Principles of early diagnosis of endometriosis based on the assessment of comorbidity and clinical manifestations

封面

如何引用文章

全文:

开放存取 开放存取
受限制的访问 ##reader.subscriptionAccessGranted##
受限制的访问 订阅或者付费存取

详细

Objective: To analyze the clinical characteristics and concomitant diseases in patients with endometriosis.

Materials and methods: The cross-sectional study was conducted at the National Medical Research Center for Obstetrics, Gynecology and Perinatology in Moscow, Russia in the period from 2021 to 2022. The main group included 110 patients (mean age 29 (25; 36) years) with extragenital endometriosis confirmed by ultrasound and MRI assessment; the control group consisted of 110 women who were comparable in age to the patients of the main group (mean age 27 (26; 32) years) without echographic signs of endometriosis. The patients of both study groups were interviewed and surveyed for a comprehensive analysis of clinical and anamnestic data; the presence of comorbid conditions was determined on the basis of laboratory and instrumental studies which were carried out in accordance with the clinical recommendations of the Ministry of Health of the Russian Federation.

Results: Not only the severity of dysmenorrhea, dyspareunia and chronic pelvic pain, assessed by the visual analog scale (VAS), are significant, but also the combination of the symptoms is of importance, as it demonstrates a two-fold increase in the risk of endometriosis. It was found that lower body mass index (BMI) is characteristic of the patients of the main group (p=0.001). Every fifth patient with endometriosis had a body weight deficit (BMI<18.5 kg/m2), every second patient had a BMI<21 kg/m2. The patients with endometriosis, in comparison with the patients of the control group, had a higher incidence of acne (39.5 and 13.6%), fibrocystic disease (29.5 and 12%), human papillomavirus (41.7% and 22.7%), endometrial polyps (20.9 and 5.5%), uterine fibroids (23.6 and 8.2%, respectively). The presence of recurrent functional cysts (OR 2.11, 95% CI 1.66–2.69) and ovarian apoplexy (OR 1.99, 95% CI 1.62–2.45) had the greatest diagnostic significance. The combination of several comorbid conditions greatly increased the likelihood of endometriosis.

Conclusion: At the initial stage of the examination of a patient with suspected endometriosis, it is advisable to listen to the patient’s complaints and also to conduct a cumulative assessment of their severity counting the points according to the VAS score. Thus, precise anamnesis and clinical examination can be considered effective and available methods of identifying women at risk for the development of endometriosis.

全文:

受限制的访问

作者简介

Veronika Pronina

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: ver22595@yandex.ru
ORCID iD: 0000-0003-4566-4065

obstetrician-gynecologist, PhD student

俄罗斯联邦, Moscow

Madina Dumanovskaya

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: dumanovskaya@gmail.com
ORCID iD: 0000-0001-7286-6047

PhD, Researcher at the Department of Gynecological Endocrinology

俄罗斯联邦, Moscow

Galina Chernukha

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

编辑信件的主要联系方式.
Email: c-galina1@yandex.ru
ORCID iD: 0000-0002-9065-5689

Dr. Med. Sci., Professor, Chief Researcher at the Department of Gynecological Endocrinology

俄罗斯联邦, Moscow

参考

  1. Nnoaham K.E., Hummelshoj L., Webster P., d'Hooghe T., de Cicco Nardone F., de Cicco Nardone C. et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil. Steril. 2011; 96(2): 366-73.e8. https://dx.doi.org/10.1016/j.fertnstert.2011.05.090.
  2. Morassutto C., Monasta L., Ricci G., Barbone F., Ronfani L. Incidence and estimated prevalence of endometriosis and adenomyosis in northeast Italy: a data linkage study. PLoS One. 2016; 11: e0154227.
  3. Signorile P.G., Cassano M., Viceconte R., Marcattilj V., Baldi A. Endometriosis: a retrospective analysis of clinical data from a cohort of 4,083 patients, with focus on symptoms. In Vivo. 2022; 36(2): 874-83. https://dx.doi.org/10.21873/invivo.12776.
  4. Eisenberg V.H., Decter D.H., Chodick G., Shalev V., Weil C. Burden of endometriosis: infertility, comorbidities, and healthcare resource utilization. J. Clin. Med. 2022; 11(4): 1133. https://dx.doi.org/10.3390/jcm11041133.
  5. Chapron C., Lafay-Pillet M.-C., Santulli P., Bourdon M., Maignien C., Gaudet-Chardonnet A. et al. A new validated screening method for endometriosis diagnosis based on patient questionnaires. EClinicalMedicine. 2022; 44: 101263. https://dx.doi.org/10.1016/j.eclinm.2021.101263.
  6. Fauconnier A., Drioueche H., Huchon C., Du Cheyron J., Indersie E., Candau Y. Early identification of women with endometriosis by means of a simple patient-completed questionnaire screening tool: a diagnostic study. Fertil. Steril. 2021; 116(6): 1580-9. https://dx.doi.org/10.1016/j.fertnstert.2021.07.1205.
  7. ESHRE Endometriosis Guideline Group. ESHRE guideline: endometriosis. Hum. Reprod. Open. 2022; 2022(2): hoac009. https://dx.doi.org/10.1093/hropen/hoac009.
  8. Singh S., Soliman A.M., Rahal Y., Robert C., Defoy I., Nisbet P., Leyland N. Prevalence, symptomati burden, and diagnosis of endometriosis in Canada: cross-sectional survey of 30 000 women. J. Obstet. Gynaecol. Canada. 2020; 42(7): 829-38. https://dx.doi.org/10.1016/j.jogc.2019.10.038.
  9. Moradi Y., Shams-Beyranvand M., Khateri S., Gharahjeh S., Tehrani S., Varse F. et al. A systematic review on the prevalence of endometriosis in women. Indian J. Med. Res. 2021; 154(3): 446-54. https://dx.doi.org/10.4103/ ijmr.IJMR_817_18.
  10. Takebayashi A., Kimura F., Kishi Y., Ishida M., Takahashi A., Yamanaka A. et al. The association between endometriosis and chronic endometritis. PLoS One. 2014; 9(2): e88354. https://dx.doi.org/10.1371/journal.pone.0088354.
  11. Tai F.-W., Chang C., Chiang J.-H., Lin W.-C., Wan L. Association of pelvic inflammatory disease with risk of endometriosis: a nationwide cohort study involving 141,460 individuals. J. Clin. Med. 2018; 7(11): 379. https://dx.doi.org/ 10.3390/jcm7110379.
  12. Saidi K., Sharma S., Ohlsson B. A systematic review and meta-analysis of the associations between endometriosis and irritable bowel syndrome. Eur. J. Obstet. Gynecol. Reprod. Biol. 2020; 246: 99-105. https://dx.doi.org/10.1016/ j.ejogrb.2020.01.031.
  13. Wu C.-C., Chung S.-D., Lin H.-C. Endometriosis increased the risk of bladder pain syndrome/interstitial cystitis: a population-based study. Neurourol. Urodyn. 2018; 37(4): 1413-8. https://dx.doi.org/10.1002/nau.23462.
  14. Maitrot-Mantelet L., Hugon-Rodin J., Vatel M., Marcellin L., Santulli P., Chapron C., Plu-Bureau G. Migraine in relation with endometriosis phenotypes: results from a french case-control study. Cephalalgia. 2020; 40(6): 606-13. https://dx.doi.org/10.1177/0333102419893965.
  15. Porpora M.G., Scaramuzzino S., Sangiuliano C., Piacenti I., Bonanni V., Piccioni M.G. et al. High prevalence of autoimmune diseases in women with endometriosis: a case-control study. Gynecol. Endocrinol. 2020; 36(4): 356-9. https://dx.doi.org/10.1080/09513590.2019.1655727.
  16. Shah D.K., Correia K.F., Vitonis A.F., Missmer S.A. Body size and endometriosis: results from 20 years of follow-up within the Nurses’ Health Study II prospective cohort. Hum. Reprod. 2013; 28(7): 1783-92. https://dx.doi.org/10.1093/humrep/det120.
  17. Ashrafi M., Sadatmahalleh S.J., Akhoond M.R., Talebi M. Evaluation of risk factors associated with endometriosis in infertile women. Int. J. Fertil. Steril. 2016; 10(1): 11-21. https://dx.doi.org/10.22074/ijfs.2016.4763.
  18. Kim H.J., Lee H.S., Kazmi S.Z., Hann H.J., Kang T., Cha J. et al. Familial risk for endometriosis and its interaction with smoking, age at menarche and body mass index: a population-based cohort study among siblings. BJOG. 2021; 128(12): 1938-48. https://dx.doi.org/10.1111/1471-0528.16769.
  19. Ballard K., Seaman H., de Vries C., Wright J. Can symptomatology help in the diagnosis of endometriosis? Findings from a national case-control study-Part 1. BJOG. 2008; 115(11): 1382-91. https://dx.doi.org/10.1111/ j.1471-0528.2008.01878.x.
  20. Ministry of Health of the Russian Federation. Clinical guidelines. Endometriosis. 2020. (in Russian). Available at: https://cr.minzdrav.gov.ru/clin_recomend
  21. Drossman D.A., Hasler W.L. Rome IV—functional GI disorders: disorders of gut-brain interaction. Gastroenterology. 2016; 150(6): 1257-61. https://dx.doi.org/10.1053/j.gastro.2016.03.035.
  22. Lipton R.B., Dodick D., Sadovsky R., Kolodner K., Endicott J., Hettiarachchi J., Harrison W.; ID migraine validation study. a self-administered screener for migraine in primary care: the ID migraine validation study. Neurology. 2003; 61(3): 375-82. https://dx.doi.org/10.1212/01.wnl.0000078940.53438.83.
  23. Choi E.J., Cho S.B., Lee S.R., Lim Y.M., Jeong K., Moon H.S., Chung H. Comorbidity of gynecological and non-gynecological diseases with adenomyosis and endometriosis. Obstet. Gynecol. Sci. 2017; 60(6): 579-86. https://dx.doi.org/10.5468/ogs.2017.60.6.579.
  24. Xie J., Kvaskoff M., Li Y., Zhang M., Qureshi A.A., Missmer S.A., Han J. Severe teenage acne and risk of endometriosis. Hum. Reprod. 2014; 29(11): 2592-9. https://dx.doi.org/10.1093/humrep/deu207.
  25. Ricci G., Castelpietra E., Romano F., Di Lorenzo G., Zito G., Ronfani L. et al. Case-control study to develop and validate a questionnaire for the secondary prevention of endometriosis. PLoS One. 2020; 15(3): e0230828. https://dx.doi.org/10.1371/journal.pone.0230828.
  26. Russian Society of Dermatovenerologists and Cosmetologists. Acne vulgar. Clinical guidelines. 2020. (in Russian).
  27. Zhang M., Qureshi A.A., Hunter D.J., Han J. A genome-wide association study of severe teenage acne in European Americans. Hum. Genet. 2014; 133(3): 259-64. https://dx.doi.org/10.1007/s00439-013-1374-4.
  28. Backonja U., Hediger M.L., Chen Z., Lauver D.R., Sun L., Peterson C.M., Buck Louis G.M. Beyond body mass index: using anthropometric measures and body composition indicators to assess odds of an endometriosis diagnosis. J. Womens Health. 2017; 26(9): 941-50. https://dx.doi.org/10.1089/ jwh.2016.6128.
  29. Aarestrup J., Jensen B.W., Ulrich L.G., Hartwell D., Trabert B., Baker J.L. Birth weight, childhood body mass index and height and risks of endometriosis and adenomyosis. Ann. Hum. Biol. 2020; 47(2): 173-80. https://dx.doi.org/10.1080/03014460.2020.1727011.
  30. Farland L.V., Missmer S.A., Bijon A., Gusto G., Gelot A., Clavel-Chapelon F. et al. Associations among body size across the life course, adult height and endometriosis. Hum. Reprod. 2017; 32(8): 1732-42. https://dx.doi.org/10.1093/humrep/dex207.
  31. Goetz L.G., Mamillapalli R., Taylor H.S. Low body mass index in endometriosis is promoted by hepatic metabolic gene dysregulation in mice. Biol. Reprod. 2016; 95: 1-8. https://dx.doi.org/10.1095/biolreprod.116.142877.
  32. Hussein S.S., Farhan F.S., Ibrahim Ali A. Serum leptin as a marker for severity of endometriosis. Obstet. Gynecol. Int. 2020; 2020: 6290693. https://dx.doi.org/10.1155/2020/6290693.
  33. Choi Y.S., Oh H.K., Choi J.H. Expression of adiponectin, leptin, and their receptors in ovarian endometrioma. Fertil. Steril. 2013; 100(1): 135-41.e1-2. https://dx.doi.org/10.1016/j.fertnstert.2013.03.019.
  34. Picó C., Palou M., Pomar C.A., Rodríguez A.M., Palou A. Leptin as a key regulator of the adipose organ. Rev. Endocr. Metab. Disord. 2022; 23(1): 13-30. https://dx.doi.org/10.1007/s11154-021-09687-5.
  35. Zheng Q.M., Mao H.I., Zhao Y.J., Zhao J., Wei X., Liu P.S. Risk of endometrial polyps in women with endometriosis: a meta-analysis. Reprod. Biol. Endocrinol. 2015; 13: 103. https://dx.doi.org/10.1186/s12958-015-0092-2.
  36. Zhang Y., Zhang Y., Yu Q., Guo Z., Ma J., Yan L. Higher prevalence of endometrial polyps in infertile patients with endometriosis. Gynecol. Obstet. Invest. 2018; 83(6): 558-63. https://dx.doi.org/10.1159/ 000487946.
  37. Cicinelli E., Trojano G., Mastromauro M., Vimercati A., Marinaccio M., Mitola P.C. et al. Higher prevalence of chronic endometritis in women with endometriosis: a possible etiopathogenetic link. Fertil. Steril. 2017; 108(2): 289-95.e1. https://dx.doi.org/10.1016/j.fertnstert.2017.05.016.
  38. Huang L., Xiang M. Recent advances in endometrial polyps. J. Int. Obstet. Gynecol. 2014; 41: 43-6.
  39. Jones R.K., Bulmer J.N., Searle R.F. Immunohistochemical characterization of proliferation, oestrogen receptor and progesterone receptor expression in endometriosis: comparison of eutopic and ectopic endometrium with normal cycling endometrium. Hum. Reprod. 1995; 10(12): 3272-9. https://dx.doi.org/10.1093/oxfordjournals.humrep.a135901.
  40. Lopes R.G., Baracat E.C., de Albuquerque Neto L.C., Ramos J.F., Yatabe S., Depesr D.B., Lippi U.G. Analysis of estrogen- and progesterone-receptor expression in endometrial polyps. J. Minim. Invasive Gynecol. 2007; 14(3): 300-3. https://dx.doi.org/10.1016/j.jmig.2006.10.022.
  41. Noble L.S., Simpson E.R., Johns A., Bulun S.E. Aromatase expression in endometriosis. J. Clin. Endocrinol. Metab. 1996; 81(1): 174-9. https://dx.doi.org/10.1210/jcem.81.1.8550748.
  42. Maia H. Jr, Pimentel K., Silva T.M., Freitas L.A., Zausner B., Athayde C., Coutinho E.M. Aromatase and cyclooxygenase-2 expression in endometrial polyps during the menstrual cycle. Gynecol. Endocrinol. 2006; 22(4): 219-24. https://dx.doi.org/10.1080/09513590600585955.
  43. Heidarpour M., Derakhshan M., Derakhshan-Horeh M., Kheirollahi M., Dashti S. Prevalence of high-risk human papillomavirus infection in women with ovarian endometriosis. J. Obstet. Gynaecol. Res. 2017; 43(1): 135-9. https://dx.doi.org/10.1111/jog.13188.
  44. Hsu L.C., Tsui K.H., Wei J.C., Yip H.T., Hung Y.M., Chang R. Female human papillomavirus infection associated with increased risk of infertility: A Nationwide Population-Based Cohort Study. In.t J. Environ. Res. Public Health. 2020; 17(18): 6505. https://dx.doi.org/10.3390/ ijerph17186505.
  45. Vestergaard A.L., Knudsen U.B., Munk T., Rosbach H., Bialasiewicz S., Sloots T.P. et al. Low prevalence of DNA viruses in the human endometrium and endometriosis. Arch. Virol. 2010; 155(5): 695-703. https://dx.doi.org/10.1007/s00705-010-0643-y.
  46. Oppelt P., Renner S.P., Strick R., Valletta D., Mehlhorn G., Fasching P.A. et al. Correlation of high-risk human papilloma viruses but not of herpes viruses or Chlamydia trachomatis with endometriosis lesions. Fertil. Steril. 2010; 93(6): 1778-86. https://dx.doi.org/10.1016/ j.fertnstert.2008.12.061.
  47. Soliman A.M.S.E., Johnson S.J., Davis M., Castelli-Haley J., Snabes M.C. Incidence of comorbidities among women with endometriosis: a retrospective matched cohort study. Fertil. Steril. 2016; 106(3): e277-8. https://dx.doi.org/10.1016/j.fertnstert.2016.07.796.
  48. Wang L., Jiang Y.J. Rupture of ovarian endometriotic cyst complicated with endometriosis: a case report. World J. Clin. Cases. 2021; 9(28): 8524-30. https://dx.doi.org/10.12998/wjcc.v9.i28.8524.
  49. Cozzolino M., Corioni S., Maggio L., Sorbi F., Guaschino S., Fambrini M. Endometriosis-related hemoperitoneum in pregnancy: a diagnosis to keep in mind. Ochsner J. 2015; 15(3): 262-4.
  50. Elgina S.I., Lavrova E.V. Extragenital endometriosis: clinical and anamnestic features. Medicine in Kuzbass. 2021; (2): 47-9. (in Russian).
  51. Kokh L.I. On pathogenesis of ovarian apoplexy. Mother and Child in Kuzbass. 2014: (4): 15-8. (in Russian).
  52. Donnez J., Smoes P., Gillerot S., Casanas-Roux F., Nisolle M. Vascular endothelial growth factor (VEGF) in endometriosis. Hum. Reprod. 1998; 13(6): 1686-90. https://dx.doi.org/10.1093/humrep/13.6.1686.
  53. Strizhakov A.N., Shakhlamova M.N., Pirogova M.N., Smimov A.A. Ovarian apoplexy: ovarian angiogenesis and the prognostic role of vascular-endothelial growth factor. Issues of Gynecology, Obstetrics and Perinatology. 2017; 16(1): 18-24. (in Russian). https://dx.doi.org/10.20953/1726-1678-2017-1-18-24.
  54. Buggio L., Aimi G., Vercellini P. Hemoperitoneum following sexual intercourse in a woman with deep infiltrating endometriosis. Gynecol. Obstet. Invest. 2016; 81(6): 559-62. https://dx.doi.org/10.1159/000447262.
  55. Ferries-Rowe E., Corey E., Archer J.S. Primary dysmenorrhea. Obstet. Gynecol. 2020; 136(5): 1047-58. https://dx.doi.org/10.1097/aog.0000000000004096.

补充文件

附件文件
动作
1. JATS XML
下载
2. Fig. Threshold values of the main indicators of pain syndrome. DISM - dysmenorrhea, DISP - dyspareunia, CPP - chronic pelvic pain.

下载 (82KB)
索引源数据

版权所有 © Bionika Media, 2023
##common.cookie##