments are generally safe, well tolerated and inexpensive. More than half (52.6%) of women were successfully managed with medical therapy to control their symptoms. This study supports the growing evidence supporting hormonal therapies in the management of deeply infiltrating endometriosis. The findings may be used to counsel women on the likely success rate of medical management.

scholarly journals Clinical Prediction of Deeply Infiltrating Endometriosis before Surgery: Is It Feasible? A Review of the Literature

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Márcia Mendonça Carneiro ◽  
Ivone Dirk de Sousa Filogônio ◽  
Luciana Maria Pyramo Costa ◽  
Ivete de Ávila ◽  
Márcia Cristina França Ferreira
Keyword(s):  
Transvaginal Ultrasound ◽  
Signs And Symptoms ◽  
Reproductive Age ◽  
Therapeutic Interventions ◽  
Deeply Infiltrating Endometriosis ◽  
Anatomical Extent ◽  
Low Sensitivity ◽  
Histological Confirmation ◽  
Specific Symptoms ◽  
Infiltrating Endometriosis

Background. Endometriosis is a chronic benign gynecologic disease that can cause pelvic pain and infertility affecting almost 10% of reproductive-age women. Deeply infiltrating endometriosis (DIE) is a specific entity responsible for painful symptoms which are related to the anatomic location of the lesions. Definitive diagnosis requires surgery, and histological confirmation is advisable. The aim of this paper is to review the current literature regarding the possibility of diagnosing DIE accurately before surgery. Despite its low sensitivity and specificity, vaginal examination and evaluation of specific symptoms should not be completely omitted as a basic diagnostic tool in detecting endometriosis and planning further therapeutic interventions. Recently, transvaginal ultrasound (TVUS) has been reported as an excellent tool to diagnose DIE lesions in different locations (rectovaginal septum, retrocervical and paracervical areas, rectum and sigmoid, and vesical wall) with good accuracy.Conclusion. There are neither sufficiently sensitive and specific signs and symptoms nor diagnostic tests for the clinical diagnosis of DIE, resulting in a great delay between onset of symptoms and diagnosis. Digital examination, in addition to TVS, may help to gain better understanding of the anatomical extent and dimension of DIE which is of crucial importance in defining the best surgical approach.

Empowerment and IPV in Married Women of Reproductive Age: Evidence from Pakistan Demographic Health Survey 2017–2018

2021 ◽  
pp. 088626052098038
Author(s):  
Mohammad Vaqas Ali ◽  
Jawad Tariq
Keyword(s):  
Sexual Violence ◽  
Health Survey ◽  
Partner Violence ◽  
Physical Violence ◽  
Secondary Analysis ◽  
Married Women ◽  
Reproductive Age ◽  
Women Empowerment ◽  
Women Of Reproductive Age ◽  
Forms Of Violence

The study was an attempt to identify demographic, household, and women empowerment factors that predicted emotional, physical, and sexual violence in ever-married women of reproductive age (15–49 years, n = 3,965) in Pakistan by performing secondary analysis on Pakistan Demographic and Health Survey, 2017–2018. The analysis was done using SPSS (v.22) and binary and multivariate logistic regression techniques were performed for analyses. The analysis found that 30.2% of women experienced emotional, 24.1% reported less severe physical, 6.5% experienced severe physical, and 4.3% experienced sexual violence, respectively. The multivariate analysis found that husband’s age, education, wealth, and alcohol consumption were significant predictors of intimate partner violence (IPV). Additionally, womens’ age, education, and number of children also significantly predicted IPV. With respect to empowerment variables, ownership of house was a significant predictor of less severe physical violence, ownership of property significantly predicted emotional violence, and autonomy in household purchase decisions was significantly related to severe physical violence. The control on husband’s income as a measure of empowerment significantly predicted all four types of IPV. Belief in patriarchy also turned out to be an important factor in determining emotional and less severe physical violence. The study concludes that women empowerment in household context can prevent less serious forms of violence but to hinder serious forms of violence, interventions at family and community level will be required.

The association between hormonal contraceptive use and glaucoma in women of reproductive age

2021 ◽  
Author(s):  
Kate Hogden ◽  
Frederick Mikelberg ◽  
Mohit Sodhi ◽  
Farzin Khosrow‐Khavar ◽  
Mohammad Ali Mansournia ◽  
...  
Keyword(s):  
Contraceptive Use ◽  
Hormonal Contraceptive ◽  
Reproductive Age ◽  
Women Of Reproductive Age

Elevated Serum and Peritoneal Interleukin-33 Levels in Deeply Infiltrating Endometriosis

2012 ◽  
Vol 19 (6) ◽  
pp. S6-S7
Author(s):  
P. Santulli ◽  
B. Borghese ◽  
S. Chouzenoux ◽  
I. Streuli ◽  
D. de Ziegler ◽  
...  
Keyword(s):  
Elevated Serum ◽  
Interleukin 33 ◽  
Deeply Infiltrating Endometriosis ◽  
Infiltrating Endometriosis

scholarly journals Identifying risk factors of anemia among women of reproductive age in Rwanda - a cross-sectional study using secondary data from the Rwanda Demographic and Health Survey 2014/2015

2019 ◽  
Author(s):  
Dieudonne Hakizimana ◽  
Marie Paul Nisingizwe ◽  
Jenae Logan ◽  
Rex Wong
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Pregnant Woman ◽  
Intrauterine Device ◽  
Cross Sectional Study ◽  
Hemoglobin Level ◽  
Reproductive Age ◽  
Sectional Study ◽  
Women Of Reproductive Age ◽  
Cross Sectional

Abstract Background Anemia among Women of Reproductive Age (WRA) continues to be among the major public health problems in many developing countries, including Rwanda, where it increased in prevalence between the 2015 and 2010 Rwanda Demographic and Health Survey (RDHS) reports. A thorough understanding of its risk factors is necessary to design better interventions. However, to the best of our knowledge, no study has been conducted in Rwanda on a nationally representative sample to assess factors associated with anemia among WRA. Accordingly, this study was conducted to address such gap. Methods A quantitative, cross-sectional study was conducted using data from the RDHS 2014-2015 report. The study population consisted of 6680 WRA who were tested for anemia during the survey. Anemia was defined as having a hemoglobin level equal to or below 10.9 g/dl for a pregnant woman, and hemoglobin level equal to or below 11.9 g/dl for a non-pregnant woman. Pearson’s chi-squared test and multiple logistic regression were conducted for bivariate and multivariable analysis, respectively. Results The prevalence of anemia among WRA was 19.2% (95% CI: 18.0 - 20.5). Four factors were found to be associated with lower odds of anemia, including being obese (OR: 0.61, 95% CI: 0.40 - 0.91), being in the rich category (OR: 0.74, 95% CI: 0.63 - 0.87), sleeping under a mosquito net (OR: 0.85, 95% CI: 0.74 - 0.98), and using hormonal contraceptives (OR: 0.61, 95% CI: 0.50 - 0.73). Five factors were associated with higher odds of anemia, including being underweight (OR: 1.39, 95% CI: 1.09 - 1.78), using an intrauterine device (OR: 1.98, 95% CI: 1.05 - 3.75), being separated or widowed (OR: 1.35, 95% CI: 1.09 - 1.67), and living in the Southern province (OR: 1.45, 95% CI: 1.11 - 1.89) or in the Eastern province (OR: 1.41, 95% CI: 1.06 - 1.88). Conclusion Anemia continues to pose public health challenges; novel public health interventions should consider geographic variations in anemia risk, seek to improve women’s economic statuses, and strengthen iron supplementation especially for Intrauterine device users. Additionally, given the association between anemia and malaria, interventions to prevent malaria should be enhanced.

scholarly journals Dienogest exerts its anti-endometriotic effect throughthe direct suppression of matrix metallopeptidases

2020 ◽  
Author(s):  
Hiroshi Honda ◽  
Norihisa Nishimichi ◽  
Michinori Yamashita ◽  
Yumiko Akimoto ◽  
Hirotoshi Tanimoto ◽  
...  
Keyword(s):  
Expression Profiles ◽  
Group Versus ◽  
Gene Expression Profiles ◽  
High Specificity ◽  
Reproductive Age ◽  
Control Group ◽  
Canonical Pathways ◽  
Hormonal Therapies ◽  
And Control ◽  
Direct Suppression

Abstract Background: Endometriosis, which affects up to 10% women of reproductive age, is defined by the presence of ectopic endometrial tissue outside the uterus. The current key drug of hormonal therapies for endometriosis is dienogest, which is a progestin with high specificity for the progesterone receptor. Although many findings about the anti-endometriotic effect of dienogest on endometriosis have been reported, the precise mechanisms of dienogest's anti-endometriotic effect remain unknown. Methods: To investigate the direct anti-endometriotic effect of dienogest on endometriotic cells, we determined and compared the genome-wide gene expression profiles of endometriotic stromal cells treated with dienogest (Dienogest group) and those not treated with dienogest (Control group) and then performed a pathway analysis using these data. To test the microarray data, we performed real-time RT-PCRs for matrix metallopeptidase (MMP)-1, MMP-3, MMP-10, and TIMP-4.Results: Six-hundred forty-seven genes were revealed to be differentially expressed between the Dienogest and Control groups. Of them, 314 genes were upregulated and 333 genes were downregulated in the Dienogest group compared to the Control group. We identified 20 canonical pathways that are significantly distinct in the Dienogest group versus the Control group. Among the 20 canonical pathways, MMPs including MMP-1, -3, and -10 were found to be the most involved genes. Conclusions: Our results suggest that dienogest may exert its anti-endometriotic effect through the direct suppression of MMPs.

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