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Medicina
Special Issues
Diagnosis and Treatment of Endometriosis: Priorities, Advances and Challenges
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Diagnosis and Treatment of Endometriosis: Priorities, Advances and Challenges

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Obstetrics and Gynecology".

Deadline for manuscript submissions: 25 November 2024 | Viewed by 6518

Special Issue Editors

Dr. Mike Armour

E-Mail Website
Guest Editor
Associate Professor, NICM Health Research Institute, Western Sydney University, Sydney, NSW 2145, Australia
Interests: pelvic pain; dysmenorrhea; endometriosis
Special Issues, Collections and Topics in MDPI journals
Dr. George Condous

E-Mail Website
Guest Editor
Associate Professor, Endometriosis Ultrasound and Advanced Endosurgery Unit, Sydney Medical School Nepean, University of Sydney Nepean Hospital, Sydney, NSW, Australia
Interests: endometriosis; pelvic pain; ultrasound; diagnosis

Special Issue Information

Dear Colleagues, 

Endometriosis is a chronic inflammatory disease process characterized by the presence of endometrial-like tissue outside the uterus. It affects ~10% of reproductive-age women and those assigned female at birth worldwide. Persistent pelvic pain, dysmenorrhea, dyspareunia, and dyschezia remain hallmarks of disease. Negative impacts on overall health and well-being are common in those with endometriosis. The diagnosis of endometriosis is made challenging by non- specific and heterogeneous symptoms, a lack of pathognomonic features, and the normalization and dismissal of pelvic pain by family, friends, and physicians. The reference standard was previously diagnostic laparoscopy and histological assessment; however, recent guidelines from the European Society of Human Reproduction and Embryology recommend that imaging with ultrasound or MRI should be the first line of investigation, with particular accuracy for deep endometriosis. Given that the average diagnostic delay is often 7–12 years, new innovative methods of diagnosis, especially non-invasive methods, have the potential to dramatically reduce the time to diagnosis while reducing cost by avoiding the need for a laparoscopy. Current mainstay medical management of endometriosis-related pain involves hormone therapy, nonsteroidal anti-inflammatory drugs, and other analgesics such as opioids and neuroleptics. Surgical treatment of endometriosis may also be offered to reduce pain. However, not all endometriosis patients are suitable candidates for surgery and many experience symptoms refractory to medical or surgical treatment. This highlights the pressing need for alternative symptom-management options.

The aim of this Special Issue is to cover advances in both diagnosis and imaging, to understand priorities for clinicians and patients in these areas, and to explore the challenges and barriers to improving treatment and reducing time and expense to diagnosis.

We welcome both clinical and pre-clinical papers including systematic reviews/meta-analyses, randomised controlled trials, animal models, as well as qualitative or mixed methods papers relevant to unmet needs, barriers, or research priorities.

Dr. Mike Armour
Dr. George Condous
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pelvic pain
  • endometriosis
  • dysmenorrhea
  • diagnosis
  • treatment
  • surgery
  • pharmacology

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Published Papers (4 papers)

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17 pages, 549 KiB  
Article
The Benefits of an Integral HAMMAM Experience Combining Hydrotherapy and Swedish Massage on Pain, Subjective Well-Being and Quality of Life in Women with Endometriosis-Related Chronic Pelvic Pain: A Randomized Controlled Trial
by Ángel Rodríguez-Ruiz, Camila Arcos-Azubel, Manuel Ruiz-Pérez, Francisco Manuel Peinado, Antonio Mundo-López, Ana Lara-Ramos, María del Mar Salinas-Asensio and Francisco Artacho-Cordón
Medicina 2024, 60(10), 1677; https://doi.org/10.3390/medicina60101677 - 13 Oct 2024
Viewed by 1097
Abstract
Background and Objectives: To evaluate the effectiveness of an integral HAMMAM experience, a 4-week therapeutic program that combined hydrotherapy and Swedish massage, applied in a multisensorial immersive environment, on pain, well-being and quality of life (QoL) in women with endometriosis-related chronic pelvic [...] Read more.
Background and Objectives: To evaluate the effectiveness of an integral HAMMAM experience, a 4-week therapeutic program that combined hydrotherapy and Swedish massage, applied in a multisensorial immersive environment, on pain, well-being and quality of life (QoL) in women with endometriosis-related chronic pelvic pain that is unresponsive to conventional treatment. Materials and Methods: This randomized controlled trial included 44 women with endometriosis. They were randomly allocated to either the ‘HAMMAM’ group (n = 21) or to a control group (n = 23). The primary outcome, pain intensity, was evaluated using numeric rating scales (NRSs). The secondary outcomes were pain interference, pain-related catastrophic thoughts, pressure pain thresholds (PPTs), subjective well-being, functional capacity and QoL, which were evaluated using the brief pain inventory (BPI), the pain catastrophizing scale (PCS), algometry, the subjective well-being scale-20 (EBS-20), the Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) and the Endometriosis Health Profile-30 Questionnaire (EHP-30), respectively. The primary and secondary outcomes were measured at the baseline and after the intervention. The statistical (between-group analyses of covariance) and clinical effects were analyzed by the intention to treat. Results: The adherence rate was 100.0% and the mean (± standard deviation) satisfaction was 9.71 ± 0.46 out of 10. No remarkable health problems were reported during the trial. The ‘HAMMAM’ intervention improved dysmenorrhea and dyspareunia after the intervention with large and moderate effect sizes, respectively. Improvements in pain interference during sleep and PPTs in the pelvic region were also observed in women allocated to the ‘HAMMAM’ group. No effects were observed in catastrophizing thoughts, well-being nor QoL, except for the sleep subscale. Conclusions: A 4-week program of an integral ‘HAMMAM’ experience combining hydrotherapy and massage in a multisensorial immersive environment is a feasible and effective intervention to alleviate pain during menstruation and sexual intercourse as well as pain interference with sleep in women with endometriosis. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Endometriosis: Priorities, Advances and Challenges)
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11 pages, 1147 KiB  
Article
Is Complete Excision Always Enough? A Quality of Sexual Life Assessment in Patients with Deep Endometriosis
by Raluca Gabriela Enciu, Octavian Enciu, Dragoș Eugen Georgescu, Adrian Tulin and Adrian Miron
Medicina 2024, 60(9), 1534; https://doi.org/10.3390/medicina60091534 - 20 Sep 2024
Viewed by 619
Abstract
Background and Objectives: The aim of this study was to find the factors associated with the severe impairment of QoSL and the factors associated with a better score in QoSL, as well as the evaluation of pain symptoms and QoSL after the [...] Read more.
Background and Objectives: The aim of this study was to find the factors associated with the severe impairment of QoSL and the factors associated with a better score in QoSL, as well as the evaluation of pain symptoms and QoSL after the complete and incomplete excision of rectovaginal nodules. Materials and methods: The present prospective study was conducted in a single tertiary center for endometriosis where 116 patients underwent laparoscopic surgery for deep endometriosis during a 3-year period. The goal of the intervention was to excise all endometriotic implants while conserving the rectum. Intraoperative findings were recorded after the intervention, and the patients were classified according to the ENZIAN classification and rASRM scores. QoSL was assessed using the EHP-30 Module C (QoSL Score). Results: When comparing the mean scores before and 2 years after the surgery, a highly significant improvement was found for QoSL and dysmenorrhea (p < 0.0001). The complete excision of rectovaginal nodules led to a significantly better QoSL and lower dyspareunia (p < 0.0001) than incomplete resection (p < 0.02). Conclusions: This prospective study proves that the complete laparoscopic excision of all endometriotic implants improved the QoSL and decreased the pain score of dyspareunia. Incomplete rectovaginal nodule excision was correlated with a poorer QoSL and a lower improvement of dysmenorrhea, dyspareunia, and chronic pelvic pain scores than complete excision. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Endometriosis: Priorities, Advances and Challenges)
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14 pages, 332 KiB  
Article
Unmet Needs of Australians in Endometriosis Research: A Qualitative Study of Research Priorities, Drivers, and Barriers to Participation in People with Endometriosis
by Nora Giese, Emilee Gilbert, Alexandra Hawkey and Mike Armour
Medicina 2023, 59(9), 1655; https://doi.org/10.3390/medicina59091655 - 13 Sep 2023
Cited by 2 | Viewed by 1907
Abstract
Background and Objectives: Endometriosis causes significant personal and societal burden. Despite this, research funding lags behind other chronic conditions. Determining where to prioritise these limited funds is therefore vital. Research priorities may also differ between individuals with endometriosis and clinicians/researchers. The aim [...] Read more.
Background and Objectives: Endometriosis causes significant personal and societal burden. Despite this, research funding lags behind other chronic conditions. Determining where to prioritise these limited funds is therefore vital. Research priorities may also differ between individuals with endometriosis and clinicians/researchers. The aim of this research project is to explore research priorities and factors shaping participation in endometriosis research from the perspective of people with endometriosis in Australia. Materials and Methods: Four focus groups involving 30 people with endometriosis were conducted and analysed using qualitative inductive content analysis. Results: Two categories were developed from the data: unmet research needs and motivators and barriers to participation in endometriosis research. Participants expressed interest in developing non-invasive diagnostic tools and a more multidisciplinary or holistic approach to treatment. Participants urgently desired research on treatment options for symptom management, with many prioritising non-hormonal treatments, including medicinal cannabis and complementary medicine. Others prioritised research on the causes of endometriosis over research on treatments to assist with prevention and eventual cure of the disease. The main drivers for participating in endometriosis research were hope for symptom improvement and a reduction in time to diagnosis. Research design features that were important in supporting participation included ease of access to testing centres (e.g., for blood tests) and sharing test results and automated data collection reminders, with simple stra-tegies to record data measurements. Research incentives for younger people with endometriosis and a broad dissemination of information about research projects was considered likely to increase participant numbers. Barriers included time commitments, a lack of flexibility around research appointments for data collection, travel or work commitments, concerns about the safety of some products, and trying to conceive a child. Conclusions: People with endometriosis were open to participating in research they felt aligned with their needs, with a significant focus on diagnostic tools and symptom relief. However, researchers must co-design approaches to ensure convenience and flexibility for research participation. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Endometriosis: Priorities, Advances and Challenges)

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9 pages, 1350 KiB  
Case Report
Isolated Deep Infiltrating Endometriosis of the Sciatic Nerve: A Case Report and Overview of the Literature
by Milena Zamurovic, Ana Tomic, Katarina Djordjevic, Sara Simanic, Jelena Sopta, Lukas Rasulic, Ljubica Simic, Jovan Jevtic, Olga Nedeljkovic-Arsenovic and Marija Rovcanin
Medicina 2023, 59(12), 2161; https://doi.org/10.3390/medicina59122161 - 13 Dec 2023
Cited by 2 | Viewed by 2120
Abstract
Isolated deep infiltrating endometriosis (DIE) of sacral nerve roots or major pelvic nerves, including the sciatic nerve, is considered to be extremely rare. Due to the overlap with sciatica symptoms, the diagnosis of sciatica DIE is difficult yet crucial, as it results in [...] Read more.
Isolated deep infiltrating endometriosis (DIE) of sacral nerve roots or major pelvic nerves, including the sciatic nerve, is considered to be extremely rare. Due to the overlap with sciatica symptoms, the diagnosis of sciatica DIE is difficult yet crucial, as it results in permanent neural damage if left untreated. We report a case of a 45-year-old woman who experienced a three-year-long and recently exacerbating pain in her right leg, accompanied by a tingling sensation and weakness in her right leg and foot, with difficulty walking. In between regular menstrual bleedings, when her aforementioned symptoms worsened, she had been experiencing mild 10-day extra-cyclical bleeding. Her neurologist’s, orthopedist’s, and gynecological examinations were unremarkable. Magnetic resonance imaging (MRI) showed an infiltrative lesion on the right sciatic nerve that was immunohistochemically confirmed to be endometriosis. The patient was treated with gonadotropin-releasing hormone analogues (GnRHa), which led to a significantly diminished size of the lesion on the control MRI, and endometriosis remission was obtained. For persistent mild, but cyclical, pain and muscle weakness, continuous progestagnes were administered, with advice for physical therapy provided for her neuro-muscle rehabilitation and a scheduled check-up in 6 months. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Endometriosis: Priorities, Advances and Challenges)
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