Prevalence of endometriosis in unexplained infertility and chronic pelvic pain in women attending Menoufia University Hospital

Abstract Background: Pelvic Inflammatory Disease (PID) is the inflammation of the adnexa of the uterus, that mainly manifests in a subclinical/chronic context and goes largely underreported. However, it poses a major threat to women’s health, as it is responsible for infertility and ectopic pregnancies, as well as chronic pelvic pain. Previous studies in Jordan have not reported PID, attributed mainly to the social structure of the country which largely represent a sexually conservative population. Our study aims to report the clinical symptoms that point towards PID and investigate the major risk determinants in a Jordanian population, in a cross-sectional study. Methods: One hundred sixty-eight consecutive adult women that came in the Outpatient Clinics of Gynaecological Department of the Jordan University Hospital were interviewed and their medical history and symptoms were registered and analysed. A Score for PID symptoms, we developed, was given to each woman. Results and correlations were then statistically tested.Results: Our study population consisted of relatively young women (37.7±11) that had their first child at an average age of 24.1 (±4.8) and a mean parity of 3.1 (±2.2). Fifty-eight women (34.5%) reported having undergone at least one CS, while the mean PID Symptom Score was 3.3 (±2.3). The women in our study exhibited 8 symptoms of PID, namely dysmenorrhea and vaginal discharge; being the commonest (45.2% and 44.6% respectively), in addition to chronic pelvic pain, pelvic heaviness, , menorrhagia, dyspareunia, , urinary symptoms, and smelly urine, and reported history of 3 conditions that can be attributed to PID, that is infertility, preterm labour, and miscarriages.Conclusions: Our PID Scoring System seems to identify the risk factors of PID and predict well the PID likelihood. This score predicts that women with higher parity, who used contraceptives and underwent any invasive medical procedure are expected to score higher in the PID Symptom Score. Our data also suggest that PID should not be ruled out in the Jordanian population when symptoms are compatible to this diagnosis.

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Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy

Journal of Personalized Medicine ◽

10.3390/jpm12010101 ◽

2022 ◽

Vol 12 (1) ◽

pp. 101

Author(s):

Augusto Pereira ◽

Manuel Herrero-Trujillano ◽

Gema Vaquero ◽

Lucia Fuentes ◽

Sofia Gonzalez ◽

...

Keyword(s):

Pelvic Pain ◽

Conventional Therapy ◽

Chronic Pelvic Pain ◽

Myofascial Pain ◽

Visceral Pain ◽

University Hospital ◽

Common Symptom ◽

Rectal Pain ◽

Inferior Hypogastric Plexus ◽

Hypogastric Plexus

Background: Although several treatments are currently available for chronic pelvic pain, 30–60% of patients do not respond to them. Therefore, these therapeutic options require a better understanding of the mechanisms underlying endometriosis-induced pain. This study focuses on pain management after failure of conventional therapy. Methods: We reviewed clinical data from 46 patients with endometriosis and chronic pelvic pain unresponsive to conventional therapies at Puerta de Hierro University Hospital Madrid, Spain from 2018 to 2021. Demographic data, clinical and exploratory findings, treatment received, and outcomes were collected. Results: Median age was 41.5 years, and median pain intensity was VAS: 7.8/10. Nociceptive pain and neuropathic pain were identified in 98% and 70% of patients, respectively. The most common symptom was abdominal pain (78.2%) followed by pain with sexual intercourse (65.2%), rectal pain (52.1%), and urologic pain (36.9%). A total of 43% of patients responded to treatment with neuromodulators. Combined therapies for myofascial pain syndrome, as well as treatment of visceral pain with inferior or superior hypogastric plexus blocks, proved to be very beneficial. S3 pulsed radiofrequency (PRF) plus inferior hypogastric plexus block or botulinum toxin enabled us to prolong response time by more than 3.5 months. Conclusion: Treatment of the unresponsive patient should be interdisciplinary. Depending on the history and exploratory findings, therapy should preferably be combined with neuromodulators, myofascial pain therapies, and S3 PRF plus inferior hypogastric plexus blockade.

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Comparative analysis of molecular signatures suggests the use of gabapentin for the management of endometriosis-associated pain

10.1101/251397 ◽

2018 ◽

Author(s):

Brice Bellessort ◽

Anne Bachelot ◽

Virginie Grouthier ◽

Camille de Lombares ◽

Nicolas Narboux-Neme ◽

...

Keyword(s):

Gene Expression ◽

Comparative Analysis ◽

Calcium Channel ◽

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Pain Perception ◽

University Hospital ◽

Small Scale ◽

Early Event ◽

Null Mouse

CapsuleComparative analysis of gene expression signatures from endometriosis and mouse models shows that CACNAα2δs calcium-channel components involved in nociception are targets for the treatment of endometriosis-associated pain.ContextDifferential gene expression analyses comparing endometriotic lesions to eutopic endometrium have shown that the transcription factors DLX5 and DLX6 are drastically down-regulated in the ectopic implants. These finding suggests that regulatory cascades involving DLX5/6 might be involved in the origin of endometriosis symptoms such as chronic pelvic pain. We have shown that mice in which Dlx5 and Dlx6 are selectively inactivated in the uterus present an endometrial phenotype reminiscent of endometriosis implants.ObjectiveIdentify new targets for the treatment of endometriosis.DesignTo better focus the search for endometriosis targets we have compared the profile of genes deregulated in normal and ectopic women endometrium to those deregulated in the uterus of normal and Dlx5/Dlx6-null mice.SettingsAcademic research unit and University Hospital research laboratoryAnimalsMice carrying a uterus-specific deletion of Dlx5/Dlx6.InterventionsAnalysis of archive sections from normal endometrium and endometriosis implants.Main OutcomeA novel endometriosis signature suggests that α2δs subunits of voltage-gated calcium channel are targets for the management of endometriosis-associated pain.ResultsWe identify a signature of 30 genes similarly deregulated in human endometriosis implants and in Dlx5/6-null mouse uteri reinforcing the notion that the down-regulation of Dlx5/6 is an early event in the progress of endometriosis. CACNA2D3, a component of the voltage-dependent calcium channel complex is strongly overexpressed both in endometriosis implants and in mutant mouse uteri; other members of the alfa2delta family, CACNA2D1 and CACNA2D2, are also overexpressed in endometriosis.ConclusionCACNA2D1, CACNA2D2 and CACNA2D3 are directly involved in pain perception. In particular, CACNA2D3 has been associated to pain sensitization and heat nociception in animal models while, in patients, variants of this gene are associated to reduced sensitivity to acute noxious stimuli. As CACNA2Ds are targets of gabapentinoids analgesics, our results suggest to consider the use of these drugs for the treatment of endometriosis-associated pain. Indeed, recent small-scale clinical studies have shown that gabapentin can be effective in the treatment of women chronic pelvic pain. Our findings reinforce the need for a large definitive trial.

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The use of brain functional magnetic resonance imaging to determine the mechanism of action of gabapentin in managing chronic pelvic pain in women: a pilot study

BMJ Open ◽

10.1136/bmjopen-2018-026152 ◽

2019 ◽

Vol 9 (6) ◽

pp. e026152 ◽

Cited By ~ 1

Author(s):

Marta Seretny ◽

Sarah Rose Murray ◽

Lucy Whitaker ◽

Jonathan Murnane ◽

Heather Whalley ◽

...

Keyword(s):

Outcome Measures ◽

Pelvic Pain ◽

Mechanism Of Action ◽

Chronic Pelvic Pain ◽

University Hospital ◽

Mechanistic Study ◽

Noxious Heat ◽

Negative Experience ◽

Pain Scores ◽

Lower Pain

ObjectiveTo inform feasibility and design of a future randomised controlled trial (RCT) using brain functional MRI (fMRI) to determine the mechanism of action of gabapentin in managing chronic pelvic pain (CPP) in women.DesignMechanistic study embedded in pilot RCT.SettingUniversity Hospital.ParticipantsTwelve women (18–50 years) with CPP and no pelvic pathology (follow-up completed March 2014).InterventionOral gabapentin (300–2700 mg) or matched placebo.Outcome measuresAfter 12 weeks of treatment, participants underwent fMRI of the brain (Verio Siemens 3T MRI) during which noxious heat and punctate stimuli were delivered to the pelvis and arm. Outcome measures included pain (visual analogue scale), blood oxygen level dependent signal change and a semi-structured acceptability questionnaire at study completion prior to unblinding.ResultsFull datasets were obtained for 11 participants. Following noxious heat to the abdomen, the gabapentin group (GG) had lower pain scores (Mean: 3.8 [SD 2.2]) than the placebo group (PG) (Mean: 5.8 [SD 0.9]). This was also the case for noxious heat to the arm with the GG having lower pain scores (Mean: 2.6 [SD 2.5]) than the PG (Mean: 6.2 [SD 1.1]). Seven out of 12 participants completed the acceptability questionnaire. 71% (five out of seven) described their participation in the fMRI study as positive; the remaining two rated it as a negative experience.ConclusionsIncorporating brain fMRI in a future RCT to determine the mechanism of action of gabapentin in managing CPP in women was feasible and acceptable to most women.Trial registration numberISRCTN70960777.

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

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i1731039 ◽

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.

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