PELVIC PAIN

Laparoscopic surgery especially benefits endometriosis patients with pelvic pain

Laparoscopic surgery especially benefits endometriosis patients with pelvic pain

Patients with severe endometriosis and pelvic pain show the most pronounced improvements in quality of life within one year after undergoing laparoscopic surgery, a new study reports.

Laparoscopic surgery is the current gold standard to treat endometriosis. A small incision is made to allow a tool called a laparoscope, coupled with a small camera, to go inside the abdomen to guide the removal of endometriosis lesions.

Although surgery has the potential to reduce pain and improve patients’ quality of life, it is crucial to evaluate how surgery is affecting physical and mental health as well as patients’ social well-being.

Endometriosis often causes chronic pelvic pain, severe pain during menstruation (dysmenorrhea), and pain during sex (dyspareunia). Other non-gynecologic symptoms include constipation, diarrhea, and rectal bleeding. Together, these symptoms have a significant impact on patients’ quality of life.

In order to investigate which factors led to changes in patients’ quality of life, a team of researchers analyzed 981 patients from five districts in the Auvergne region of France who underwent laparoscopic treatment between 2004 and 2012.

Enrolled participants, ages 15-50, had received laparoscopic surgery or been newly diagnosed with a histological confirmation of endometriosis.

The team compared quality of life prior to surgery and one year after surgery using the 36-Item Short Form (SF-36) questionnaire, data on presence or absence of specific symptoms, and intensity of pain. Improvement in quality of life was measured using effect size method (ES), in which a value of 0.8 or higher corresponds to a significant improvement.

The SF-36 consists of eight sections covering physical functioning, energy/fatigue, bodily pain, role limitations due to physical health, general health perception, social functioning, role limitations due to emotional problems, and emotional well-being. The lower the score in the questionnaire, the greater the disability.

In total, 44% of patients with endometriosis and chronic pelvic pain had an improvement in quality of life equal to or above 0.8 ES compared to 23% of patients without pain who had similar ES scores.

Moreover, 47% of patients with stage 4 endometriosis had an ES score above 0.8, whereas only 26%, 31%, and 27.5% of patients in stage I, II, and III respectively had a similar improvement in quality of life.

Researchers observed that patients with chronic pelvic pain were more likely to improve their quality of life after surgery compared to those without it. Fertile patients also were more likely to improve quality of life compared to infertile patients.

Mental health of patients with chronic pelvic pain was also improved after surgery compared to patients without pain.

Similarly, patients with anxiety also showed better mental score compared to non-anxious patients.

Overall, researchers found that chronic pelvic pain was the most significant factor in predicting patients’ improvement in quality of life after surgery.

Patients presenting with severe endometriosis and who experience higher levels of pain are more likely to show improvement in [quality of life] after surgery,” researchers said.

[Chronic pelvic pain] is the most significant independent predictive factor for changes in QoL scores,” the study concluded.

The study, “Identification of predictive factors in endometriosis for improvement in patient quality of life,” was published in the Journal of Minimally Invasive Gynecology.

Read more: https://www.sciencedirect.com/science/article/pii/S1553465019302274?via%3Dihub

 

Endometriosis diagnosis takes 7 to 12 years

Endometriosis diagnosis takes 7 to 12 years

Endometriosis may affect all aspects of a woman’s life, including sexual relations, social activities, emotional well-being and work productivity.

The disease is costly. Claims data show that average annual health care costs (medical and prescription) are more than three times higher for women with endometriosis compared to patients without endometriosis, even five years pre- and five years post-diagnosis. Τhe cost can increase in cases of greater severity of the disease, presence of pelvic pain and infertility.

However, endometriosis is still underfunded and under-researched, thus limiting scientific progress and the number of available diagnostic and treatment options, according to a new review study.

Aiming to address these concerns, the Society for Women’s Health Research (SWHR) brought together a group of researchers, clinicians, and patients as well as industry and government officials, who evaluated barriers affecting endometriosis diagnosis and treatment, reviewed current practice, and highlighted research priorities.

Multidisciplinary approaches addressing all patient needs and greater disease awareness are needed to improve care, diagnosis and development of treatments for people with endometriosis, showed the resutls of the research “Assessing Research Gaps and Unmet Needs in Endometriosis,” which was published in the American Journal of Obstetrics and Gynecology.

According to the expert group, the current lack of knowledge and awareness about the causes of endometriosis contributes to the significant delays (7 to 12 years) from first experiencing symptoms to diagnosis. These delays are even worse for women with pelvic pain and for younger women, and may cause physical and emotional damage, as well as increase costs associated with the disease.

Another contributing factor is that the current gold standard for diagnosis requires surgery (laparoscopy), warranting the development of accurate, noninvasive and less costly diagnostic tools, such as biomarkers. Also, current guidelines only recommend assessing endometrial lesions, despite reports of a questionable association between the number of lesions and disease severity, symptoms and impact on women’s quality of life.

Campaigns to educate patients, healthcare providers, and the public may also help achieve more timely and accurate diagnosis and treatment, the team noted.

Additional barriers are difficulties with insurance coverage, and the stigma around menstrual issues and society’s normalization of women’s pain, which may make patients reluctant to discuss symptoms or seek care.

“In addition, women who do bring up their symptoms may fall victim to the well-documented clinical gender bias that has resulted in some women’s pain being dismissed or inadequately treated,” Rebecca Nebel, PhD, the study’s senior author and director of scientific programs at SWHR, said.

Standardized screenings, such as those used in cases of potential violence against women, could be used as a model in endometriosis, the experts said.

Other barriers are related to healthcare providers, as women need to make an average of seven visits to their primary provider before being referred to specialists, and often are misdiagnosed.

As for current practice in treatment, most medical and surgical approaches — including hysterectomy and uterus removal — focus on managing pain and associated symptoms by suppressing or removing endometrial lesions, but may not be effective.

Physical therapy, acupuncture, and yoga are examples of non pharmacological strategies that may help ease pain. Mental health professionals may help treat depression and grieving associated with endometriosis, while also providing coping and relaxation strategies.

Available medical therapies may induce side effects such as bone loss, hot flashes, and weight gain. Also, many cannot be used when women are trying to get pregnant, often forcing them to decide on whether to minimize pain or time their attempts to conceive while off medication.

Overall, “future treatments and care should shift toward a patient-centric, multidisciplinary approach that focuses on the patient as a whole, rather than one symptom at a time,” the experts said.

Centers of expertise taking an interdisciplinary approach with experts in “laparoscopy, medical management, pain education, physical therapy, and psychological care” may help implement treatment strategies “that address all the needs of the patient, including quality-of-life issues,” the team stated.

Read more: https://www.ajog.org/article/S0002-9378(19)30385-0/pdf

https://www.ajog.org/article/S0002-9378(19)30385-0/fulltext

Source: https://endometriosisnews.com/2019/02/28/multidisciplinary-approach-awareness-will-most-benefit-endometriosis-patients-experts-say/

Early life sexual and physical abuse dramatically increases risk of endometriosis

Early life sexual and physical abuse dramatically increases risk of endometriosis

By I.Soussis MD

A prospective cohort study found that women reporting severe and/or chronic abuse of multiple types during childhood and adolescence had a 79% higher risk of laparoscopically confirmed endometriosis.

Severe abuse was defined as being kicked, bitten, punched or physically attacked more than once, or choked or burned ever, whereas severe sexual abuse was considered forced sexual activity during both childhood and adolescence.

“We saw stronger associations among women whose endometriosis was most likely diagnosed as a result of pelvic pain symptoms,” said lead author Holly Harris, ScD, an assistant professor of epidemiology at the Fred Hutchinson Cancer Research Center in Seattle, Washington.

Previous studies led by members of Dr. Harris’ research team had shown a connection between early life abuse and both uterine fibroids and hypertension. “Given recent links found between endometriosis and hypertension, one of the next logical steps was to examine the association between abuse and risk of endometriosis,” Dr. Harris told Contemporary OB/GYN.

For the study, which appeared in the journal Human Reproduction, data were collected from 60,595 premenopausal women from 1989 to 2013 as part of the Nurses’ Health Survey II cohort.

Participants completed a questionnaire on exposure to violence.

A total of 3,394 cases of endometriosis were diagnosed during 24 years of follow-up.

Overall, 34% of study participants reported moderate or severe physical abuse during early life and 11% of study participants reported forced sex, while 14% of women diagnosed with endometriosis had severe sexual abuse history.

“It is extremely important for readers, clinicians and women with or those who care about women with endometriosis to understand that these results absolutely do not imply that all women who have endometriosis have been abused,” Dr. Harris said. “Abuse in early childhood and adolescence is common among both women with and without endometriosis.”

The associations between abuse and endometriosis were stronger in women presenting without infertility. This group was also more likely to report pelvic pain.

“Sadly, childhood abuse is real, is a major public health issue, and can have long-lasting impacts on health,” Dr. Harris said. “In addition, for women with pelvic pain with or without endometriosis, it is important that they know that these symptoms are not normal.”

When these women raise concerns about their pain with clinicians, they should not be dismissed, no matter their age or history, according to Dr. Harris. “There is a growing body of evidence that pain sensitization can result from a physiologic response to the stress and trauma of abuse,” she said. “This occurs not only among women with endometriosis but also among women with other pain conditions.”

 

Read more: https://academic.oup.com/humrep/article-abstract/33/9/1657/5055017?redirectedFrom=fulltext

 

Source: http://www.contemporaryobgyn.net/endometriosis/does-abuse-affect-risk-endometriosis?rememberme=1&elq_mid=4894&elq_cid=607376&GUID=69980457-AFA5-43B0-B217-28D67525EA6C

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