Treatment strategies for pelvic pain associated with adenomyosis

Radzinsky, V.E.; Хамошина, М.Б.; Носенко, Е. Н.; Духин, А. О.; Sojunov, M A; Оразмурадов, А. А.; Lebedeva, M. G.; Оразов, М Р

doi:10.1080/09513590.2016.1232673

Cited by 24 publications

(17 citation statements)

References 7 publications

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“…A comparative analysis of the number of macrophages in the myometrium in patients of the main group and the control group showed increased recruitment of these cells in adenomiosis complicated by the development of syndrome of pelvic pain. Moreover, CD68-positive cells were associated not only with areas of ectopic endometrial growth, but also the perivascular region and is the carrier of the nerves and center of the remodeling processes in the uterine wall in this pathology, as we have shown in previous studies [11,12].…”

Section: Resultssupporting

confidence: 74%

Immune-inflammatory predictors of the pelvic pain syndrome associated with adenomyosis

Оразов

Radzinsky

Носенко

et al. 2017

Gynecological Endocrinology

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The aim of the study was the analysis of immune inflammatory processes in the development of the pelvic pain syndrome associated with adenomyosis. For morphological examination were used 54 fragments of the myometrium obtained from patients after hysterectomy with pelvic pain on a background of diffuse adenomyosis of II-III degree, and 20 patients with painless form of adenomyosis. The identification of the macrophages distribution was held by means of an immune-hysto-chemical analysis of MAT (monoclonal antibody) for CD68. (Clone PG-M1, 'Diagnostic BioSystems', USA). The results of the study showed a significantly higher expression of CD68 (49.3 ± 2.3 vs. 21.2 ± 1.7 units. p < .01) in patients with painful adenomyosis form in areas of the ectopic endometrium, in the perivascular regions of the myometrium, as compared to those areas in women with painless group. We assume that these factors increase neurogenic inflammation and sensitivity of nociceptors in myometrium, activation of peripheral nerve fibers and, can act as triggers of the pelvic pain syndrome associated with adenomyosis.

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Section: Resultssupporting

confidence: 74%

Immune-inflammatory predictors of the pelvic pain syndrome associated with adenomyosis

Оразов

Radzinsky

Носенко

et al. 2017

Gynecological Endocrinology

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“…Furthermore, in our models, pre-operative dysmenorrhea is associated with higher risk of failure and surgical re-intervention. Adenomyosis has been suggested to be a factor influencing the increased occurrence of (post-ablation) pelvic pain [35][36][37][38]. Pain is a subjective outcome measure.…”

Section: Explaining the Modelsmentioning

confidence: 99%

“…On the one hand, the level of pain can be explained by the coping mechanism of the patient; on the other hand, if a patient experiences many pre-operative complaints, the cause can be multifactorial (e.g. coping, dysmenorrhea, adenomyosis, endometriosis [37][38][39][40][41]. Performing ablation in patients with a certain extent of uterine pathology (fibroids, adenomyosis) can be seen as a risk for success of therapy [2,34,41,42].…”

Section: Explaining the Modelsmentioning

confidence: 99%

Prediction of unsuccessful endometrial ablation: a retrospective study

et al. 2019

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Background: Endometrial ablation (EA) is a frequently used treatment for abnormal uterine bleeding, mainly due to the low risks, low costs and short recovery time associated with the procedure. On the short term, it seems successful, long-term follow-up however, shows decreasing patient satisfaction as well as treament efficacy. There even is a postablation hysterectomy rate up to 21%. Multiple factors seem to`influence the outcome of EA. Due to dissimilarities in and variety of these factors, it has not been possible so far to predict the success rate of EA based on pre-operative factors. Therefore, the aim of this study is to develop two prediction models to help counsel patients for failure of EA or necessity of surgical re-intervention within 2 years after EA. Methods: We designed a retrospective two-centred cohort study in Catharina Hospital, Eindhoven and Elkerliek Hospital, Helmond, both non-university teaching hospitals in the Netherlands. The study population consisted of 446 pre-menopausal women who underwent EA for abnormal uterine bleeding, with a minimum follow-up time of 2 years. Multivariate logistic regression analysis was used to create the prediction models. Results: The mean age of the patients was 43.8 years (range 20-55), 97.3% had complaints of menorrhagia, 57.4% of dysmenorrhoea and 61.0% had complaints of intermittent or irregular bleeding. 18.8% of patients still needed a hysterectomy after EA. The risk of re-intervention was significantly greater in women with menstrual duration > 7 days or a previous caesarean section, while pre-operative menorrhagia was significantly associated with success of EA. Younger age, parity ≥ 5 and dysmenorrhea were significant multivariate predictors in both models. These predictors were used to develop prediction models, which had a C-index of 0.71 and 0.68 respectively. Conclusion: We propose two multivariate models to predict the chance of failure and surgical re-intervention within 2 years after EA. Due to the permanent character of EA, the increasing number of post-operative failure and re-interventions, these prediction models could be useful for both the doctor and patient and may contribute to the shared decision-making.

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“…Unlike the Maguire study, participants in present study predominantly chose hormonal IUDs which is known to be a treatment for cyclic pelvic pain associated with dysmenorrhea, endometriosis and adenomyosis. 8,9,10 The popularity of hormonal IUDs in present study may have contributed to the higher rate of IUD retention among participants with a history of pelvic pain, although not statistically significant. Additionally, unlike Maguire et al, present study did not differentiate dysmenorrhea from chronic and non-cyclic forms of pelvic pain.…”

Section: Discussionmentioning

confidence: 58%

Pelvic pain and early IUD discontinuation: a prospective cohort study

Gerber

Natell

Doty

et al. 2019

Int J Reprod Contracept Obstet Gynecol

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Background:The aim of the study is to assess if pelvic pain is a risk factor for intrauterine device (IUD) discontinuation within one year of placement. Methods: This is a prospective cohort study of women who had IUDs inserted at a family planning office for the primary intent of contraception. Baseline pelvic pain characteristics were assessed using a validated pelvic pain questionnaire. Women were contacted at 1 year to assess IUD continuation. Results: From authors enrolled a sample of 179 women. Of the 179 enrolled,163 participants completed the questionnaire, 98 reported a history of baseline pelvic pain and 65 reported no history of baseline pelvic pain. 20 participants were lost to follow-up. 86 women in the pelvic pain and 57 in the no pelvic pain group were included in the final analysis. Discontinuation rates at one year follow up were 25.6% (22) and 35.1% (20) respectively. There was no significant difference in those with and without pelvic pain discontinuing IUDs at one year (p = 0.22). Conclusions: Baseline generalized pelvic pain may not be a risk factor for IUD discontinuation within one year of placement.

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Treatment strategies for pelvic pain associated with adenomyosis

Cited by 24 publications

References 7 publications

Immune-inflammatory predictors of the pelvic pain syndrome associated with adenomyosis

Immune-inflammatory predictors of the pelvic pain syndrome associated with adenomyosis

Prediction of unsuccessful endometrial ablation: a retrospective study

Pelvic pain and early IUD discontinuation: a prospective cohort study

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