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Endometriosis: Current Perspectives on Diagnosis and Treatment

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: closed (25 September 2022) | Viewed by 35119

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Special Issue Editor

Prof. Dr. Sylvia Mechsner

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Guest Editor

Klinik für Gynäkologie, Endometriosezentrum Charité, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
Interests: pathogenisis; neurogenic inflammation; stem cells; central sensitization; peripheral sensitization; multimodal tretment; adenomyosis; infertility; malignat transition; invasion factors

Special Issue Information

Dear Colleagues,

Endometriosis is a disease that is becoming increasingly challenging for the medical community. The current therapeutic concepts (surgical therapy or hormonal therapies) often do not lead to sufficient pain control, and late diagnosis and high recurrence rates mean that women affected by the disease can suffer for decades before receiving proper treatment. Although the introduction of certified endometriosis centers has created contact points for surgical therapies performed by endometriosis experts, these centers are not sufficient enough to offer the affected patients the all-encompassing long-term support they need.

In recent years, new findings regarding the pathogenesis and correlations of the pain phenomena caused by endometriosis have shown that conventional therapy strategies are not adequate and individual long-term concepts must be developed. Not only can endometriosis cause nociceptive pain, but it can also lead to a nociplastic reaction with central sensitization. Hence, aside from the classic cyclic complaints, patients increasingly suffer from atypical pain.

Due to the high number of affected patients who are treated inadequately, it is necessary for gynecologists in private practices to become familiarized with multimodal treatment concepts, as they are the linchpin of patient care.

The Special Issue will provide an overview of treatment strategies for chronic symptomatic endometriosis. With this Special Issue, we hope to encourage submissions that discuss the current treatment strategies for chronic symptomatic endometriosis.

Prof. Dr. Sylvia Mechsner
Guest Editor

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Keywords

chronic pelvic pain
pelvic floor dysfunction
central sensitization
peripheral sensitization
neurogenic inflammation
hormonal treatment
multimodal treatment

Published Papers (12 papers)

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Research

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10 pages, 1606 KiB

Open AccessArticle

Improvement of Post-Operative Quality of Life in Patients 2 Years after Minimally Invasive Surgery for Pain and Deep Infiltrating Endometriosis

by Sophie Legendri, Marie Carbonnel, Anis Feki, Gaby Moawad, Gabrielle Aubry, Alexandre Vallée and Jean-Marc Ayoubi

J. Clin. Med. 2022, 11(20), 6132; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11206132 - 18 Oct 2022

Viewed by 1417

Abstract

This study addressed the improvement in the quality of life of patients 2 years after minimally invasive surgery for painful deep infiltrating endometriosis (DIE), evaluated with EHP-5 (Endometriosis Health Profile-5) scores and the intensity of dysmenorrhea and dyspareunia. This was a retrospective study, performed in a referral centre for endometriosis, between January 2010 and January 2019. EHP-5 scores were complete for 54 patients, and two subgroups were analysed: classic laparoscopy (CL) vs. robotic laparoscopy (RL), and conservative surgery (ConservS) vs. total surgery (TS). There was an important decrease in 2-year post-operative EHP-5 scores in the global population (pre-op: 61.36 (42.18–68.75) and 2-year post-op: 20.45 (0–38.06); p < 0.001). The Visual Analogic Scale (VAS) was also lower for dysmenorrhea (pre-op: 8 (7–9.75) vs. 2-year post-op: 3 (2–5.25); p < 0.001) and dyspareunia (pre-op: 6 (3.1–8.9) vs. 2-year post-op: 3 (0–6); p < 0.001). In the subgroup analysis, EHP-5 scores were improved in the RL group (pre-op: 65.9 (59.09–71.02) vs. 2-year post-op: 11.4 (0–38.06); p < 0.001) and the CL group (pre-op: 50 (34.65–68.18) vs. 2-year post-op: 27.27 (14.20–40.90); p < 0.001), with a slight advantage for RL (p = 0.04), and the same improvements were found for ConservS (pre-op: 61.4 (38.06–71.59) vs. 2-year post-op: 22.7 (11.93–38.07); p < 0.001) and TS groups (pre-op: 61.59 (51.70–68.75) vs. 2-year post-op: 13.63 (0–44.30); p < 0.001). Minimally invasive surgery improved the quality of life for DIE patients 2 years after surgery, and conservative surgery showed comparable results to total surgery. Full article

(This article belongs to the Special Issue Endometriosis: Current Perspectives on Diagnosis and Treatment)

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11 pages, 1355 KiB

Open AccessArticle

Association between Endometriosis, Irritable Bowel Syndrome and Eating Disorders: ENDONUT Pilot Study

by Alexandra Aupetit, Sébastien Grigioni, Horace Roman, Moïse Coëffier, Amélie Bréant, Clotilde Hennetier and Najate Achamrah

J. Clin. Med. 2022, 11(19), 5773; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11195773 - 29 Sep 2022

Cited by 2 | Viewed by 1978

Abstract

Background and aim: Irritable bowel syndrome (IBS), eating disorders (ED) and endometriosis share common pathophysiological mechanisms, involving alterations of the gut–brain axis. The aim of the ENDONUT pilot study was to investigate an association between these three diseases by screening for IBS and ED in patients with endometriosis. Method: We included patients from the CIRENDO cohort (Inter-Regional North-West Cohort of women with ENDOmetriosis) with a recent documented diagnosis of endometriosis of less than 4 years, regardless of age, date of onset of symptoms, type of endometriosis (digestive or not), with or without endometriosis-related digestive surgery. Validated questionnaires were used to screen for IBS (Rome IV, Francis score), ED (SCOFF-F, EAT-26), and anxiety/depression (HAD). Anthropometric data and lifestyle habits were also collected. The primary composite endpoint was SCOFF-F and ROME-IV scores. Results: Among 100 patients meeting inclusion criteria, 54 patients completed all the questionnaires. Of these, 19 had a positive SCOFF-F score (35.2%), 26 had a positive ROME-IV score (48.1%), and 14 patients (25.9%) had both a positive SCOFF-F score and a positive ROME-IV score (p = 0.006). Patients with positive SCOFF-F and ROME-IV scores had significantly higher HAD-anxiety and depression scores (p < 0.05). Conclusion: These results suggest a significant association between IBS, ED and endometriosis. The prevalence of IBS and ED in our population is higher than in the general population. Larger studies are needed to confirm these results, to better understand this triad, and to improve the diagnostic and multidisciplinary therapeutic management of these patients. Full article

(This article belongs to the Special Issue Endometriosis: Current Perspectives on Diagnosis and Treatment)

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11 pages, 1539 KiB

Open AccessArticle

Expression of Fucosyltransferase 4 (FUT4) mRNA Is Increased in Endometrium from Women with Endometriosis

by Marta Żeberkiewicz, Anna Hyc, Anna Iwan, Aneta Zwierzchowska, Aneta Ścieżyńska, Ilona Kalaszczyńska, Ewa Barcz and Jacek Malejczyk

J. Clin. Med. 2022, 11(19), 5606; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11195606 - 23 Sep 2022

Cited by 3 | Viewed by 2582

Abstract

Endometriosis is a common gynecological disorder defined as the presence of endometrial-like tissue (glands and stroma) outside the uterus. The etiopathogenesis of endometriosis is still poorly recognized. It is speculated that stage-specific embryonic antigen 1 (SSEA-1)-positive stem-like glandular epithelial cells may contribute to the development of the disease. The synthesis of SSEA-1 is mediated by fucosyltransferase 4 encoded by the FUT4 gene. Therefore, this study aimed to evaluate the specific expression of FUT4 mRNA in biopsies of the endometrium from women with and without endometriosis. FUT4 mRNA levels were examined in 49 women with laparoscopically confirmed endometriosis and 28 controls by means of quantitative reverse-transcription polymerase chain reaction (qRT-PCR). The expression of FUT4 mRNA was significantly increased in the endometrium of patients with endometriosis when compared to the controls (p < 0.0001). Expression of FUT4 mRNA in the endometrium was correlated with the severity of endometriosis (r_s = 0.5579, p < 0.0001); however, there were no differences in endometrial FUT4 mRNA expression when comparing endometriotic lesions from various locations. The discriminatory ability of FUT4 mRNA expression was evaluated by receiver-operating characteristics (ROC), which showed high statistical significance (AUC = 0.90, p < 0.0001), thus indicating that an increased level of endometrial FUT4 mRNA may serve as a specific marker for endometriosis. Full article

(This article belongs to the Special Issue Endometriosis: Current Perspectives on Diagnosis and Treatment)

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15 pages, 1294 KiB

Open AccessArticle

Factors Associated with Increased Analgesic Use in German Women with Endometriosis during the COVID-19 Pandemic

by Roxana Schwab, Kathrin Stewen, Tanja Kottmann, Mona W. Schmidt, Katharina Anic, Susanne Theis, Bashar Haj Hamoud, Tania Elger, Walburgis Brenner and Annette Hasenburg

J. Clin. Med. 2022, 11(19), 5520; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11195520 - 21 Sep 2022

Cited by 2 | Viewed by 1201

Abstract

(1) Background: Endometriosis is a frequent chronic pain condition in women of fertile age. Pain management with analgesics is frequently used by women with endometriosis. During the COVID-19 pandemic, access to health services was temporarily restricted in various countries for persons without serious conditions, resulting in increased physical and mental health issues. The present study was conducted in order to assess the risk factors predicting increased analgesic intake by women with endometriosis during the COVID-19 pandemic. (2) Methods: The increased intake of over-the-counter (OTC) and prescription-only (PO) analgesics was assessed with an anonymous online questionnaire, along with demographic, pandemic-specific, disease-specific, and mental health characteristics. Anxiety and depression were assessed with the Generalized Anxiety Disorder Scale (GAD-2) and the Patient Health Questionnaire for Depression (PHQ-2), respectively. Pain-induced disability was assessed with the pain-induced disability index (PDI). (3) Results: A high educational level (OR 2.719; 95% CI 1.137–6.501; p = 0.025) and being at higher risk for depressive disorders, as measured by PHQ-2 ≥ 3 (OR 2.398; 95% CI 1.055–5.450; p = 0.037), were independent risk factors for an increased intake of OTC analgesics. Current global pain-induced disability (OR 1.030; 95% CI 1.007–1.054; p = 0.010) was identified as a risk factor for an increased intake of PO pain medication. The degree of reduction in social support and in social networks were independent predictors of an increased intake of PO analgesics in a univariate logistic regression analysis, but lost significance when adjusted for additional possible influencing factors. (4) Conclusions: In this population, an increased intake of OTC analgesics was related to a higher educational level and having a depressive disorder, while a higher pain-induced disability was an independent risk factor for an increased intake of PO analgesics. Pandemic-specific factors did not significantly and independently influence an increased intake of analgesics in women with endometriosis during the first wave of the COVID-19 pandemic in Germany. Healthcare providers should be aware of the possible factors related to increased analgesic use in women with endometriosis in order to identify persons at risk for the misuse of pain medication and to prevent potential adverse effects. Full article

(This article belongs to the Special Issue Endometriosis: Current Perspectives on Diagnosis and Treatment)

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12 pages, 3534 KiB

Open AccessArticle

Transvaginal Ultrasound Combined with Strain-Ratio Elastography for the Concomitant Diagnosis of Uterine Fibroids and Adenomyosis: A Pilot Study

by Vlăduț Săsăran, Sabin Turdean, Claudiu Mărginean, Marius Gliga, Levente Ilyes, Ovidiu Grama and Lucian Pușcașiu

J. Clin. Med. 2022, 11(13), 3757; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11133757 - 28 Jun 2022

Cited by 5 | Viewed by 2224

Abstract

Uterine fibroids (UFs) and adenomyosis (AM) represent two benign uterine conditions that can affect fertility and are most frequently commonly responsible for abnormal uterine bleeding and chronic pelvic pain. Their differential diagnosis still represents a challenge, and several authors advise the addition of elastography to transvaginal ultrasound (TVUS) for a more accurate imagistic recognition. Through this study, we aimed to assess the diagnostic accuracy of TVUS combined with strain-ratio elastography (SRE) in concomitant AM and UFs. We conducted a study on 17 patients diagnosed with concomitant UFs and AM undergoing hysterectomy and 46 healthy patients. TVUS combined with SRE was conducted in each patient, focusing on identifying rigidity patterns of the lesions. Significantly higher mean SR and maximum SR values were identified among both AM and UF lesions as opposed to controls (p < 0.01), with the highest tissue stiffness being encountered among AM lesions, which allows for the differentiation of UF (p < 0.01) and concomitant identification of both lesions. These results are reflected by higher cut-off values obtained for AM, both for mean SR (5.42 vs. 2.85) and maximum SR (5.80 vs. 3.30). TVUS combined with SRE showed good diagnostic performance in identifying coexisting UFs and AM within the same uterine specimen. Future studies on wider populations are required to validate our findings. Full article

(This article belongs to the Special Issue Endometriosis: Current Perspectives on Diagnosis and Treatment)

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8 pages, 231 KiB

Open AccessArticle

Are the Stage and the Incidental Finding of Endometriosis Associated with Fallopian Tube Occlusion? A Retrospective Cohort Study on Laparoscopic Chromopertubation in Infertile Women

by Daniel Mayrhofer, John Preston Parry, Marlene Hager, Klara Beitl, Christine Kurz and Johannes Ott

J. Clin. Med. 2022, 11(13), 3750; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11133750 - 28 Jun 2022

Cited by 2 | Viewed by 1320

Abstract

Endometriosis seems to have a strong negative effect on female fertility. The aim of this study was to assess the rate of tubal occlusion diagnosed via laparoscopic chromopertubation in infertile women with endometriosis and compare the results to infertile women without endometriosis. In this retrospective cohort study, 275 infertile women with endometriosis and 49 infertile women without endometriosis undergoing diagnostic laparoscopy for primary or secondary infertility with chromopertubation at the Medical University of Vienna between January 2012 and December 2020 have been investigated. During the laparoscopic assessment of tubal patency, significantly more fallopian tubes were occluded in the endometriosis group compared to the control group (25.8 versus 15.3%; p = 0.029). Unilateral and bilateral occlusion was found significantly more often in patients with endometriosis (p = 0.021). In the multivariate analysis, only the rASRM stage (the revised classification of endometriosis by the American Society for Reproductive Medicine) showed a significant association with bilateral occlusion (OR 1.400, 95%CI: 1.018–1.926; p = 0.038). Both a higher rASRM stage (OR 2.181, 95%CI: 1.191–3.995; p = 0.012) and secondary infertility (OR 1.514, 95%CI: 1.156–1.983; p = 0.003) were associated with an increased risk for any kind of fallopian tube occlusion. Endometriosis seems to be associated with an increased risk for fallopian tube occlusion. The rate of tubal occlusion increased significantly with the rASRM stage. Full article

(This article belongs to the Special Issue Endometriosis: Current Perspectives on Diagnosis and Treatment)

14 pages, 978 KiB

Open AccessArticle

Chronic Pelvic Pain in Endometriosis: Cross-Sectional Associations with Mental Disorders, Sexual Dysfunctions and Childhood Maltreatment

by Johanna Netzl, Burkhard Gusy, Barbara Voigt, Jalid Sehouli and Sylvia Mechsner

J. Clin. Med. 2022, 11(13), 3714; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11133714 - 27 Jun 2022

Cited by 11 | Viewed by 1593

Abstract

The aim of this cross-sectional study was to compare the rates of mental disorders, sexual dysfunctions and childhood maltreatment (CM) in women with endometriosis with either chronic pelvic pain (CPP) or minimal to no pelvic pain. Additionally, two models to predict a current mental disorder were tested, including pelvic-pain-related or psychosocial predictor variables. We examined 100 women with confirmed endometriosis (group CPP, n = 50; group NOPAIN, n = 50). Participants responded to a comprehensive questionnaire and the Childhood Trauma Questionnaire. The Diagnostic Interview for Mental Disorders was used to assess mental disorders according to DSM-5 and to screen for sexual dysfunctions. The mean age was 28.8 ± 5.6 (CPP)/2.7 ± 6.3 (NOPAIN). Participants with CPP had higher rates of current mental disorders (p = 0.019), lifetime mental disorders (p = 0.006) and sexual dysfunctions (p < 0.001), but not CM (p = 0.074). In two binary-logistic regression analyses, a greater need for pain relief (aOR = 4.08, p = 0.026) and a sexual dysfunction (aOR = 2.69, p = 0.031) were significant predictors for a current mental disorder. Our findings confirmed the crucial role of pelvic pain for mental and sexual well-being in endometriosis. They highlight the need for pain relief and interdisciplinary care in the treatment of endometriosis. Full article

(This article belongs to the Special Issue Endometriosis: Current Perspectives on Diagnosis and Treatment)

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10 pages, 284 KiB

Open AccessArticle

Evaluation of Women’s Age and Ultrasonographic Features to Choose Surgical Treatment for Endometriosis Associated with Ovarian Cancer

by Alicia Hernández, Angela Sanz, Emanuela Spagnolo, María Carbonell, Elena Rodríguez, Ana López, Riccardo Raganato, Simona Del Forno and David Ramiro-Cortijo

J. Clin. Med. 2022, 11(9), 2414; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11092414 - 25 Apr 2022

Cited by 5 | Viewed by 1709

Abstract

Adequate surgical management of malignant endometriosis remains a clinical challenge in gynecology. Age, sonography variables, and tumor biomarkers have been reported as candidates in the clinical decision. This study aims were to analyze the factors of women’s age, body mass index, ultrasound features, and tumor biomarkers to predict endometriosis-associated ovarian cancer in a large series of endometriomas and to study the surgical treatment performed in this cohort. In this retrospective study, we reviewed the medical records of patients with ultrasound diagnosis of ovarian cyst classified as endometrioma (benign as well as with risk of malignancy), surgically treated in the endometriosis unit of Hospital Universitario La Paz (Madrid, Spain) between January 2019 and July 2021. According to the final histology examination, the women were clustered as non-endometriosis-associated ovarian cancer (OE, benign endometriomas, n = 59) and endometriosis-associated ovarian cancer (EAOC) (n = 17). Demographic, clinical, and surgical data were collected from these women. International Ovarian Tumor Analysis (IOTA) criteria were assessed for the ultrasound examination. The age of the women in the EAOC group was 50.0 [43.0; 63.0] years, which was significantly higher than OE (39.0 [34.0; 46.0] years; p-value < 0.001). In addition, the body mass index for the OE group (24.9 ± 5.3 kg/m²) was significantly higher than for the EAOC group (23.3 ± 4.6 kg/m²; p-value < 0.001). However, the tumor biomarker levels (CA 125, CA 19.9 and He4) were not significantly different among the groups. We performed 51.4% cystectomies and 48.6% adnexectomies, with an association between the adnexectomy and EAOC group (p-value < 0.001). In addition, a significant association was found between ultrasound features suspicious for malignancy and the EAOC group. Conclusively, women’s age and ultrasound features, such as papillary projections, septa, and positive echo-Doppler, were the main factors to consider when evaluating the malignancy risk associated with endometriosis. Full article

(This article belongs to the Special Issue Endometriosis: Current Perspectives on Diagnosis and Treatment)

9 pages, 451 KiB

Open AccessArticle

Postoperative Pain Is Driven by Preoperative Pain, Not by Endometriosis

by Panagiotis Kanellos, Konstantinos Nirgianakis, Franziska Siegenthaler, Christian Vetter, Michael D. Mueller and Sara Imboden

J. Clin. Med. 2021, 10(20), 4727; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10204727 - 15 Oct 2021

Cited by 3 | Viewed by 1838

Abstract

(1) Background: The aim of this study was to evaluate the impact of endometriosis on postoperative pain following laparoscopic hysterectomy; (2) Methods: A total of 214 women who underwent a laparoscopic hysterectomy between January 2013 and October 2017 were divided into four subgroups as follows: (1) endometriosis with chronic pain before the surgery (n = 57); (2) pain-free endometriosis (n = 50); (3) pain before the surgery without endometriosis (n = 40); (4) absence of both preoperative pain and endometriosis (n = 67). Postoperative pain was compared by using Visual Analog Scale (VAS) scores and by tracking the use of painkillers during the day of surgery and the first two postoperative days; (3) Results: Women with chronic pain before the surgery reported higher VAS scores during the first postoperative days, while the use of analgesics was similar across the groups. There was no difference in the postoperative pain when comparing endometriosis patients to non-endometriosis patients; (4) Conclusions: Women with chronic pelvic pain demonstrated increased postoperative pain after laparoscopic hysterectomy, which was independent of the presence or severity of endometriosis. The increased VAS scores did not, however, translate into equally greater use of painkillers, possibly due to the standardised protocols of analgesia in the immediate postoperative period. These findings support the need for careful postsurgical pain management in patients with pain identified as an indication for hysterectomy, independent of the extent of the surgery or underlying diagnosis. Full article

(This article belongs to the Special Issue Endometriosis: Current Perspectives on Diagnosis and Treatment)

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Review

Jump to: Research

7 pages, 244 KiB

Open AccessReview

The Role of Visceral Therapy in the Sexual Health of Women with Endometriosis during the COVID-19 Pandemic: A Literature Review

by Tomasz Gozdziewicz, Grazyna Jarzabek-Bielecka, Dawid Luwanski, Malgorzata Wojcik, Katarzyna Plagens-Rotman, Malgorzata Mizgier, Magdalena Pisarska-Krawczyk and Witold Kedzia

J. Clin. Med. 2022, 11(19), 5825; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11195825 - 30 Sep 2022

Cited by 3 | Viewed by 1831

Abstract

Patients with endometriosis had limited possibilities for contemporary diagnosis and treatment during the SARS-CoV-2 (COVID-19) pandemic. Surgeries that may have eliminated pain or restored fertility were postponed. Endometriosis may affect the vagina, peritoneum, bladder, or other organs outside the pelvis and impact women’s sexual health, especially during pandemics. Holistic care of patients is crucial to improving their lives and sexual health. A scoping review was conducted to analyze the relevant literature in light of our experience in gynecology and physiotherapy during the COVID-19 pandemic. Full article

(This article belongs to the Special Issue Endometriosis: Current Perspectives on Diagnosis and Treatment)

11 pages, 1714 KiB

Open AccessReview

Endometriosis, an Ongoing Pain—Step-by-Step Treatment

by Sylvia Mechsner

J. Clin. Med. 2022, 11(2), 467; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11020467 - 17 Jan 2022

Cited by 30 | Viewed by 9909

Abstract

Endometriosis is a disease that is becoming more and more challenging for the medical community. The current therapeutic concepts (surgical therapy and/or hormonal therapies) often do not lead to sufficient pain control, and late diagnosis and high recurrence rates mean that women affected by the disease can suffer for decades before receiving proper treatment. Although the introduction of certified endometriosis centers has created contact points for surgical therapies performed by endometriosis experts, these centers are not sufficient to offer the affected patients the all-encompassing long-term support they need. In recent years, new findings regarding the pathogenesis and correlations of the pain phenomena caused by endometriosis have shown that conventional therapy strategies are not adequate and individual long-term concepts must be developed. Not only can endometriosis cause nociceptive pain, but it can also lead to a nociplastic reaction with central sensitization. Hence, aside from the classic cyclic complaints, patients increasingly suffer from atypical pain. Due to the high number of affected patients who are treated inadequately, it is necessary for gynecologists in private practices to become familiar with multimodal treatment concepts since they are the central point of contact of their patients. The following article will provide an overview of treatment strategies for chronic symptomatic endometriosis. Full article

(This article belongs to the Special Issue Endometriosis: Current Perspectives on Diagnosis and Treatment)

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12 pages, 743 KiB

Open AccessReview

Deep Infiltrating Endometriosis and Adenomyosis: Implications on Pregnancy and Outcome

by Teresa Mira Gruber, Laura Ortlieb, Wolfgang Henrich and Sylvia Mechsner

J. Clin. Med. 2022, 11(1), 157; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11010157 - 29 Dec 2021

Cited by 1 | Viewed by 6089

Abstract

Endometriosis (EM), especially deep infiltrating endometriosis (DIE) and adenomyosis (AM), are known to cause pain and sterility in young women. More recently, they have also been described as risk factors for obstetric complications. While the pathophysiology is not yet completely understood, they seem to share a common origin: archimetrosis. Methods: A systematic literature review was conducted to summarize the existing evidence on DIE and AM as risk factors for obstetric complications. Results: Preterm birth, caesarean section delivery (CS) and placental abnormalities are associated with the diagnosis of DIE and AM. Women with AM seem to experience more often hypertensive pregnancy disorders, premature rupture of membranes and their children are born with lower birth weights than in the control groups. However, many of the studies tried to evaluate AM, EM and DIE as separate risk factors. Moreover, often they did not adjust for important confounders such as multiple pregnancies, parity, mode of conception and maternal age. Therefore, prospective studies with larger numbers of cases and appropriate adjustment for confounders are needed to explore the pathophysiology and to prove causality. Full article

(This article belongs to the Special Issue Endometriosis: Current Perspectives on Diagnosis and Treatment)

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