Modern methods of evaluating endometriosis

Endometriosis is a common chronic disease, affecting women of reproductive age. Typical symptoms include severe menstrual pain, other pelvic pain symptoms as well as infertility. Adolescent onset of symptoms is common, and the delay between the onset of symptoms and the diagnosis is typically several years. Presently, the diagnosis can be confirmed only by laparoscopy. The symptoms can be alleviated with hormonal medications or surgery, but there is no curable treatment. This study aimed to evaluate the prevalence of symptoms suggestive of endometriosis among adolescent girls. Furthermore, the value of a panel of 29 serum cytokines in the diagnosis of endometriosis, the usefulness of serum HE4 (Human Epididymis Secretory Protein 4), a novel biomarker for ovarian cancer, in discriminating ovarian endometriotic cysts from ovarian cancer, as well as the longterm effects of surgery on pain were assessed. These studies were based on two prospective cohorts: The ENDOMET study, including 137 endometriosis patients scheduled for surgery and 62 healthy women, and the TEENMAPS questionnaire study that included 1103 adolescent girls aged 15–19 years. The study showed that dysmenorrhea was prevalent among teenagers, while other pain symptoms were less common. Importantly, approximately 5–10% of adolescent girls had symptoms suggestive of endometriosis. Among the potential diagnostic markers, the serum concentrations of five cytokines were significantly different between endometriosis patients and healthy controls, but these markers did no significantly improve the diagnostic accuracy of that obtained with the biomarker CA-125 alone. Interestingly, serum levels of HE4 were not increased in endometriosis, and thus, this biomarker is useful in differentiating ovarian endometriosis from ovarian cancer. Surgery was found to result in significant longterm alleviation of pain during 5-year follow-up, and women with deep infiltrating endometriosis benefitted the most.Endometrioosi on yleinen krooninen hedelmällisessä iässä olevien naisten sairaus, joka aiheuttaa voimakkaita kuukautis- ja lantiokipuja sekä lapsettomuutta. Oireet alkavat usein jo teini-iässä, mutta viive oireiden alusta diagnoosiin on tyypillisesti useita vuosia. Tällä hetkellä diagnoosi voidaan varmistaa vain laparoskopialla. Oireita hoidetaan hormonilääkkein ja/tai leikkauksella, mutta parantavaa hoitoa ei ole. Tutkimuksessa selvitettiin endometrioosiin viittaavien kipuoireiden esiintyvyyttä teini-ikäisillä. Lisäksi arvioitiin 29 seerumin sytokiinin hyödyllisyyttä endometrioosin diagnostiikassa, uuden munasarjansyövän merkkiaineen HE4:n (Human Epididymis Secretory Protein 4) käyttökelpoisuutta munasarjan endometrioosikystojen ja munasarjasyövän erotusdiagnostiikassa sekä leikkaushoidon pitkäaikaisvaikutusta kipuun. Tutkimus koostui kahdesta prospektiivisesta aineistosta: ENDOMET-tutkimukseen rekrytoitiin 137 endometrioosileikkauspotilasta sekä 62 tervettä naista ja TEENMAPS-kyselytutkimukseen osallistui 1103 15– 19-vuotiasta tyttöä. Tutkimuksen mukaan kuukautiskipu oli yleinen oire teini-ikäisillä, mutta muita endometrioosiin viittaavia kipuja esiintyi harvemmin. Noin 5–10%:lla teiniikäisistä tytöistä oli endometrioosiin viittaavia oireita. Tutkituista merkkiaineista viiden seerumin sytokiinin pitoisuus erosi merkitsevästi endometrioosipotilailla verrattuna terveisiin naisiin, mutta sytokiinit eivät lisänneet diagnostiikan tarkkuutta verrattuna pelkän CA-125-merkkiaineen käyttöön. Merkittävä löydös oli, että endometrioosi ei nostanut HE4-pitoisuutta ja merkkiainetta voidaan käyttää munasarjasyövän ja endometrioosikystojen erotusdiagnostiikassa. Endometrioosin leikkaushoito lievitti merkittävästi kipuja viiden vuoden seurannassa ja erityisesti syvää endometrioosia sairastavat naiset hyötyivät toimenpiteestä

Milloin epäilen endometrioosia?

Endometrioosi aiheuttaa monimuotoisia vatsa- ja lantiokipuja, toiminnallisia suoli- ja rakkovaivoja sekä lapsettomuutta.  Kuukautiskipu on keskeisin mutta harvoin ainoa oire. Oireilu alkaa yleensä teini-iässä tai nuorella aikuisiällä, mutta taudin tunnistaminen on haastavaa. Monet naiset kärsivät vuosia kivuista saamatta riittävää hoitoa ja selitystä oireilleen. Endometrioosioireet voidaan tunnistaa ja lääkehoito aloittaa perusterveydenhuollossa. Erikoissairaanhoidon arviota tarvitaan, mikäli lääkehoito ei paranna riittävästi elämänlaatua tai oireiluun liittyy lapsettomuus

Case Report Sacral Neuromodulation: Foray into Chronic Pelvic Pain in End Stage Endometriosis

Excision of all endometriotic lesions is the method of choice in the treatment of severe endometriosis resistant to medical therapy. The infiltrating nature of the disease as well as extensive surgery may, however, cause chronic pain that cannot be relieved by either surgery or hormonal treatment. As a pilot treatment, we tested the effect of sacral neuromodulation (SNM) for four endometriosis patients suffering chronic pelvic pain and pelvic organ dysfunction after radical surgical treatment. Three out of four patients reported improvement in their symptoms during the neuromodulation testing period and a permanent pulse generator was installed. After 2.5 years, all three patients report better quality of life and want to continue with SNM

A relational database to identify differentially expressed genes in the endometrium and endometriosis lesions

Endometriosis is a common inflammatory estrogen-dependent gynecological disorder, associated with pelvic pain and reduced fertility in women. Several aspects of this disorder and its cellular and molecular etiology remain unresolved. We have analyzed the global gene expression patterns in the endometrium, peritoneum and in endometriosis lesions of endometriosis patients and in the endometrium and peritoneum of healthy women. In this report, we present the EndometDB, an interactive web-based user interface for browsing the gene expression database of collected samples without the need for computational skills. The EndometDB incorporates the expression data from 115 patients and 53 controls, with over 24000 genes and clinical features, such as their age, disease stages, hormonal medication, menstrual cycle phase, and the different endometriosis lesion types. Using the web-tool, the end-user can easily generate various plot outputs and projections, including boxplots, and heatmaps and the generated outputs can be downloaded in pdf-format.Peer reviewe

Sacral Neuromodulation: Foray into Chronic Pelvic Pain in End Stage Endometriosis

Excision of all endometriotic lesions is the method of choice in the treatment of severe endometriosis resistant to medical therapy. The infiltrating nature of the disease as well as extensive surgery may, however, cause chronic pain that cannot be relieved by either surgery or hormonal treatment. As a pilot treatment, we tested the effect of sacral neuromodulation (SNM) for four endometriosis patients suffering chronic pelvic pain and pelvic organ dysfunction after radical surgical treatment. Three out of four patients reported improvement in their symptoms during the neuromodulation testing period and a permanent pulse generator was installed. After 2.5 years, all three patients report better quality of life and want to continue with SNM

Sacral Neuromodulation: Foray into Chronic Pelvic Pain in End Stage Endometriosis

Excision of all endometriotic lesions is the method of choice in the treatment of severe endometriosis resistant to medical therapy. The infiltrating nature of the disease as well as extensive surgery may, however, cause chronic pain that cannot be relieved by either surgery or hormonal treatment. As a pilot treatment, we tested the effect of sacral neuromodulation (SNM) for four endometriosis patients suffering chronic pelvic pain and pelvic organ dysfunction after radical surgical treatment. Three out of four patients reported improvement in their symptoms during the neuromodulation testing period and a permanent pulse generator was installed. After 2.5 years, all three patients report better quality of life and want to continue with SNM

Dienogest 2 mg Daily in the Treatment of Adolescents with Clinically Suspected Endometriosis: The VISanne Study to Assess Safety in ADOlescents

International audienceTo study the safety and efficacy of dienogest 2 mg in adolescents with suspected endometriosis.Dienogest 2 mg once daily

Sacral neuromodulation in endometriosis - A promising treatment option for chronic pelvic pain

Peer reviewe

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