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1.
Artigo em Inglês | MEDLINE | ID: mdl-31574938

RESUMO

Objective: The association between phthalates and endometriosis risk is inconclusive. This meta-analysis aims to evaluate the association between five different phthalate metabolites and endometriosis, based on current evidence. Methods: The literature included PubMed, WOS (web of science), and EMBASE, published until 3 March 2019. We selected the related literature and evaluated the relationship between phthalates exposure and endometriosis risk. All statistical analyses were conducted with STATA version 12.0. Results: Data from eight studies were used in this review. The results of this analysis showed that mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) exposure was potentially associated with endometriosis (OR = 1.246, 95% CI = 1.003-1.549). We have not found positive results in mono(2-ethylhexyl) phthalate (MEHP), monoethyl phthalate (MEP), monobenzyl phthalate (MBzP) and mono(2-ethyl-5-oxohexyl) phthalate (MEOHP) analyses (MEHP: OR = 1.089, 95% CI = 0.858-1.383; MEP: OR = 1.073, 95% CI = 0.899-1.282; MBzP: OR = 0.976, 95% CI = 0.810-1.176; MEOHP: OR = 1.282, 95% CI = 0.874-1.881). In subgroup analyses for regions, the associations were significant between MEHHP and endometriosis in Asia (OR = 1.786, 95% CI = 1.005-3.172, I² = 0%), but not in USA (OR = 1.170, 95% CI = 0.949-1.442, I² = 45.6%). Conclusions: Our findings suggested a potential statistical association between MEHHP exposure and endometriosis, particularly, the exposure of MEHHP might be a potential risk for women with endometriosis in Asia. However, positive associations between the other four Phthalate acid esters (PAEs) and endometriosis was not found. Given the weak strength of the results, well-designed cohort studies, with large sample sizes, should be performed in future.


Assuntos
Endometriose/epidemiologia , Ácidos Ftálicos/metabolismo , Endometriose/metabolismo , Feminino , Humanos , Fatores de Risco
2.
Nat Commun ; 10(1): 4857, 2019 10 24.
Artigo em Inglês | MEDLINE | ID: mdl-31649266

RESUMO

Uterine leiomyomata (UL) are the most common neoplasms of the female reproductive tract and primary cause for hysterectomy, leading to considerable morbidity and high economic burden. Here we conduct a GWAS meta-analysis in 35,474 cases and 267,505 female controls of European ancestry, identifying eight novel genome-wide significant (P < 5 × 10-8) loci, in addition to confirming 21 previously reported loci, including multiple independent signals at 10 loci. Phenotypic stratification of UL by heavy menstrual bleeding in 3409 cases and 199,171 female controls reveals genome-wide significant associations at three of the 29 UL loci: 5p15.33 (TERT), 5q35.2 (FGFR4) and 11q22.3 (ATM). Four loci identified in the meta-analysis are also associated with endometriosis risk; an epidemiological meta-analysis across 402,868 women suggests at least a doubling of risk for UL diagnosis among those with a history of endometriosis. These findings increase our understanding of genetic contribution and biology underlying UL development, and suggest overlapping genetic origins with endometriosis.


Assuntos
Endometriose/genética , Leiomioma/genética , Neoplasias Uterinas/genética , Adulto , Proteínas Mutadas de Ataxia Telangiectasia/genética , Endometriose/epidemiologia , Grupo com Ancestrais do Continente Europeu/genética , Feminino , Proteína Forkhead Box O1/genética , Proteína Forkhead Box O1/metabolismo , Estudo de Associação Genômica Ampla , Humanos , Leiomioma/complicações , Leiomioma/epidemiologia , Análise da Randomização Mendeliana , Menorragia/etiologia , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Modelos de Riscos Proporcionais , Receptor Tipo 4 de Fator de Crescimento de Fibroblastos/genética , Transdução de Sinais , Telomerase/genética , Neoplasias Uterinas/complicações , Neoplasias Uterinas/epidemiologia
3.
Artigo em Inglês | MEDLINE | ID: mdl-31540449

RESUMO

BACKGROUND: Endometriosis has been associated with the subsequent development of ovarian and breast cancers. This study evaluated whether nurses were at increased risks of developing endometriosis and subsequent ovarian and breast cancers. METHODS: From Taiwan National Health Insurance Research Database during 2000 to 2011, we established 3 study cohorts, consisting of 23,801 nurses, 11,973 other hospital employees, and 143,096 general women free of endometriosis and cancer. Women in all cohorts were followed to the end of 2011 to measure the occurrences of endometriosis and subsequent ovarian and breast cancers. The incident endometriosis cases and related hazard ratio (HR) and 95% confidence interval (CI) were calculated. The incident cases of ovarian cancer and breast cancer and related odds ratio were calculated. RESULTS: The incidence of endometriosis was the highest in the nurse cohort (4.23 per 100, n = 966) followed by other health professionals (3.74 per 100, n = 427) and control cohort (3.06 per 100, n = 4193), with adjusted hazard ratios of 1.28 (95% CI = 1.20-1.38) and 1.13 (95% CI = 1.02-1.25), respectively, comparing to controls. Among those who developed endometriosis, nurses had higher subsequent ovarian cancer and lower breast cancer, but not significant. CONCLUSIONS: Nurses are at a higher risk of developing endometriosis. However, the link between endometriosis and subsequent cancers is weak.


Assuntos
Neoplasias da Mama/epidemiologia , Endometriose/epidemiologia , Enfermeiras e Enfermeiros/estatística & dados numéricos , Neoplasias Ovarianas/epidemiologia , Adulto , Neoplasias da Mama/etiologia , Estudos de Casos e Controles , Estudos de Coortes , Endometriose/complicações , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Neoplasias Ovarianas/etiologia , Modelos de Riscos Proporcionais , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
4.
J Ovarian Res ; 12(1): 79, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470880

RESUMO

OBJECTIVE: To explore the risk factors for the recurrence of endometrioma and the risk factors for the recurrence of endometriosis-related pain after long-term follow-up. METHODS: This study retrospectively analyzed 358 women with endometriomas who had a minimum of 5-years follow up after laparoscopic endometrioma excision, which was performed at Peking Union Medical College Hospital from January 2009 to April 2013. All women were divided into recurrence group and nonrecurrence group. Analysis was performed with regard to preoperative history, laboratory analysis, findings during surgery, and symptoms during follow-up, including improvement and recurrence. RESULTS: The cumulative incidence rates of recurrence from 5 to 10 years after surgery were 15.4, 16.8, 19.3, 22.5, 22.5, and 22.5%, respectively. Significant differences were found between two groups in terms of age at surgery (RR: 0.764, 95% CI: 0.615-0.949, p = 0.015), duration of dysmenorrhea (RR: 1.120, 95% CI: 1.054-1.190, p < 0.001), presence of adenomyosis (RR: 1.629, 95% CI: 1.008-2.630, p = 0.046), CA125 level (RR: 1.856, 95% CI: 1.072-3.214, p = 0.021) and severity of dysmenorrhea. The severity of dysmenorrhea (RR: 1.711, 95% CI: 1.175-2.493, p = 0.005) and postoperative pregnancy (RR: 0.649, 95% CI: 0.460-0.914, p = 0.013) were significantly correlated with endometrioma recurrence in the multivariate analysis. No significant associations were found between the recurrence rate and gravida, parity, body mass index, infertility, leiomyoma presence, the size of ovarian endometrioma, the presence of deep infiltrating endometriosis, disease stage or postoperative medication. CONCLUSIONS: The severity of dysmenorrhea and postoperative pregnancy were independent risk factors for the recurrence of ovarian endometriomas after surgery during the long-time follow up.


Assuntos
Endometriose/epidemiologia , Doenças Ovarianas/epidemiologia , Adulto , Dismenorreia/epidemiologia , Endometriose/cirurgia , Feminino , Seguimentos , Humanos , Doenças Ovarianas/cirurgia , Recidiva , Fatores de Risco
5.
Medicina (Kaunas) ; 55(8)2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31416164

RESUMO

Hormonal replacement therapy (HRT) is effective in treating the symptoms of menopause. Endometriosis is defined as the presence of functional endometrial tissue outside the uterine cavity with a tendency towards invasion and infiltration. Being an estrogen-dependent disease, it tends to regress after menopause. Nevertheless, it affects up to 2.2% of postmenopausal women. Conclusive data are not available in the literature on the appropriateness of HRT in women with endometriosis or a past history of the disease. The hypothesis that exogenous estrogen stimulation could reactivate endometriotic foci has been proposed. The aim of this state-of-the-art review was to revise the current literature about endometriosis in perimenopause and menopause and to investigate the possible role of HRT in this setting of patients. An electronic databases search (MEDLINE, Scopus, ClinicalTrials.gov, EMBASE, Sciencedirect, the Cochrane Library at the CENTRAL Register of Controlled Trials, Scielo) was performed, with the date range of from each database's inception until May 2019. All of the studies evaluating the impact of different HRT regimens in patients with a history of endometriosis were selected. 45 articles were found: one Cochrane systematic review, one systematic review, five narrative reviews, two clinical trials, two retrospective cohort studies, 34 case reports and case series. Some authors reported an increased risk of malignant transformation of endometriomas after menopause in patients assuming HRT with unopposed estrogen. Low-quality evidence suggests that HRT can be prescribed to symptomatic women with a history of endometriosis, especially in young patients with premature menopause. Continuous or cyclic combined preparations or tibolone are the best choices. HRT improves quality of life in symptomatic post-menopausal women, who should not be denied the replacement therapy only due to their history of endometriosis. Based on low-grade literature evidence, we recommend to prescribe combined HRT schemes; tibolone could be considered.


Assuntos
Endometriose/epidemiologia , Terapia de Reposição Hormonal , Menopausa/fisiologia , Moduladores de Receptor Estrogênico/administração & dosagem , Feminino , Humanos , Norpregnenos/administração & dosagem , Estudos Retrospectivos
6.
Int J Gynaecol Obstet ; 147(2): 212-218, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31469423

RESUMO

OBJECTIVE: To assess the utility of hematologic, inflammatory, and immunologic biomarkers for differentiating between ovarian cancer and endometriosis. METHODS: Data were retrospectively reviewed from women diagnosed with ovarian cancer and endometriosis after ovarian cyst surgery in Zhejiang, China, 2014-2016. Serologic and hematologic biomarkers, including white blood cell count, lymphocyte count, neutrophil count, red blood cell count, hemoglobin, platelets, and D-dimer, albumin, globulin, cancer antigen 125 (CA125) and CA199 serum levels recorded pre-operatively were assessed by ROC curve and logistic regression analysis. RESULTS: Overall, 49 women were diagnosed with ovarian cancer and 192 with endometriosis. For predicting ovarian cancer, the area under the curve (AUC) was 0.96 (95% confidence interval [CI], 0.94-0.99); sensitivity, 93.2%; specificity, 87.5%) for log(D-dimer), 0.95 (95% CI, 0.91-0.98; sensitivity, 81.3%; specificity, 96.3%) for log(CA125), and 0.92 (95% CI, 0.86-0.98; sensitivity, 92.6%; specificity, 79.2%) for neutrophil-to-lymphocyte ratio (NLR). The AUC for the combination of D-dimer, NLR, and CA125 was 0.96 (95% CI, 0.94-0.99; sensitivity, 91.6%; specificity, 89.6%). CONCLUSION: Serum D-dimer, NLR, and CA125 were found to be potential diagnostic factors for ovarian cancer. Combined measurement of D-dimer, NLR, and CA125 might offer a convenient screening method.


Assuntos
Antígeno Ca-125/sangue , Carcinoma Epitelial do Ovário/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Linfócitos/metabolismo , Neutrófilos/metabolismo , Neoplasias Ovarianas/sangue , Adulto , Biomarcadores Tumorais/sangue , Carcinoma Epitelial do Ovário/diagnóstico , Carcinoma Epitelial do Ovário/epidemiologia , China/epidemiologia , Diagnóstico Diferencial , Endometriose/sangue , Endometriose/diagnóstico , Endometriose/epidemiologia , Feminino , Humanos , Contagem de Linfócitos , Linfócitos/patologia , Pessoa de Meia-Idade , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/epidemiologia , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade
7.
PLoS One ; 14(7): e0219497, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31335888

RESUMO

OBJECTIVE: To evaluate the association between the endometriosis phenotype and the age at menarche. DESIGN: An observational, cross-sectional study using prospectively collected data (Canadian Task Force classification II-2). SETTING: Single university tertiary referral center. PATIENTS: To be eligible, women had to have undergone their 1st complete surgical exeresis of endometriotic lesions. For each patient, a standardized questionnaire was completed the month before the surgery. Endometriotic lesions were classified into 3 phenotypes: superficial peritoneal endometriosis (SUP), endometrioma (OMA), or deep infiltrating endometriosis (DIE). Patients were divided into 3 groups: early menarche (< 12 years), typical menarche (≥ 12 and ≤ 13 years) and late menarche (> 13 years). The groups were compared in terms of general characteristics, medical history, disease phenotype, and disease severity. INTERVENTIONS: Surgical management for a benign gynecologic condition. MAIN OUTCOME MEASURE(S): Correlation between the endometriosis phenotype and the age at menarche. MEASUREMENTS AND MAIN RESULTS: From January 2004 to December 2016, 789 women with histologically confirmed endometriosis were enrolled in the study. The mean age at menarche was 12.9 ± 1.6 years of age, (range 9 to 18). The mean age at menarche and the mean time interval between menarche and the 1st surgery for endometriosis were not significantly different between the three phenotypes (SUP, OMA, DIE). When women with early menarche, typical menarche, or late menarche were compared, no differences were observed in terms of the endometriosis phenotype and the anatomical distribution of the endometriotic lesions. CONCLUSION: For women operated for the first time for endometriosis, age at menarche is not associated with the disease phenotype.


Assuntos
Endometriose/epidemiologia , Menarca/fisiologia , Adolescente , Adulto , Fatores Etários , Criança , Feminino , Humanos , Fenótipo
8.
Eur J Contracept Reprod Health Care ; 24(3): 216-221, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31055972

RESUMO

Objective: Our aim was to study the association between early-life factors and the development of endometriosis. Methods: This case-control study included 440 women with surgically confirmed endometriosis (cases) and 880 women without endometriosis (controls). Information on early-life factors was ascertained retrospectively by in-person interviews with participants and their mothers. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between endometriosis and maternal and paternal characteristics and foetal and infant exposures were estimated using unconditional logistic regression, adjusting for frequency matching and confounding variables. Results: We observed that women who were not breastfed as infants had twice the risk of endometriosis compared with women who were breastfed (adjusted OR 2.0; 95% CI 1.6, 4.5). Our data suggested an increased endometriosis risk with neonatal vaginal bleeding (adjusted OR 1.9; 95% CI 1.2, 4.3) and paternal smoking (adjusted OR 1.8; 95% CI 1.1, 4.9). Although the CIs included the null hypothesis value, caesarean section (adjusted OR 1.7; 95% CI 1.0, 3.5) and prematurity (adjusted OR 1.4; 95% CI 0.8, 3.7) were probably associated with the incidence of endometriosis. Conclusions: Some early-life factors including breastfeeding, neonatal vaginal bleeding and paternal smoking were associated with subsequent, surgically confirmed endometriosis in this cohort of Chinese women.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Endometriose/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Hemorragia Uterina/epidemiologia , Adolescente , Adulto , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , China/epidemiologia , Pai/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fumar/epidemiologia , Adulto Jovem
9.
Depress Anxiety ; 36(6): 543-551, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31025812

RESUMO

BACKGROUND: Hormonal fluctuations may trigger the onset of bipolar disorder. We designed a longitudinal follow-up study to evaluate the association between hysterectomies and bipolar disorder risk. METHODS: We conducted a large retrospective cohort study using Taiwan's National Health Insurance Research Database. A total of 4,337 women aged 30 to 50 years who underwent the hysterectomy during 2000-2013 were selected and 17,348 patients without hysterectomy were selected for comparison (1:4 match). Poisson regression analysis was used to calculate the incidence rate ratio (IRR) and 95% confidence interval (CI). RESULTS: During the follow-up of 7.93 years, 20 participants with hysterectomy and 28 without hysterectomy developed bipolar disorder. Receiving hysterectomy was associated with the risk of developing bipolar disorder (adjusted IRR = 2.80; 95% CI = 2.54-3.09). Women with hysterectomy had a higher risk of bipolar disorder in follow-up durations of <1 year (adjusted IRR = 2.18 with 95% CI = 1.94-1.45) and ≥1 year (adjusted IRR = 2.85 with 95% CI = 2.58-3.15). Endometriosis and Premarin use increased bipolar disorder incidence in the hysterectomy group (adjusted IRR = 3.17 [95% CI = 2.83-3.56] and 4.22 [95% CI = 3.71-4.80], respectively). CONCLUSION: This study concluded that women with hysterectomy have an increased risk of bipolar disorder. Endometriosis and hormone therapy may add to the risk of bipolar disorder after hysterectomy. Knowledge about how surgical or natural hormonal withdrawal influences mood is fundamental and emphasizes the importance of coordinated psychiatric and gynecological care.


Assuntos
Transtorno Bipolar/etiologia , Histerectomia/efeitos adversos , Adulto , Transtorno Bipolar/epidemiologia , Estudos de Coortes , Suscetibilidade a Doenças , Endometriose/epidemiologia , Feminino , Seguimentos , Ginecologia , Humanos , Histerectomia/estatística & dados numéricos , Incidência , Pessoa de Meia-Idade , Estudos Retrospectivos , Taiwan/epidemiologia
10.
Int J Gynaecol Obstet ; 146(2): 157-163, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30973964

RESUMO

OBJECTIVE: To estimate the prevalence of fibromyalgia among women with endometriosis and analyze the effect of fibromyalgia on health-related quality of life (HRQoL). METHODS: An observational case-control study conducted at a tertiary hospital in Barcelona between April 2015 and March 2017 among women with deep infiltrating endometriosis (DIE; n=80), women with superficial endometriosis or ovarian endometrioma (non-DIE; n=76), and control women without endometriosis (n=73). Fibromyalgia was assessed via the London Fibromyalgia Epidemiological Study Screening Questionnaire (LFESSQ). HRQoL was evaluated with the 36-Item Short Form (SF-36) questionnaire. The impact of fibromyalgia and other clinical characteristics was assessed by multivariate regression analysis. RESULTS: More women fulfilled the criteria for fibromyalgia in the DIE group than in the non-DIE and control groups by LFESSQ-4 (31 [39%], 12 [16%], and 6 [8%], respectively; P=0.009) and LFESSQ-6 (22 [28%], 8 [11%], and 4 [5%], respectively; P=0.008). The DIE group reported significantly poorer HRQoL for all SF-36 dimensions. Women with DIE who fulfilled the criteria for fibromyalgia had lower physical component scores (-31.6; 95% confidence interval, -50.8 to -12.3; P=0.003). CONCLUSION: The estimated prevalence of fibromyalgia was higher among women with DIE. Women with DIE and positive fibromyalgia screening had lower HRQoL.


Assuntos
Endometriose/epidemiologia , Fibromialgia/epidemiologia , Qualidade de Vida , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Análise Multivariada , Prevalência , Inquéritos e Questionários
11.
BJOG ; 126(9): 1104-1115, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30908874

RESUMO

BACKGROUND: Understanding the impact of race/ethnicity on the prevalence and presentation of endometriosis may help improve patient care. OBJECTIVE: To review systematically the evidence for the influence of race/ethnicity on the prevalence of endometriosis. SEARCH STRATEGY: CENTRAL, MEDLINE, PubMed, Embase, LILACS, SCIELO, and CINAHL databases, as well as the grey literature, were searched from date of inception until September 2017. SELECTION CRITERIA: Randomised control trials and observational studies reporting on prevalence and/or clinical presentation of endometriosis. DATA COLLECTION AND ANALYSIS: Twenty studies were included in the review and 18 studies were used to calculate odds ratio (OR) with 95% confidence interval (CI) through a random effects model. Methodological quality was assessed using the Newcastle-Ottawa risk of bias scale (NOS). MAIN RESULTS: Compared with White women, Black woman were less likely to be diagnosed with endometriosis (OR 0.49, 95% CI 0.29-0.83), whereas Asian women were more likely to have this diagnosis (OR 1.63, 95% CI 1.03-2.58). Compared with White women, there was a statistically significant difference in likelihood of endometriosis diagnosis in Hispanic women (OR 0.46, 95% CI 0.14-1.50). Significant heterogeneity (I2  > 50%) was present in the analysis for all racial/ethnic groups but was partially reduced in subgroup analysis by clinical presentation, particularly when endometriosis was diagnosed as self-reported, CONCLUSIONS: Prevalence of endometriosis appears to be influenced by race/ethnicity. Most notably, Black women appear less likely to be diagnosed with endometriosis compared with White women. There is scarce literature exploring the influence of race/ethnicity on symptomatology, as well as treatment access, preference, and response. TWEETABLE ABSTRACT: Prevalence of endometriosis may be influenced by race/ethnicity, but there is limited quality literature exploring this topic.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Endometriose/epidemiologia , Grupos Étnicos/estatística & dados numéricos , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Endometriose/etnologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Prevalência , Adulto Jovem
12.
Gynecol Endocrinol ; 35(8): 645-650, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30907174

RESUMO

Endocrine-disrupting chemicals (EDCs) are suspected to be associated with endometriosis (EMs). This study aimed to synthesize published data and evaluate the relationship between four classic EDCs exposure and the risk of EMs. A systematic literature search for original peer reviewed papers was performed in the databases PubMed, EMBASE, and Web of Science based on inclusion criteria up to January 2018. Subsequently, a total of 20 papers conducting 30 studies fulfilled the eligibility criteria and were included in this meta-analysis (four studies for bisphenol A (BPA), 12 studies for polychlorinated biphenyls (PCBs), eight studies for organochlorine pesticides (OCPs), and six studies for phthalate esters (PAEs)). The overall odds ratio (OR) across all exposures and EMs was 1.41 (95% confidence interval (CI): 1.23-1.60). When assessing four specific chemicals, respectively, consistent increases in the risk of EMs were found in PCBs group (OR = 1.58; 95% CI: 1.18-2.12), OCPs group (OR = 1.40; 95% CI: 1.02-1.92) and PAEs group (OR = 1.27; 95% CI: 1.00-1.60), while BPA showed no significant association with EMs. Besides, in the di-(2-ethylhexyl)-phthalate (DEHP) group - the most commonly used PAEs, significant risk was also found (OR = 1.42; 95% CI: 1.19-1.70). The current meta-analysis strengthens the evidence that specific EDCs or their metabolites may promote the occurrence of EMs.


Assuntos
Disruptores Endócrinos/toxicidade , Endometriose/induzido quimicamente , Endometriose/epidemiologia , Exposição Ambiental/estatística & dados numéricos , Exposição Ambiental/análise , Feminino , Humanos , Fatores de Risco
13.
Am J Obstet Gynecol ; 221(2): 132.e1-132.e13, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30926265

RESUMO

OBJECTIVE: To describe the incidence of and factors associated with lower urinary tract complications recognized in the immediate postoperative period following hysterectomy for benign gynecologic indications using the NSQIP (National Surgical Quality Improvement Program) database. METHODS: Patients who underwent hysterectomy for benign indications from 2014 through 2016 were identified in the NSQIP database using Current Procedural Terminology codes and International Classification of Diseases codes. Patient demographics, preoperative comorbidities, ASA classification system scores, and total operating time were collected. Data on 30-day postoperative complication rates, including rates of reoperation and readmission, were also captured. Genitourinary complications were defined as ureteral obstruction, ureteral fistula, and bladder fistula. RESULTS: A total of 45,139 patients met inclusion criteria during the study period. Mean age and body mass index were 31 ± 11years and 32 ± 8 kg/m2. The majority of patients were white (66%), had an ASA class of 2 (67%), and had no major medical comorbidities (68%). The most commonly performed primary surgery was laparoscopic hysterectomy (43%), followed by abdominal hysterectomy (27%). The incidence of any lower urinary tract complication was 0.2% (95% confidence interval, 0.19-0.28): 55 ureteral obstructions (0.1%, 95% confidence interval, 0.09-0.16), 33 ureteral fistulae (0.07%, 95% confidence interval, 0.05-0.1), and 28 bladder fistulae (0.06%, 95% confidence interval, 0.04-0.09). In a multivariable logistic regression model, black race (adjusted odds ratio, 1.90; 95% confidence interval, 1.20-2.96), endometriosis (adjusted odds ratio, 2.29; 95% confidence interval, 1.44-3.52), and prior abdominal surgery (adjusted odds ratio, 1.53; 95% confidence interval, 1.01-2.28) remained significantly associated with the occurrence of any lower urinary tract complication recognized in the immediate 30-day postoperative window. CONCLUSION: Lower urinary tract complications recognized in the immediate postoperative period following hysterectomy for benign gynecologic disease are rare, with ureteral obstruction being the most commonly reported complication. The risk of these complications may be higher in patients who identify as black, had prior abdominal surgery, and/or have a diagnosis of endometriosis.


Assuntos
Histerectomia/efeitos adversos , Obstrução Ureteral/epidemiologia , Fístula da Bexiga Urinária/epidemiologia , Fístula Urinária/epidemiologia , Adulto , Grupo com Ancestrais do Continente Africano , Estudos de Coortes , Bases de Dados Factuais , Diagnóstico Tardio , Endometriose/epidemiologia , Feminino , Humanos , Análise Multivariada , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia , Obstrução Ureteral/diagnóstico , Fístula da Bexiga Urinária/diagnóstico , Fístula Urinária/diagnóstico
14.
BMC Res Notes ; 12(1): 88, 2019 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-30764858

RESUMO

OBJECTIVE: Currently, it is estimated that one in 10 women of reproductive age are affected by the reproductive condition known as endometriosis. However, there has been limited research and policy attention on the prevalence of endometriosis in Australia. Utilising a nationally-representative Australian sample (N = 2025), this study aimed to report on the prevalence of endometriosis in the general population and to examine the sociodemographic factors associated with the condition. RESULTS: The results identified a prevalence rate for endometriosis of 3.4%, which aligns with previous Australian research on this topic. However, the prevalence rate from this data set is lower than the estimate prevalence from the Global Burden of Disease Study. In addition, this study reported that women self-reporting diagnosis of endometriosis, were between 40-49 years of age, with a higher proportion living in South Australia (18.2%) compared to women within the general population (8.4%). The findings highlight endometriosis as a significant health care issue warranting further research and policy attention. While acknowledging some limitations, the study provides an important foundation for further large-scale research to be conducted on this important women's health topic.


Assuntos
Endometriose/epidemiologia , Adolescente , Adulto , Austrália/epidemiologia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Autorrelato , Adulto Jovem
15.
Thromb Haemost ; 119(4): 606-617, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30722077

RESUMO

BACKGROUND: Since venous thromboembolism (VTE) is one of the causes of maternal mortality, several guidelines recommend prophylaxis using low molecular weight heparin for women in high-risk groups. The number of large population-based studies examining predictors for VTE has been limited, and there has been no study based on a Japanese population. OBJECTIVE: Our objective was to examine VTE risk factor during the pregnancy and post-partum period. MATERIALS AND METHODS: A nationwide birth cohort study known as the 'Japan Environment and Children's Study (JECS)' was conducted by the Ministry of the Environment. The subjects consisted of 103,070 pregnancies recruited by the JECS between January 2011 and March 2014. Pregnant women completed the questionnaires during the first and second/third trimester. Their medical records were transcribed by physicians or research coordinators at registration, just after delivery and at 1 month after delivery. RESULTS: The frequency of VTE was 7.5 per 10,000 pregnancies (77 of 103,070) during the pregnancy and post-partum period. After the adjustment of multiple covariates for each factor, endometriosis and recurrent pregnancy loss (RPL) were identified as novel independent risk factors for VTE. Adjusted odds ratios were as follows: 2.70 (95% confidence interval, 1.21-6.00) for endometriosis and 6.13 (2.48-15.16) for RPL. Threatened abortion, threatened pre-term birth, pre-term birth and caesarean section were ascertained to be risk factors for VTE. CONCLUSION: Careful attention should be given to novel predictors, such as endometriosis and a history of RPL, to prevent VTE during the pregnancy and post-partum period.


Assuntos
Aborto Habitual/epidemiologia , Endometriose/complicações , Tromboembolia Venosa/complicações , Ameaça de Aborto , Adulto , Cesárea/efeitos adversos , Estudos de Coortes , Endometriose/epidemiologia , Feminino , Humanos , Recém-Nascido , Japão/epidemiologia , Masculino , Idade Materna , Período Pós-Parto , Gravidez , Complicações na Gravidez , Complicações Cardiovasculares na Gravidez , Nascimento Prematuro , Fatores de Risco , Inquéritos e Questionários , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiologia
17.
BMC Complement Altern Med ; 19(1): 17, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30646891

RESUMO

BACKGROUND: Endometriosis has a significant negative impact on the lives of women, and current medical treatments often do not give sufficient pain relief or have intolerable side effects for many women. The majority of women with primary dysmenorrhea use self-management strategies (including self-care techniques or lifestyle choices) to help manage period related symptoms, but little is known about self-management in women with endometriosis. The aim of this survey was to determine the prevalence of use, safety, and self-rated effectiveness of common forms of self-management. METHODS: A cross-sectional online survey was distributed via social media using endometriosis support and advocacy groups in Australia between October and December 2017. Women were eligible to answer the survey if they were 18-45, lived in Australia, and had a confirmed diagnosis of endometriosis. Survey questions covered the types of self-management used, improvements in symptoms or reduction in medication, and safety. RESULTS: Four hundred and eighty-four valid responses were received. Self-management strategies, consisting of self-care or lifestyle choices, were very common (76%) amongst women with endometriosis. The most common forms used were heat (70%), rest (68%), and meditation or breathing exercises (47%). Cannabis, heat, hemp/CBD oil, and dietary changes were the most highly rated in terms of self-reported effectiveness in pain reduction (with mean effectiveness of 7.6, 6.52, 6.33, and 6.39, respectively, on a 10-point scale). Physical interventions such as yoga/Pilates, stretching, and exercise were rated as being less effective. Adverse events were common, especially with using alcohol (53.8%) and exercise (34.2%). CONCLUSIONS: Self-management was very commonly used by women with endometriosis and form an important part of self-management. Women using cannabis reported the highest self-rated effectiveness. Women with endometriosis have unique needs compared to women with primary dysmenorrhea, and therefore any self-management strategies, especially those that are physical in nature, need to be considered in light of the potential for 'flare ups'.


Assuntos
Terapias Complementares/estatística & dados numéricos , Endometriose/epidemiologia , Endometriose/terapia , Autogestão/métodos , Autogestão/estatística & dados numéricos , Adulto , Austrália/epidemiologia , Cannabis , Estudos Transversais , Exercício Físico , Feminino , Humanos , Maconha Medicinal , Meditação
18.
PLoS One ; 14(1): e0208464, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30629598

RESUMO

OBJECTIVES: Endometriosis and quality of life has been the subject of much research, however, there is little consensus on how best to evaluate quality of life in endometriosis, resulting in many and diverse scales being used. In our study, we aim to identify quality of life scales used in endometriosis, to review their strengths and weaknesses and to establish what would define an ideal scale in the evaluation of endometriosis-related quality of life. MATERIALS AND METHODS: A search of the MEDLINE and EMBASE databases was carried out for publications in English and French for the period from 1980 to February 2017, using the words 'endometriosis' and 'quality of life'. Publications were selected if they reported on quality of life in patients with endometriosis and specified use of a quality of life scale. A quantitative and a qualitative analysis of each scale was performed in order to establish the strengths and weaknesses for each scale (systematic registration number: PROSPERO 2014: CRD42014014210). RESULTS: A total of 1538 articles publications were initially identified. After exclusion of duplicates and application of inclusion criteria, 201 studies were selected for analysis. The SF-36, a generic HRQoL measure, was found to be the most frequently used scale, followed by the EHP-30, a measure specific to endometriosis. Both perform well, when compared with other scales, with scale weaknesses offset by strengths. EHP-5 and EQ-5D also showed to be of good quality. All four were the only scales to report on MCID studied in endometriosis patients. CONCLUSION: For clinical practice, routine evaluation of HRQOL in women with endometriosis is essential both for health-care providers and patients. Both SF-36 and EHP-30 perform better overall with regard to their strengths and weaknesses when compared to other scales.


Assuntos
Endometriose/epidemiologia , Qualidade de Vida , Comitês Consultivos , Canadá , Feminino , Inquéritos Epidemiológicos , Humanos , Reprodutibilidade dos Testes , Inquéritos e Questionários
19.
J Gynecol Obstet Hum Reprod ; 48(1): 45-49, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30321609

RESUMO

OBJECTIVES: Determining the incidence and causes of lower urinary tract injury in patients undergoing total laparoscopic hysterectomy and examining the procedures applied for management. METHODS: Patients who underwent total laparoscopic hysterectomy in a large referral center between 1 January 2015 and 31 October 2017 for benign gynecological reasons were included in the study. Patients who underwent laparoscopic supracervical hysterectomy, laparoscopy-assisted vaginal hysterectomy and robot-assisted laparoscopic hysterectomy were not included in this study. The hospital records of all patients included in the study were examined and the incidence, causes and management of lower urinary tract injuries were reviewed. RESULTS: Total lower urinary tract injury rate was found as 2.01%, and these injuries were evaluated separately as bladder and ureter injuries. All the bladder injuries had occurred on the posterior wall of the bladder during vesicouterine dissection; six cases were intraoperatively detected and one case was detected on the first postoperative day. Most of ureteral injury cases were detected in the early postoperative period (75%). The rates of previous cesarean section and endometriosis were significantly higher in patients with injury to the bladder and ureter than in the control group (p<0,001). There was no significant difference between the patients with lower urinary tract injury and the control group regarding uterine weight, estimated blood loss, bilateral salpingo-oophorectomy, the presence and location of fibroids, and laparoscopic or vaginal closure of the vaginal cuff. CONCLUSION: Laparoscopic hysterectomy may be a good option in appropriate patients, but in case of previous cesarean section and endometriosis cases, patients should be informed about the possible complications in detail before the operation and care should be taken during dissection.


Assuntos
Cesárea , Endometriose , Histerectomia/efeitos adversos , Complicações Intraoperatórias , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias , Ureter/lesões , Doenças Uretrais , Doenças da Bexiga Urinária , Bexiga Urinária/lesões , Adulto , Cesárea/estatística & dados numéricos , Endometriose/epidemiologia , Feminino , Humanos , Histerectomia/estatística & dados numéricos , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/terapia , Laparoscopia/estatística & dados numéricos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Doenças Uretrais/epidemiologia , Doenças Uretrais/etiologia , Doenças Uretrais/terapia , Doenças da Bexiga Urinária/epidemiologia , Doenças da Bexiga Urinária/etiologia , Doenças da Bexiga Urinária/terapia
20.
J Obstet Gynaecol Res ; 45(2): 368-375, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30280468

RESUMO

AIM: To determine the efficacious treatment for infertile couples, we assessed the impact of infertility factors including endometriosis on assisted reproductive technology (ART) and non-ART treatment, and the effect of age in infertility treatment outcomes was also investigated. METHODS: The medical records of 1864 females, infertile patients from January 2000 to December 2015 at our hospital, were retrospectively reviewed under the approval of the Institutional Review Board. We extracted 10 representative factors and calculated the cumulative live birth rate (CLBR) in these patients. Multivariate analysis of ART and non-ART treatment was performed to assess the impact of infertility factors, and the age-related decline in cumulative live birth rate was calculated by creating eight age-stratified subgroups. RESULTS: In total, 21.9% and 49.4% of the patients conceived after being treated with non-ART and ART, respectively. Multivariate analysis revealed that age > 35, advanced endometriosis defined by the revised American Society for Reproductive Medicine classification system stages III to IV, and the past history or current presence of uterine fibroid had significantly negative impact on the outcome of non-ART. Age stratification revealed that advanced endometriosis adversely affected the outcome of non-ART, especially for patients in their 30s. Assisted reproductive technology treatment for patients with advanced endometriosis was shown to be efficacious because the negative impact had been diminished. CONCLUSION: Considering that non-ART treatment had limited role in patients with advanced endometriosis, prompt initiation of ART in these patients aged as young as 30 years can be recommended to achieve conception.


Assuntos
Endometriose/epidemiologia , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/terapia , Técnicas de Reprodução Assistida/estatística & dados numéricos , Adulto , Fatores Etários , Endometriose/complicações , Feminino , Humanos , Infertilidade Feminina/etiologia , Estudos Retrospectivos , Tóquio/epidemiologia
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