Impact of diagnosis and surgical treatment of early stage borderline ovarian tumours on distress, anxiety, and psychosexual health.

Women diagnosed with gynecological cancer are likely to face additional consequences beyond those common to all cancer patients leading to significant physical and psychological morbidity. Longitudinal studies addressing the prevalence of psychological distress, anxiety, or psychosexual health during follow-up in patients diagnosed with borderline ovarian tumors are lacking. This study explores this prevalence compared with controls who underwent comparable surgical treatment for benign ovarian tumors. A prospective 1:1 nonmatched case-control study was set up, registered on ClinicalTrials.gov under number NCT04253327. Thirty early stage borderline ovarian tumor patients participated, and 30 controls were included. The study materials consisted of different questionnaires. A general one on patient's sociodemographic and medical information. A questionnaire about anxiety and distress made up of three validated questionnaires: Hospital Anxiety and Depression Scale, Perceived Stress Scale and Body Image Scale. As last one the psychosexual health questionnaire consisted of the Female Sexual Function Index, the Female Sexual Distress Scale and two European Organisation for Research and Treatment of Cancer questionnaires. Both groups were comparable and did not differ significantly in terms of demographic characteristics. Patients with early stage borderline ovarian tumors experience a significant higher burden of mental health issues due to disease and treatment and/or are more worried about their future health. Surprisingly, both early stage borderline ovarian tumor patients and controls showed high levels of anxiety and moderate stress. Many patients in both groups experience sexual dysfunction and distress. These findings support active screening for anxiety, depression and psychosexual perturbance during postoperative follow-up to accommodate this.

Ultrasonographic appearance of the endometrium after saline infusion in women presenting with PRM-associated endometrial changes, due to the use of ulipristal acetate.

Ulipristal acetate (UPA), used for the treatment in women with symptomatic fibroids, is associated with endometrial changes visualised on ultrasound as thickening up to more than 16 mm in approximately 10% of the patients. Is saline infusion sonography (SIS) a good alternative for more invasive techniques, to evaluate the presence of intrauterine pathology? Ten patients, presenting with UPA associated endometrial changes at their follow up ultra-sonographic evaluation, were included. Our study demonstrated that SIS is feasible and painless in patients presenting with UPA associated endometrial changes. The thickened endometrium appears to divide at the midline, making it possible to study both layers separately and exclude any suspected intrauterine pathology. Our findings suggest that SIS may be a first choice, non-invasive, painless technique to provide a proper visualisation to rule out intrauterine pathology when UPA associated endometrial changes are diagnosed after fibroid treatment. This is especially of clinical interest in front of assisted reproductive technology treatment. Invasive techniques can be withheld for patients in whom SIS examination is not contributive.Impact StatementWhat is already known on this subject? Reversible endometrial changes after ulipristal acetate (UPA) treatment in patients with symptomatic fibroids have been described. In patients who receive UPA, especially if planned to undergo ART, assessment of potential endometrial pathology is important as such interfere with proper implantation after ART. Consequently, clinicians may consider ruling out intrauterine pathology by invasive examinations such as biopsy or hysteroscopy after visualisation of the thickened endometrium.What do the results of this study add? Saline infusion sonography (SIS) was feasible and painless in patients presenting with UPA associated endometrial changes.What are the implications of these findings for clinical practice and/or further research? SIS may be a first choice, non-invasive, painless technique to provide a proper visualisation to rule out intrauterine pathology when UPA associated endometrial changes are diagnosed after fibroid treatment. This is especially of clinical interest in front of assisted reproductive technology treatment. Invasive techniques can be withheld for patients in whom SIS examination is not contributive in excluding intrauterine pathology.