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OBJECTIVE To quantify the impact of endometriosis-related symptoms on physical and mental health status, health-related quality of life (HRQoL), and work-related aspects (absenteeism, presenteeism, work productivity, activity impairment). DESIGN Cross-sectional quantitative study. SETTING Academic and research institution. PATIENT(S) Women (n=193) with self-reported surgically diagnosed endometriosis from the Endometriosis Patient Registry at Ponce School of Medicine and Health Sciences (PSMHS). INTERVENTION(S) Patients completed an anonymous questionnaire divided into three sections consisting of questions from the Patient Health Survey (SF-12®), the Endometriosis Health Profile (EHP-5), and the Work Productivity and Activity Impairment Survey (WPAI). MAIN OUTCOME MEASURE(S) Impact of endometriosis symptoms on physical and mental health status, health-related quality of life (HRQoL), absenteeism, presenteeism, work productivity and activity impairment was quantified. RESULTS Patients had SF-12 scores denoting significant disability in the phyisical and mental health components. They also reported an average of 7.41 hrs (approximately one working day) of work time loss during the week the symptoms are worse. In addition, WPAI scores show high impact on work-related domains: 13% of average loss in work time (absenteeism), 65% of their work was impaired (presenteeism), 64% loss in efficiency levels (work productivity loss), and 60% of daily activities perturbed (activity impairment). CONCLUSION Endometriosis symptoms such as chronic, incapacitating pelvic pain and infertility negatively and substantially impact the physical and mental health status, HRQoL, and productivity at work of patients with endometriosis.

Epigenetic mechanisms have been ascribed important roles in endometriosis. Covalent histone modifications at lysine residues have been shown to regulate gene expression and thus contribute to pathological states in many diseases. In endometriosis, histone deacetylase inhibition (HDACi) resulted in reactivation of E-cadherin, attenuation of invasion, decreased proliferation of endometriotic cells, and caused lesion regression in an animal model. This study was conducted to assess basal and hormoneregulated gene expression levels of HDAC1 and HDAC2 (HDAC1/2) in cell lines and protein expression levels in tissues. Basal and steroid hormone-regulated HDAC1/2 gene expression levels were determined by quantitative polymerase chain reaction in cell lines and tissues. Protein levels were measured by immunohistochemistry (IHC) in tissues on an endometriosis tissue microarray (TMA). Basal HDAC1/2 gene expression levels were significantly higher in endometriotic versus endometrial stromal cells, which was confirmed by Western blot analysis. Estradiol (E2) and progesterone (P4) significantly downregulated HDAC1 expression in endometrial epithelial cells. Levels of HDAC2 were upregulated by E2 and downregulated by E2 þ P4 in endometrial stromal cells. Hormone modulation of HDAC1/2 gene expression was lost in the endometriotic cell line. Immunohistochemistry showed that HDAC1/2 proteins were expressed in a substantial proportion of lesions and endometrium from patients, and their expression levels varied according to lesion localization. The highest proportion of strong HDAC1 immunostaining was seen in ovarian, skin, and gastrointestinal lesions, and of HDAC2 in skin lesions and endometrium from patients with endometriosis. These studies suggest that endometriosis etiology may be partially explained by epigenetic regulation of gene expression due to dysregulations in the expression of HDACs.

Objective-To determine the prevalence of endometriosis and its symptoms in a Puerto Rican cohort, and to describe the menstrual, obstetric, and clinical profiles of the women.Methods-A self-administered questionnaire was given to 1285 Puerto Rican women. Categorical variables were compared using χ 2 analysis or Fisher exact test.Results-There were 57 self-reported cases of endometriosis (48 surgically confirmed) among 1193 valid questionnaires, for a point prevalence of 4.0%. A diagnosis of endometriosis was significantly associated with dysmenorrhea, dyspareunia, and chronic pelvic pain, but not with menstrual cycle characteristics. Undiagnosed women commonly reported signs and symptoms of endometriosis.Conclusions-The estimated prevalence of endometriosis in Puerto Rico is 4.0%, comparable to what has been reported in other populations. Endometriosis symptoms were common in the population surveyed, indicating the need for increased awareness and development of public health policies leading to early diagnosis and appropriate management.

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This study was conducted to assess genetic associations to endometriosis in a Puerto Rican population. Significant differences in allelic frequencies and genotype distribution of genetic variants in LOXL4 and C3 were documented in patients with endometriosis-associated infertility vs controls, and in patients with endometriosis vs controls, respectively, and in women having the risk genotype at both SNPs, the estimated risk for endometriosis nearly doubled.

Purpose To describe lifetime differences in clinical characteristics of women with endometriosis between the USA and Puerto Rico. Methods A descriptive study using self-administered demographic and clinical questionnaires was undertaken. Women with self-reported surgically diagnosed endometriosis who completed questionnaires from the Endometriosis Association (EA), Wisconsin, USA (n = 4358) and the Endometriosis Research Program (ERP) in Puerto Rico (n = 878), were included in this study. We compared demographic, gynecological and clinical history, frequency of endometriosis-associated symptoms and co-morbidities. Results Although both groups have similar symptomatology, EA respondents had significantly higher rates of chronic pelvic pain and incapacitating pain than ERP participants. EA respondents were significantly more likely to report a history of problems getting pregnant, heavy bleeding, and hysterectomy than ERP respondents. Miscarriages were more frequently reported by the ERP group. Co-morbidities such as allergies, chronic fatigue syndrome, and fibromyalgia were more prevalent in EA respondents, whereas asthma was significantly more frequent in participants from ERP. Conclusions Overall, women with endometriosis from the USA and Puerto Rico reported high rates of pain and infertility and a similar spectrum of symptoms. Those from the EA reported longer time to diagnosis, and diagnostic delays than those from the ERP, which may explain the observed increased in rates of endometriosis-related symptoms and co-morbidities in EA as compared to ERP.

Problem: Associations between immune dysfunction conditions (eg, systemic lupus erythematous, rheumatoid arthritis) and endometriosis have been observed in adult women, but not assessed among a younger population. We investigated the association between immune-mediated conditions and endometriosis among young women. Method of Study:This cross-sectional analysis in the Women's Health Study: From Adolescence to Adulthood included 551 participants with surgically diagnosed endometriosis (median age=19) and 652 controls without endometriosis (median age=24). Participants completed an expanded Endometriosis Phenome and Biobanking Harmonization Project questionnaire. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) to investigate the associations between autoimmune/inflammatory, atopic, chronic pain/fatigue, and endocrine disorders with endometriosis, adjusting for confounders.Results: Participants with any autoimmune and/or inflammatory condition had an increased odds of co-occurring endometriosis (OR: 1.87; CI: 0.92-3.80), as did par-