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1.
Artigo em Inglês | MEDLINE | ID: mdl-31897607

RESUMO

Preliminary evidence suggests that mind-body interventions, including mindfulness-based interventions and yoga, may be effective in reducing mental health difficulties and psychological distress in infertile patients undergoing fertility treatments. We systematically reviewed and synthesized current medical literature of the effectiveness of mind-body interventions in reducing the severity of psychological distress and improving marital function and pregnancy outcomes in infertile women/couple. Databases including PsychINFO, PubMed, EMBASE, and the Cochrane Library were searched for relevant studies. Manual searches were conducted in relevant articles. We included 12 studies that met the inclusion criteria. Four studies were randomized controlled trials (RCT), 4 non-randomized controlled trial (NRCT), and 4 uncontrolled studies (UCT). Participation in a mind-body intervention was associated with reduced anxiety trait and depression scores. The reduction was of low or moderate amplitude in most studies. Our review offers evidence for the effectiveness of mind-body interventions in reducing anxiety state and depression in infertile women and a possible improvement in pregnancy rate. Further RCTs with a precise timing of intervention are needed.

2.
Rev Med Suisse ; 16(676-7): 42-46, 2020 Jan 15.
Artigo em Francês | MEDLINE | ID: mdl-31961082

RESUMO

Uterine transplant is a novel treatment option for women with absolute uterine infertility. Sixty uterine transplants have been performed worldwide to date. The first live birth happened in 2014 and since then 20 children have been born after this procedure. The procedure has several challenges: The donor is usually a woman alive. Surgery is long and complex for both the donor and the recipient, with a high risk of complications. Embryos have to be obtained through IVF. Pregnancies are at high risk for complications and require cesarean delivery, and transplant is temporary (the transplanted uterus is removed after pregnancy in order to allow discontinuation of immunosuppressive therapy). Uterine transplant is a new hope for women with absolute uterine infertility but a high-risk experimental procedure for the donor, the recipient and the newborns and raises major ethical questions.


Assuntos
Infertilidade Feminina , Útero , Cesárea , Feminino , Humanos , Recém-Nascido , Infertilidade Feminina/cirurgia , Gravidez , Suíça , Doadores de Tecidos , Útero/transplante
5.
Fertil Steril ; 111(5): 944-952.e1, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30878253

RESUMO

OBJECTIVE: To examine whether serum antimüllerian hormone (AMH) levels correlate with the size of ovarian endometrioma (OMA). DESIGN: An observational cross-sectional study. SETTING: University hospital. PATIENT(S): Two hundred and sixty-seven nonpregnant women, aged 18-42 years, with no prior history of surgery for endometriosis and a histologically documented ovarian cyst. INTERVENTION(S): Surgical management for a benign ovarian cyst. MAIN OUTCOME MEASURE(S): Correlation between serum AMH concentration and cyst size according to OMA and non-OMA benign cyst. RESULT(S): Women with OMA were compared with a control group of women who had non-OMA benign ovarian cysts. The AMH assay samples were collected less than a month before the surgery. Between January 2004 and September 2016, 148 women were allocated to the OMA group and 119 to the non-OMA benign cyst group. The AMH concentrations were not statistically significantly different between the two groups (3.7 ± 2.8 ng/mL vs. 4.1 ± 3.3 ng/mL). A multiple linear regression model accounting for potential confounders revealed that the log10 of the serum AMH concentration positively correlated with the log10 of the OMA cyst volume (R2 = 0.23; coefficient = 0.05; 95% CI, 0.007-0.10). CONCLUSION(S): In women no prior history of surgery for endometriosis, serum AMH levels increased with cyst size in cases of OMA.


Assuntos
Hormônio Antimülleriano/sangue , Endometriose/sangue , Endometriose/diagnóstico por imagem , Cistos Ovarianos/sangue , Cistos Ovarianos/diagnóstico por imagem , Adolescente , Adulto , Biomarcadores/sangue , Estudos de Coortes , Estudos Transversais , Endometriose/cirurgia , Feminino , Humanos , Cistos Ovarianos/cirurgia , Ovário/diagnóstico por imagem , Ovário/cirurgia , Adulto Jovem
6.
Minerva Ginecol ; 71(3): 224-234, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30727724

RESUMO

Sexual dysfunctions, particularly sexual pain, are common in adult women of all ages. In patients with endometriosis, a chronic gynecological pain condition affecting women of reproductive age, sexual pain is the third most common symptom. Multiple biological factors are involved in endometriosis-related sexual pain including tissue damage, inflammation, hormonal changes, alterations within the peripheral and central nervous system and pelvic floor muscle dysfunctions. Conceptual models of sexual pain espouse a multifactorial view, with empirical evidence suggesting the implication of psychosexual and relationship difficulties in the development and persistence of sexual pain and associated distress. We review literature on the biological, psychological, sexual and interpersonal factors associated with development and persistence of sexual pain in women with endometriosis. In addition, we discuss chronic pain conditions frequently associated with endometriosis (vulvodynia, bladder pain syndrome and inflammatory bowel syndrome) and how they are linked with sexual pain. Finally we discuss the clinical implications and provided suggestions for future research and medical care, focusing on a multidisciplinary and biopsychosocial approach.


Assuntos
Dispareunia/etiologia , Endometriose/complicações , Doenças dos Genitais Femininos/complicações , Pesquisa Biomédica/tendências , Dispareunia/psicologia , Feminino , Previsões , Humanos
7.
Curr Stem Cell Res Ther ; 14(6): 454-459, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30760192

RESUMO

Asherman's Syndrome or Intrauterine adhesions is an acquired uterine condition where fibrous scarring forms within the uterine cavity, resulting in reduced menstrual flow, pelvic pain and infertility. Until recently, the molecular mechanisms leading to the formation of fibrosis were poorly understood, and the treatment of Asherman's syndrome has largely focused on hysteroscopic resection of adhesions, hormonal therapy, and physical barriers. Numerous studies have begun exploring the molecular mechanisms behind the fibrotic process underlying Asherman's Syndrome as well as the role of stem cells in the regeneration of the endometrium as a treatment modality. The present review offers a summary of available stem cell-based regeneration studies, as well as highlighting current gaps in research.


Assuntos
Endométrio/fisiopatologia , Ginatresia/fisiopatologia , Regeneração , Feminino , Ginatresia/terapia , Humanos , Transplante de Células-Tronco
8.
Rev Med Suisse ; 15(N° 632-633): 53-56, 2019 Jan 09.
Artigo em Francês | MEDLINE | ID: mdl-30629370

RESUMO

Preimplantation genetic testing avoids the transmission of monogenic diseases or structural chromosome abnormality to the offspring in fertile couples. Furthermore, it allows screening for aneuploidies (PGT-A, Preimplantation genetic testing for aneuploidy), with the aim of selecting one euploid embryo before transfer in infertile couples undergoing in vitro fertilization (IVF). Indeed, aneuploidies are frequent and explain most IVF failures and early miscarriages. The indications for PGT-A remain controversial, due to the lack of clear evidence of improved outcomes after IVF. Cost-effectiveness studies and follow-up of neonatal outcomes are needed. Finally, each situation requires counseling taking into account ethical considerations.


Assuntos
Testes Genéticos , Infertilidade , Diagnóstico Pré-Implantação , Aneuploidia , Feminino , Fertilização In Vitro , Humanos , Gravidez
9.
Eur J Obstet Gynecol Reprod Biol ; 229: 172-178, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30199816

RESUMO

Endometriosis, a hormone-dependant condition affecting around 10% of women in their reproductive years, has frequent consequences on fertility. Indeed, a proportion of women will require assisted reproductive techniques or surgery in order to achieve pregnancy. Recent refining of stimulation protocols and vitrification techniques has created new possibilities in the field of fertility preservation. As a consequence, oocyte vitrification is now discussed not only in oncologic situations, but also in other conditions at risk of altered ovarian reserve and poor fertility outcome. In endometriosis, various mechanisms can impair ovarian function and diminish ovarian, particularly bilateral or repeated cystectomy. Fertility preservation could represent an option for women with endometriosis but still remains controversial. In order to shed some light on this complex subject and to outline different issues at stake we conducted a SWOT analysis highlighting strengths, weaknesses, opportunities and threats of oocyte vitrification in women with endometriosis.


Assuntos
Endometriose , Preservação da Fertilidade , Feminino , Humanos
10.
Artigo em Inglês | MEDLINE | ID: mdl-29545113

RESUMO

Endometriosis-associated pelvic pain is a major health concern in women of childbearing age. Controlled studies have shown that endometriosis can adversely affect women and their partners' general psychological well-being, relationship adjustment and overall quality of life. Furthermore, women with endometriosis report significantly more sexual dysfunctions compared to healthy women. Empirical studies indicate that specific psychosocial factors may modulate pain experience, pain-related distress and treatment outcome. Research on psychosexual interventions in endometriosis treatment is limited but shows to be effective in reducing endometriosis-related pain and associated psychosexual outcomes. An individualized, couple-centered, multimodal approach to care, integrating psychosexual and medical management for endometriosis, is thought to be optimal.


Assuntos
Endometriose/psicologia , Dor Pélvica/psicologia , Disfunções Sexuais Fisiológicas/psicologia , Comorbidade , Efeitos Psicossociais da Doença , Endometriose/complicações , Feminino , Humanos , Dor Pélvica/etiologia , Qualidade de Vida , Disfunções Sexuais Fisiológicas/etiologia , Parceiros Sexuais/psicologia
11.
Rev Med Suisse ; 13(580): 1821-1825, 2017 Oct 25.
Artigo em Francês | MEDLINE | ID: mdl-29071830

RESUMO

Venous thromboembolism is frequently associated with hormonal factors in women. A thorough medical history taking of vascular risks and an individual evaluation of the risk-benefit ratio should precede any prescription of hormonal therapies. In contrary to progestin-only-pills, estroprogestative contraceptives increase 3-6 times the risk of venous thrombosis. In assisted reproductive techniques, venous thrombosis is frequently associated with the occurrence of a severe ovarian hyperstimulation syndrome. Antagonist ovarian stimulation protocols lower the risk of hyperstimulation and should therefore be preferred. Finally, at menopause, hormonal treatments combining transdermal estradiol and micronized progesterone do not seem to increment the risk of thrombosis.


Assuntos
Anticoncepcionais , Tromboembolia Venosa , Trombose Venosa , Anticoncepcionais/efeitos adversos , Anticoncepcionais Orais Hormonais/efeitos adversos , Feminino , Humanos , Menopausa , Fatores de Risco , Tromboembolia Venosa/induzido quimicamente , Trombose Venosa/induzido quimicamente
12.
Rev Med Suisse ; 13(549): 371-374, 2017 Feb 08.
Artigo em Francês | MEDLINE | ID: mdl-28708359

RESUMO

Infertility treatment doesn't stop in the technical and specific processing. The psychological distress may be very important and a frequent cause of drop-out during the medical procedure. Therefore the couple should be taken into account globally. Different level of counselling sessions should be offered to give the couple complete information about the procedure. The psychological counselling should be tailored to their need in term of coping strategies in the management of the stress or more specific psychotherapeutical approach. Indeed consultation-liaison psychiatric interventions should be offered when the couple is known for psychiatric comorbidities or is presenting anxio-depressive symptoms in reaction to medical procedure.


Assuntos
Infertilidade/complicações , Infertilidade/psicologia , Estresse Psicológico/etiologia , Humanos , Guias de Prática Clínica como Assunto , Estresse Psicológico/diagnóstico , Estresse Psicológico/terapia
13.
Hum Reprod ; 32(7): 1393-1401, 2017 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-28510724

RESUMO

STUDY QUESTION: What is the relationship between endometriosis phenotypes superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA), deep infiltrating endometriosis (DIE) and the adenomyosis appearance by magnetic resonance imaging (MRI)? SUMMARY ANSWER: Focal adenomyosis located in the outer myometrium (FAOM) was observed more frequently in women with endometriosis, and was significantly associated with the DIE phenotype. WHAT IS KNOWN ALREADY: An association between endometriosis and adenomyosis has been reported previously, although data regarding the association between MRI appearance of adenomyosis and the endometriosis phenotype are currently still lacking. STUDY DESIGN, SIZE, DURATION: This was an observational, cross-sectional study using data prospectively collected from non-pregnant patients who were between 18 and 42 years of age, and who underwent surgery for symptomatic benign gynecological conditions between January 2011 and December 2014. For each patient, a standardized questionnaire was completed during a face-to-face interview conducted by the surgeon during the month preceding the surgery. Only women with preoperative standardized uterine MRIs were retained for this study. PARTICIPANTS/MATERIALS, SETTING, METHODS: Surgery was performed on 292 patients with signed consent and available preoperative MRIs. After a thorough surgical examination of the abdomino-pelvic cavity, 237 women with histologically proven endometriosis were allocated to the endometriosis group and 55 symptomatic women without evidence of endometriosis to the endometriosis free group. The existence of diffuse or FAOM was studied in both groups and according to surgical endometriosis phenotypes (SUP, OMA and DIE). MAIN RESULTS AND THE ROLE OF CHANCE: Adenomyosis was observed in 59.9% (n = 175) of the total sample population (n = 292). Based on MRI, the distribution of adenomyosis was as follows: isolated diffuse adenomyosis (53 patients; 18.2%), isolated FAOM (74 patients; 25.3%), associated diffuse and FAOM (48 patients; 16.4%). Diffuse adenomyosis (isolated and associated to FAOM) was observed in one-third of the patients regardless of whether they were endometriotic patients or endometriosis free women taken as controls (34.2% (81 cases) versus 36.4% (20 cases)); P = 0.764. Among endometriotic women, diffuse adenomyosis (isolated and associated to FAOM) failed to reach significant correlation with the endometriosis phenotypes (SUP, 20.0% (8 cases); OMA, 45.2% (14 cases) and DIE, 35.5% (59 cases); P = 0.068). In striking contrast, there was a significant increase in the frequency of FAOM in endometriosis-affected women than in controls (119 cases (50.2%) versus 5.4% (3 cases); P < 0.001). FAOM correlated with the endometriosis phenotypes, significantly with DIE (SUP, 7.5% (3 cases); OMA, 19.3% (6 cases) and DIE, 66.3% (110 cases); P < 0.001). LIMITATIONS, REASONS FOR CAUTION: There was a possible selection bias due to the specificity of the study design, as it only included surgical patients in a referral center that specializes in endometriosis surgery. Therefore, women referred to our center may have suffered from particularly severe forms of endometriosis. This could explain the high number of women with DIE (166/237-70%) in our study group. This referral bias for women with severe lesions may have amplified the difference in association of FAOM with the endometriosis-affected patients compared to women without endometriosis. Furthermore, according to inclusion criteria, women in the endometriosis free group were symptomatic women. This may introduce some bias as symptomatic women may be more prone to have associated adenomyosis that in turn could have been overrepresented in the endometriosis free group. Whether this selection could have introduced a bias in the relationship between endometriosis and adenomyosis remains unknown. WIDER IMPLICATIONS OF THE FINDINGS: This study opens the door to future epidemiological, clinical and mechanistic studies aimed at better characterizing diffuse and focal adenomyosis. Further studies are necessary to adequately determine if diffuse and focal adenomyosis are two separate entities that differ in terms of pathogenesis. STUDY FUNDING/COMPETING INTEREST(S): No funding supported this study. The authors have no conflict of interest to declare.


Assuntos
Adenomiose/diagnóstico por imagem , Endometriose/diagnóstico por imagem , Infertilidade Feminina/etiologia , Dor Pélvica/etiologia , Hemorragia Uterina/etiologia , Útero/diagnóstico por imagem , Adenomiose/epidemiologia , Adenomiose/fisiopatologia , Adolescente , Adulto , Comorbidade , Estudos Transversais , Endometriose/epidemiologia , Endometriose/fisiopatologia , Feminino , Hospitais Universitários , Humanos , Imagem por Ressonância Magnética , Paris/epidemiologia , Prevalência , Estudos Prospectivos , Índice de Gravidade de Doença , Terminologia como Assunto , Útero/fisiopatologia , Adulto Jovem
14.
Gynecol Endocrinol ; 33(5): 342-348, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28277114

RESUMO

Premenstrual disorders (PMD) can affect women throughout their entire reproductive years. In 2016, an interdisciplinary expert meeting of general gynecologists, gynecological endocrinologists, psychiatrists and psychologists from Switzerland was held to provide an interdisciplinary algorithm on PMD management taking reproductive stages into account. The Swiss PMD algorithm differentiates between primary and secondary PMD care providers incorporating different levels of diagnostic and treatment. Treatment options include cognitive behavioral therapy, alternative therapy, antidepressants, ovulation suppression and diuretics. Treatment choice depends on prevalent PMD symptoms, (reproductive) age, family planning, cardiovascular risk factors, comorbidities, comedication and the woman's preference. Regular follow-ups are mandatory.


Assuntos
Algoritmos , Síndrome Pré-Menstrual/terapia , Terapias Complementares/métodos , Terapias Complementares/normas , Consenso , Feminino , Humanos , Comunicação Interdisciplinar , Fitoterapia/métodos , Fitoterapia/normas , Síndrome Pré-Menstrual/diagnóstico , Síndrome Pré-Menstrual/epidemiologia , Síndrome Pré-Menstrual/psicologia , Suíça
15.
Reprod Sci ; 24(5): 773-782, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-27678100

RESUMO

We investigated whether serum osteopontin (OPN) levels are different according to specific phenotypes of adenomyosis and endometriosis. We conducted a prospective laboratory study in a university referral center for endometriosis between May 2005 and May 2013 and included 148 nonpregnant women, younger than 42 years, undergoing surgery for a benign gynecological condition and who had a preoperative pelvic magnetic resonance imaging (MRI). The presence of focal and/or diffuse adenomyosis was determined by pelvic MRI, and women were classified into 3 groups: no-adenomyosis (No-AM), isolated diffuse adenomyosis (DIF-AM), and focal adenomyosis with or without diffuse adenomyosis (FOC-AM). After complete surgical exploration of the pelvic cavity, the presence and type of endometriosis was surgically determined and histologically confirmed. We distinguished 4 phenotypes: no endometriosis, superficial peritoneal endometriosis (SUP), ovarian endometrioma, and deep infiltrating endometriosis (DIE). Osteopontin levels were measured by enzyme-linked immunosorbent assay in serum samples obtained in all participants in the month preceding surgery. Our results show lower OPN levels in women with focal adenomyosis compared to adenomyosis-free controls. Our results also show a decrease in OPN levels in women with associated DIE and focal adenomyosis compared to women with SUP. Various serum biomarkers have been studied in the context of endometriosis severity and subtypes, whereas data on serum markers of adenomyosis are scarce. Both entities are often associated, and adenomyosis could be a confounding factor influencing results. Future research on serum biomarkers should describe subtypes of adenomyosis and endometriosis and analyze results according to well-defined subtypes.


Assuntos
Adenomiose/sangue , Endometriose/sangue , Osteopontina/sangue , Adenomiose/diagnóstico , Adenomiose/diagnóstico por imagem , Adulto , Biomarcadores/sangue , Estudos Transversais , Endometriose/diagnóstico , Endometriose/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Fenótipo , Estudos Prospectivos
16.
Rev Med Suisse ; 12(536): 1805-1810, 2016 Oct 26.
Artigo em Francês | MEDLINE | ID: mdl-28692231

RESUMO

The menopausal hormone therapy (MHT) is the first line treatment for climacteric symptoms related to estrogen deficiency. A personalized evaluation of the benefit-risk ratio should precede a MHT prescription, and take into consideration cardiovascular, thromboembolic, oncological and osteoporosis risks. MHT should be prescribed at the lowest effective dose and for the shortest duration, respecting the window of opportunity in the 10 years following menopause or before the age of 60 years. The choice of the MHT type depends on the patient's profile, her medical history and personal preferences, with the aim of improving quality of life from a physical, psychological and sexual point of view.


Assuntos
Terapia de Reposição Hormonal/métodos , Menopausa , Qualidade de Vida , Fatores Etários , Idoso , Feminino , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Fatores de Tempo
17.
Expert Rev Clin Pharmacol ; 9(2): 317-27, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26645363

RESUMO

Endometriosis is a chronic disease of unknown etiology that affects approximately 10% of women in reproductive age. Several evidences show that endometriosis lesions are associated to hormonal imbalance, including estrogen synthesis, metabolism and responsiveness and progesterone resistance. These hormonal alterations influence the ability of endometrial cells to proliferate, migrate and to infiltrate the mesothelium, causing inflammation, pain and infertility. Hormonal imbalance in endometriosis represents also a target for treatment. We provide an overview on therapeutic strategies based on innovations of classical hormonal mechanisms involved in the development of endometriosis lesions. The development phase of new molecules targeting these pathways is also discussed. Endometriosis is a chronic disease involving young women and additional biological targets of estrogen and progesterone pharmacological manipulation (brain, bone and cardiovascular tissue) need to be carefully considered in order to improve and overcome current limits of long-term medical management of endometriosis.


Assuntos
Endometriose/tratamento farmacológico , Estrogênios/metabolismo , Progesterona/metabolismo , Animais , Movimento Celular , Proliferação de Células , Desenho de Drogas , Endometriose/patologia , Endométrio/anormalidades , Feminino , Humanos , Infertilidade Feminina/etiologia , Inflamação/tratamento farmacológico , Inflamação/etiologia , Dor/tratamento farmacológico , Dor/etiologia , Doenças Uterinas
18.
Reprod Sci ; 22(12): 1549-60, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26071388

RESUMO

We investigated whether the myometrium might be intrinsically different in women with adenomyosis. We studied whether the mitogen-activated protein kinases/extracellular signal-regulated kinases (MAPKs/ERKs) and phosphoinositide 3-kinase/mammalian target of rapamycin/AKT (PI3K/mTOR/AKT) cell-signaling pathways, implicated in the pathogenesis of endometriosis, might also be activated in uterine smooth muscle cells (uSMCs) of women with adenomyosis and measured the production of reactive oxygen species (ROS), proinflammatory mediators that modulate cell proliferation and have been shown to activate the MAPK/ERK pathway in endometriosis. The uSMC cultures were derived from myometrium biopsies obtained during hysterectomy or myomectomy in women with adenomyosis and controls with leiomyoma. Proliferation of uSMCs and in vitro activation of the MAPK/ERK cell-signaling pathway were increased in women with adenomyosis compared to controls. The activation of the PI3K/mTOR/AKT pathway was not significant. The ROS production and ROS detoxification pathways were not different between uSMCs of women with adenomyosis and controls suggesting an ROS-independent activation of the MAPK/ERK pathway. Our results also provide evidence that protein kinase inhibitors and the rapanalogue temsirolimus can control proliferation of uSMCs in vitro suggesting an implication of the MAPK/ERK and the PI3K/mTOR/AKT pathways in proliferation of uSMCs in women with adenomyosis and leiomyomas.


Assuntos
Adenomiose/enzimologia , Proliferação de Células , MAP Quinases Reguladas por Sinal Extracelular/metabolismo , Miócitos de Músculo Liso/enzimologia , Miométrio/enzimologia , Transdução de Sinais , Adenomiose/patologia , Adulto , Antioxidantes/farmacologia , Estudos de Casos e Controles , Proliferação de Células/efeitos dos fármacos , Células Cultivadas , Ativação Enzimática , MAP Quinases Reguladas por Sinal Extracelular/antagonistas & inibidores , Feminino , Humanos , Mediadores da Inflamação/metabolismo , Miócitos de Músculo Liso/efeitos dos fármacos , Miócitos de Músculo Liso/patologia , Miométrio/efeitos dos fármacos , Miométrio/patologia , Fosfatidilinositol 3-Quinase/metabolismo , Inibidores de Proteínas Quinases/farmacologia , Proteínas Proto-Oncogênicas c-akt/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Transdução de Sinais/efeitos dos fármacos , Serina-Treonina Quinases TOR/metabolismo
19.
J Minim Invasive Gynecol ; 22(2): 275-84, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25446542

RESUMO

STUDY OBJECTIVE: To determine whether cancer antigen-125 (CA-125) levels are increased in women with endometriosis, especially in those with endometriomas (OMAs), deep infiltrating lesions (DIE), and superficial endometriosis (SUP) compared with controls without endometriosis in a large cohort of operated women. DESIGN: Cross-sectional study (Canadian Task Force classification II-2). SETTING: Tertiary-care university hospital. PATIENTS: Four hundred six women with histologically proven endometriosis and 279 women without endometriosis. INTERVENTIONS: Surgical examination of the abdomino-pelvic cavity. MEASUREMENTS AND MAIN RESULTS: Preoperative serum CA-125 antigen levels were evaluated by electrochemoluminescence immunoassay in women with endometriosis and controls. Correlations between serum CA-125 levels and clinical and anatomical characteristics of disease severity were examined. Women with endometriosis displayed higher mean serum CA-125 levels compared with disease-free controls (50.1 ± 62.4 U/mL vs 22.5 ± 25.2 U/mL; p ≤ .001). CA-125 levels were significantly increased in women with OMA (60.8 ± 63.5 U/mL) and DIE (55.2 ± 68.7 U/mL) compared with women with SUP (23.2 ± 24.5 U/mL) and controls (22.5 ± 25.2 U/mL). There was no difference in CA-125 levels between patients with SUP and controls and between patients with OMA and DIE. CA-125 serum levels were correlated with DIE severity: the mean number of DIE lesions and worst DIE lesion. CONCLUSION: Serum CA-125 levels were significantly increased in women with severe forms of endometriosis, OMA, and DIE lesions. In addition, elevated serum Ca-125 levels were associated with more severe and extended DIE lesions. In women with superficial peritoneal lesions, CA-125 levels were not different from women without endometriosis.


Assuntos
Antígeno Ca-125/sangue , Endometriose/sangue , Endometriose/patologia , Peritônio/patologia , Adulto , Biomarcadores/sangue , Estudos Transversais , Endometriose/cirurgia , Feminino , França , Humanos , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Adulto Jovem
20.
Expert Opin Pharmacother ; 15(16): 2347-60, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25196637

RESUMO

INTRODUCTION: Adenomyosis, characterized by the infiltration of the myometrium by ectopic endometrial islets, is a common condition that causes dysmenorrhea, abnormal uterine bleeding and infertility. Different treatment options exist, including medical and surgical treatments. The most commonly used medications are NSAIDs, progestogens and GnRH agonists (GnRHas). AREAS COVERED: We conducted a literature search for in vitro and animal studies, randomized and non-randomized studies, systematic reviews and ongoing trials registered on ClinicalTrials.gov. There are almost no well-conducted randomized controlled trials on the pharmacological treatment of adenomyosis and the information collected from published studies is insufficient. Several therapeutic targets have been identified through animal and in vitro studies, and it is hoped that they will lead to further clinical studies on new compounds and treatment targets in this heterogeneous disease. EXPERT OPINION: Hysterectomy is very effective at treating women with symptomatic adenomyosis who have completed their wish of pregnancy. For women with a future desire of pregnancy medical treatments remain the best options. Progestogens and GnRHas are the most frequently used long-term treatments for abnormal uterine bleeding and pain symptoms. In assisted reproductive techniques long agonist stimulation protocols and pretreatment with GnRHas for differed embryo transfer seem to improve pregnancy rates.


Assuntos
Adenomiose/tratamento farmacológico , Adenomiose/complicações , Adenomiose/fisiopatologia , Inibidores da Angiogênese/uso terapêutico , Animais , Anti-Inflamatórios não Esteroides/uso terapêutico , Ensaios Clínicos como Assunto , Feminino , Hormônio Liberador de Gonadotropina/agonistas , Humanos , Infertilidade Feminina/etiologia , Infertilidade Feminina/terapia , Metrorragia/etiologia , Dor Pélvica/tratamento farmacológico , Progestinas/uso terapêutico , Receptores LHRH/antagonistas & inibidores , Técnicas de Reprodução Assistida
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