Prevalence of Endometriosis During Abdominal or Laparoscopic Hysterectomy for Chronic Pelvic Pain

Mowers, Erika L.; Lim, Courtney S.; Skinner, Bethany; Mahnert, Nichole; Kamdar, Neil; Morgan, Daniel M.; As‐Sanie, Sawsan

doi:10.1097/aog.0000000000001422

Cited by 89 publications

(57 citation statements)

References 26 publications

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“…Worldwide prevalence rates range between 5.7 and 26.6% [2]. Endometriosis is the presence of endometrial tissue outside the uterine cavity and is the most common cause of CPP [3] with 24 to 40% of women with CPP diagnosed with endometriosis [4, 5]. Endometriosis-related CPP includes a variety of pain symptoms including dysmenorrhea (period pain), dyspareunia (pain during sexual intercourse), dyschezia (pain on bowel motions) and dysuria (pain on urination).…”

Section: Introductionmentioning

confidence: 99%

Manual acupuncture plus usual care versus usual care alone in the treatment of endometriosis-related chronic pelvic pain: study protocol for a randomised controlled feasibility study

Armour

Smith

Schabrun

et al. 2017

Pilot Feasibility Stud

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BackgroundEndometriosis is the most common cause of chronic pelvic pain worldwide. Non-surgical treatments are effective for only 30–50% of women and have a significant side effect burden that leads to high discontinuation rates. Surgery can be effective but is expensive and invasive, and symptoms tend to recur within 5 years. There is early evidence that acupuncture may be effective in treating endometriosis-related chronic pelvic pain, showing clinically significant analgesia. Both levels of inflammation and pain processing have been shown to be altered in women with chronic pelvic pain. Acupuncture has been shown to reduce inflammation and change central pain processing in other conditions, but research on women with endometriosis is currently lacking. The aim of this feasibility study is to provide data on recruitment rates, retention, appropriateness of outcome measures, minimal clinically important difference in numeric rated scales for pain and the potential effect of acupuncture on pain processing and markers of inflammation in endometriosis-related CPP.MethodsWe will include women aged 18–45 years with a diagnosis of endometriosis via laparoscopy in the past 5 years. A total of 30 participants will be recruited and randomly allocated in a 1:1 ratio to receive acupuncture or usual care. Women in the acupuncture group will receive two 45-min treatment sessions per week for 8 weeks (total of 16 sessions). Women in the usual care group will continue with their current treatment regimen. The primary feasibility outcomes are recruitment rates, retention rates and the safety and acceptability of the intervention; secondary patient-centred outcomes include a change in 0–10 daily pelvic pain ratings, the Endometriosis Health Profile 30 (EHP-30) and changes in conditioned pain modulation, resting and task-related EEG activity and inflammatory markers. Analyses will be performed blind to group allocation.DiscussionThis is a two-armed, assessor blind, randomised controlled feasibility trial. Data will be compared at baseline and trial completion 8 weeks later. Outcomes from this feasibility study will inform a larger, fully powered clinical trial should the treatment show trends for potential effectiveness.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12617000053325 (http://www.ANZCTR.org.au/ACTRN12617000053325.aspx).Electronic supplementary materialThe online version of this article (doi:10.1186/s40814-017-0152-9) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Manual acupuncture plus usual care versus usual care alone in the treatment of endometriosis-related chronic pelvic pain: study protocol for a randomised controlled feasibility study

Armour

Smith

Schabrun

et al. 2017

Pilot Feasibility Stud

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“…The data was based on assessments given by experienced senior consultants working in centers which participated in QS ENDO Real and suggests that many measures recommended as the gold standard of treatment in national and international guidelines are not being implemented in the DACH region. Assuming that the participating centers are institutions which at least engage with the clinical picture and symptoms of endometriosis and are involved in promoting the best possible treatment, then the percentage of centers implementing recommended measures in the other 2 2 ⁄3 3 of departments is likely to be considerably lower.…”

Section: Discussionmentioning

confidence: 99%

“…Endometriosis affects approximately 10-15 % of premenopausal women [1,2]. Patients commonly suffer from cycle-related pain but also report non-cycle-related discomfort.…”

Section: Introductionmentioning

confidence: 99%

QS ENDO Real – A Study by the German Endometriosis Research Foundation (SEF) on the Reality of Care for Patients with Endometriosis in Germany, Austria and Switzerland

Zeppernick¹,

Zeppernick²,

Janschek³

et al. 2020

Geburtshilfe Frauenheilkd

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Endometriosis affects a significant number of young premenopausal women. Quite apart from the medical challenges, endometriosis is a relevant burden for healthcare and social security systems. Standardized quality indicators for the treatment of endometriosis have not previously been systematically verified. The three-stage study QS ENDO was initiated to record and improve the reality and quality of care. One of its aims is to create quality indicators for the diagnosis and treatment of endometriosis. For the first stage of QS ENDO Real, letters were sent to all 1014 gynecological departments in the German-speaking area of Europe (the DACH region) which included a questionnaire as a means of surveying the current state of care. A total of 296 (29.2%) of the centers which received the questionnaire participated in the survey. The subsequent evaluation of the completed questionnaires showed that the majority of patients with endometriosis (around 60%, based on estimates from the data) are not treated in hospitals which have been certified by the SEF. The guidelines recommend the use of specific classification systems (rASRM, ENZIAN) but, depending on the level of care offered by the hospital, only around 44.4 to 66.4% of departments used the rASRM score and only 27% of hospitals used the ENZIAN classification system to describe deep-infiltrating endometriosis. When taking patientsʼ medical history, some centers (6.6 – 17.9%) considered questions about leading symptoms such as dyschezia, dysuria and dyspareunia to be unimportant. QS ENDO Real has made it possible, for the first time, to get an overview of the reality of care provided to patients with endometriosis in the German-speaking areas of Europe. The findings indicate that several of the measures recommended in international guidelines as the gold standard of care are only used to treat some of the patients. In this respect, more efforts will be needed to provide more advanced training. The approach used for treatment must be guideline-based, also in not-certified centers, to improve the quality of care in the treatment of patients with endometriosis.

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“…8 A recent retrospective cohort study showed that prevalence of endometriosis in all patients undergoing abdominal or laparoscopic hysterectomy was approximately 15.2% and within chronic pelvic pain patients, 21.4% were noted to have endometriosis; patients with anticipated endometriosis had 42.8% confirmed postsurgically. 9 In another study of chronic pelvic pain patients treated surgically, endometriosis was present in 33%. 4 There is poor correlation between operative findings and histopathological diagnosis with a positive predictive value as low as 45% according to one study.…”

mentioning

confidence: 97%

“…These findings further increase the complexity of establishing a clear relationship between endometriosis and chronic pelvic pain as its sentinel symptom. 9,11 Therapies for endometriosis are directed mostly at symptomatic relief and will be discussed in more detail in a separate review. Typically, initial treatment of presumed endometriosis entails conservative medical therapy such as nonsteroidal anti-inflammatory drugs (NSAIDs) or hormonebased therapy such as combined estrogen and progestin methods, progestin-only methods, and gonadotropin-releasing hormone (GnRH) agonists.…”

mentioning

confidence: 99%

Surgical Management of Endometriosis in Patients with Chronic Pelvic Pain

Flyckt

Kim

Falcone³

2017

Semin Reprod Med

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Surgical approaches to endometriosis patients with chronic pelvic pain are multimodal and require individualization. Laparoscopic approaches are preferred over laparotomy when conservatively treating endometriosis via excision or ablation/fulguration of lesions. The available data support cystectomy over fenestration or fulguration for endometriomas; however, there may be associated decreases in ovarian reserve with endometrioma treatment. Presacral neurectomy may be useful in patients with midline pain and LUNA is not effective for the treatment of pelvic pain related to endometriosis. Appendectomy may be considered prophylactically at the time of the surgery for pelvic pain, although more studies are needed. For deep infiltrating endometriosis, the risks of aggressive bowel surgery must be weighed against the benefits of clear pain reduction. Postoperative medical suppressive therapy is strongly recommended to prolong symptom-free intervals of this chronic disease. As definitive therapy, hysterectomy can be helpful especially when combined with endometriosis excision. When performing hysterectomy, bilateral oophorectomy should be given careful consideration, as this procedure leads to premature surgical menopause and may not decrease the possibility of reoperation and persistence of symptoms in patients aged 30 to 39 years with chronic pain.

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Prevalence of Endometriosis During Abdominal or Laparoscopic Hysterectomy for Chronic Pelvic Pain

Abstract: Fewer than 25% of women undergoing laparoscopic or abdominal hysterectomy for chronic pelvic pain have endometriosis at the time of surgery.

Cited by 89 publications

References 26 publications

Manual acupuncture plus usual care versus usual care alone in the treatment of endometriosis-related chronic pelvic pain: study protocol for a randomised controlled feasibility study

Manual acupuncture plus usual care versus usual care alone in the treatment of endometriosis-related chronic pelvic pain: study protocol for a randomised controlled feasibility study

QS ENDO Real – A Study by the German Endometriosis Research Foundation (SEF) on the Reality of Care for Patients with Endometriosis in Germany, Austria and Switzerland

Surgical Management of Endometriosis in Patients with Chronic Pelvic Pain

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