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Objetivo: Estudiar la relación que existe entre algunos factores predisponente a desarrollar endometriosis y síntomas más frecuentes que manifiestan las pacientes. Métodos: Estudio observacional longitudinal, retrospectivo y descriptivo, mediante la revisión de 455 historias tomadas 560 pacientes que acudieron a la consulta de endometriosis y realizando diagnóstico definitivo en el Hospital Universitario "Dr. Ángel Larralde" y consulta privada, en Venezuela, estado Carabobo, en el periodo de enero 2006 a mayo 2023. Resultados: El diagnóstico se realizó en un 47,1 % de las pacientes con edades entre 26 a 35 años. La menarquia se presentó entre los 8 y los 12 años (el 69 %). El 63 % no tenía embarazos. La dismenorrea primaria fue más frecuente en el 63,07 %. El dolor pélvico y dispareunia en el 48 %, los síntomas digestivos en el 21 %. La localización más frecuente fue en ovario (78,7 %). Conclusión: La endometriosis, enfermedad inflamatoria benigna, estrógeno dependiente, se caracteriza por presencia de glándulas y estroma endometrial ectópico, usualmente acompañados de fibrosis. Se manifiesta en el periodo reproductivo, su principal síntoma es el dolor. Se localiza con mayor frecuencia en la pelvis y de esta en los ovarios, en intestino, vejiga, hígado, pulmones, cerebro, pared abdominal y periné. No hay tratamiento para su cura, pero si para los síntomas y retardar su progreso. Su diagnóstico por su desarrollo multifactorial y manifestaciones clínicas en muchas oportunidades se realiza en forma tardía(AU)

Objective: To study the relationship that exists between some predisposing factors to develop endometriosis and the most frequent symptoms manifested by patients. Methods: Longitudinal, retrospective and descriptive observational study, through the review of 455 records taken from 560 patients who attended the endometriosis consultation and made a definitive diagnosis at the "Dr. Ángel Larralde" and private consultation, in Venezuela, Carabobo state, in the period from January 2006 to May 2023. Results: The diagnosis was made in 47.1% of the patients aged between 26 and 35 years. Menarche occurred between 8 and 12 years of age (69%). 63% did not have pregnancies. Primary dysmenorrhea was more frequent in 63.07%. Pelvic pain and dyspareunia in 48%, digestive symptoms in 21%. The most frequent location was in the ovary (78.7%). Conclusion: Endometriosis, a benign, estrogen-dependent inflammatory disease, is characterized by the presence of ectopic endometrial glands and stroma, usually accompanied by fibrosis. It manifests itself in the reproductive period, its main symptom is pain. It is located most frequently in the pelvis and from this in the ovaries, intestine, bladder, liver, lungs, brain, abdominal wall and perineum. There is no treatment to cure it, but there is treatment for the symptoms and slowing its progress. Its diagnosis due to its multifactorial development and clinical manifestations is often made late(AU)

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Endometriosis presents a pro-inflammatory microenvironment influenced by cytokines, such as interleukin (IL)-8, which expression may be influenced by genetic polymorphisms. Therefore, we aimed to investigate the role of interleukin (IL)-8 rs4073 polymorphism in endometriosis' development and its related symptoms. A case-control study was conducted with 207 women with endometriosis and 193 healthy controls. Polymorphism was genotyped using a TaqMan validated assay. Associations were evaluated by binary logistic regression, using odds ratios (OR) and 95 % confidence intervals (CI), and P ≤ 0.05 was considered significant. Cases were younger (36 ± 6.8 versus 39 ± 8.4) and had lower body mass index (26.5 ± 5.3 versus 35.7 ± 6.3 Kg/m2) than controls (P < 0.001). Higher prevalence of symptoms and infertility was observed in cases, compared to controls (P < 0.001). Minor allele frequencies of IL-8 rs4073 (T) were 42.3 % and 39.9 % for cases and controls, respectively, and no associations were found between IL and 8 rs4073 polymorphism and endometriosis' prevalence or staging. However, the polymorphism was associated with chronic pelvic pain among cases (OR = 0.54; 95 %CI = 0.29-0.98). The IL-8 rs4073A > T polymorphism may contribute to lower IL-8 expression and, consequently, decrease endometriosis-related pelvic pain. These findings can support the early diagnosis of endometriosis' painful symptoms, preventing its complications, and allowing an individualized treatment.

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OBJECTIVE: Analyze clinical factors and non-oncological gynecological diagnoses before and during the initial months of the COVID-19 pandemic. METHOD: Crosssectional study at an Outpatient Gynecology Clinic in Brazil involving medical consultations performed during the pre-pandemic and pandemic periods. The number of visits, prevalence of non-oncological gynecological diagnoses, and clinical-demographic data were analyzed. Parametric continuous variables were evaluated by Student's t-test and ANOVA tests, non-parametric variables were evaluated by the Mann-Whitney and Wilcoxon tests, and categorical or binary variables were evaluated by chi-square and Fisher's exact tests. Univariate logistic regression tests were performed, and variables with p ≤ 0.20 were subjected to multivariate logistic regression. Statistical significance was set at p < 0.05. RESULTS: There were 1,236 records during the pre-pandemic period and 530 during the pandemic, reflecting a significant reduction (57.88%; p = 0.001) in medical consultations. The outpatient prevalence of women older than 50 y (OR 0.85; 95%CI 0.68-1.05) reduced, and the outpatient prevalence of postmenopausal women with hot flashes (OR 1.34; 95%CI 1.09-1.65; p = 0.005) and alcohol consumption habits (OR 2.76; 95%CI 1.15-6.59; p = 0.023) increased. There was a 6% proportional increase in noninflammatory disorders of the female genital tract (p = 0.030) and a 72.4% decrease in general physical examinations, contraception, and procreation (p = 0.001). Multivariate analysis showed that there was an increased prevalence of abnormal uterine bleeding (OR, 1.7; 95% CI 1.34-2.16; p = 0.001) and endometriosis (OR 1.65; 95% CI 1.13-2.42; p = 0.01). CONCLUSION: Medical consultations for benign gynecological diseases during the pandemic prevented non-inflammatory disorders of the female genital tract, with an emphasis on abnormal uterine bleeding and endometriosis. There was an increased prevalence of women under 50 years of age, women with symptoms of hot flashes, and alcohol consumption habits and a reduction in the prevalence of general physical examinations, contraception, and procreation.

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OBJECTIVE: Endometrioma surgery is associated with a reduction in ovarian reserve. However, removal of an endometrioma may increase the likelihood of a spontaneous conception. The objective of this study was to assess the pre-operative and operative variables affecting spontaneous conception following endometrioma surgery. METHODS: Data from 211 women ≤40 years of age who underwent an endometrioma surgery at a university-based infertility clinic between January 2005 and June 2020 were reviewed retrospectively. The main outcome measure was spontaneous clinical pregnancy. We had 84 women with and 127 women without a successful spontaneous conception making up the case and control groups. RESULTS: The median ages of the cases and controls were 27 and 32 years, respectively (p<0.001). The rate of recurrence was significantly lower in the spontaneous conception group when compared to controls (29.8% vs. 52.8%, respectively; p=0.001). Our results showed no differences in the number, size, or side of the endometriomas in both groups. Multivariate logistic regression analysis showed significant independent effects of age (B: -.166, OR {odds ratio}: 0.847, 95% CI {confidence interval}: 0.791-0.907, p<0.001), recurrence (B: -1.030, OR: 0.357, 95% CI: 0.188-0.678, p=0.002), and laparoscopic surgery rather than laparotomy (B: 1.585, OR: 4.879, 95% CI: 1.029-23.133, p=0.046) for spontaneous conception. CONCLUSIONS: The size, number and bilaterality of the endometrioma did not affect the spontaneous conception likelihood following surgical removal. However, increasing age and recurrence are negatively associated with the likelihood of spontaneous conception. Laparoscopic surgery may increase the chance of spontaneous conception when compared to laparotomy.

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PURPOSE: This study aimed to assess the prevalence and progression of lower urinary tract symptoms following laparoscopic surgery for deep-infiltrating endometriosis of the rectosigmoid and identify preoperative factors associated with worse postoperative outcomes. METHODS: Prospective, observational study. SETTINGS: single-center, referral hospital for endometriosis. Patients undergoing laparoscopic surgery for deep-infiltrating endometriosis of the rectosigmoid colon between October 2016 and October 2018. MAIN OUTCOME MEASURES: urinary function was assessed with the validated Portuguese language version of the International Prostate Symptom Score, which is also used in women. The score was collected before and after surgery. The Wilcoxon signed-rank test was used to compare pre and postoperative scores and the chi-square test compared symptoms categorized by severity. RESULTS: Fifty-three patients were assessed and 44 were included. Concerning urinary symptoms after surgery, the irritative symptoms prevailed over the obstructive ones. Additionally, 58.8% and 54.5% of the women reported moderate or severe symptoms at pre and postoperative, respectively. In at least one questionnaire category, the postoperative questionnaire scores increased in ten (22.7%) participants. A statistically significant difference was found comparing the changes from absent/mild to moderate/severe IPSS categories (P = 0.039). No significant changes were identified in any of the International Prostate Symptom Score pre and postoperatively (P = 0.876). CONCLUSIONS: There was a high prevalence of pre and postoperative urinary symptoms. Patients with preoperative moderate/severe International Prostate Symptom Score are at risk of persisting urinary dysfunction after surgery for rectosigmoid deep endometriosis.

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PURPOSE: To investigate the relationship between pain intensity and insomnia frequency in women with a diagnosis of deep endometriosis. The hypothesis is that these patients with moderate or severe pain have a higher frequency of insomnia than those with mild or no pain. METHODS: We conducted a cross-sectional study of women with deep endometriosis categorized by pelvic pain intensity based on a numerical scale. Insomnia was assessed through a self-reported questionnaire, and multiple logistic regression was used to control for confounders between pain and insomnia. RESULTS: We included 234 women in the study, 39 (17%) without pelvic pain; 66 (29%) with mild pain; 53 (23%) moderate pain; and 76 (32%) severe pain. Twenty-nine (74%) pain-free women and 50 (75%) with mild pain had no insomnia; only 3 (8%) of the former and 3 (4%) of the latter group had severe insomnia. However, twenty-nine (55%) women with moderate pain and 37 (48%) with severe pain had insomnia. The logistic regression model showed that moderate to severe pain increased insomnia 2.8 times, twice for every 10 years of pain duration, and twice in women with low education levels. CONCLUSIONS: Women with moderate or severe pain had a high frequency of insomnia, increasing management complexity in patients with deep endometriosis. Pain intensity, pain duration, and low education level increased the chance of insomnia in those patients.

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The objective is to evaluate quality of life, anxiety, and depression in women with endometriosis, and to correlate these parameters with pain intensity. This multicenter cross-sectional study was conducted on 102 women with endometriosis from 2017 to 2020. The women were divided into two groups according to the pain intensity: group 1 (severe pain, 62 women) and group 2 (mild/moderate pain, 40 women). The Endometriosis Health Profile Questionnaire, Beck Anxiety Inventory, and Beck Depression Inventory were used to assess quality of life and levels of anxiety and depression, respectively. In both groups, mean age and mean body mass index were similar (p˃ 0.5). Most women had deep endometriosis and were on treatment, but group 2 had a longer treatment time (p = 0.044). Group 1 exhibited more depression and anxiety than group 2 (17.1 ± 9.98 vs. 11.15 ± 9.25, p = 0.003 and 23.71 ± 12.92 vs 12.58 ± 10.53, p = 0.001, respectively). Women with high pain had a significantly worse quality of life than those with low pain (48.88 ± 16.02 vs. 23.32 ± 15.93, p < 0.001). Women with endometriosis and high pain intensity have a worse quality of life, and more severe levels of anxiety and depression.

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Endometriosis is a chronic gynaecological condition characterized by inflammatory and immune abnormalities. Likewise, these dysfunctions are important hallmarks of systemic lupus erythematosus (SLE), a condition that also has a high prevalence among women in reproductive age. Therefore, we conducted a systematic review and meta-analysis to investigate the association between endometriosis and SLE. We searched Medline and Web of Science for articles published from database inception to March 1, 2021. Random-effects meta-analysis was performed to provide a pooled risk ratio (RR). Individual study quality was evaluated following the National Heart, Lung, and Blood Institute Quality Assessment Tools (NHLBI QAT). From the 225 articles identified through our search, five studies-assessing 152,355 women-were included. Included studies presented an overall poor or fair quality rating. We observed a significant association between endometriosis and SLE (RR = 2.47, 95% confidence interval: 1.33-4.59, P < 0.004, I2 = 54%). Sensitivity analyses stratifying articles by study design demonstrated that the association was significant in cross-sectional and case-control studies (RR = 5.07, 95% confidence interval: 1.42-18.11, P < 0.012), as well as in cohort studies (RR = 2.07, 95% confidence interval: 1.02-4.20, P < 0.044). In spite of the limited quality of included studies, our results suggest the existence of an association between endometriosis and SLE. These findings can aid medical assessment of patients with endometriosis, as well as provide further insights to better understand this gynaecological disorder.

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Endometriosis is defined as ectopic endometrial tissues dispersed outside the endometrium. This can cause disruption in hormonal and immunological processes, which may increase susceptibility to SARS-CoV-2 infection. Worsening of endometriosis symptoms may occur as a result of this infection. The aim of our review was to estimate the pooled prevalence of SARS-CoV-2 infection and the health impacts of the COVID-19 pandemic in endometriosis patients. We conducted a systematic review and meta-analysis. MEDLINE, Science Direct, Scopus, and Google Scholar databases were searched, using the keywords: (endometriosis) AND (COVID-19 OR SARS-CoV-2). Forest plots and pooled estimates were created using the Open Meta Analyst software. After screening 474 articles, 19 studies met the eligibility criteria for the systematic review, and 15 studies were included in the meta-analyses. A total of 17,799 patients were analyzed. The pooled prevalence of SARS-CoV-2 infection in endometriosis patients was 7.5%. Pooled estimates for the health impacts were 47.2% for decreased access to medical care, 49.3% increase in dysmenorrhea, 75% increase in anxiety, 59.4% increase in depression, and 68.9% increase in fatigue. Endometriosis patients were undeniably impacted by the COVID-19 pandemic, which caused the worsening of symptoms such as dysmenorrhea, pelvic pain, anxiety, depression, and fatigue.

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Endometriosis Fertility Index (EFI) is a clinical staging system created to predict spontaneous pregnancy outcomes in patients with endometriosis. The present study aimed at evaluating the performance of EFI in symptomatic patients, submitted to laparoscopy for moderate and severe endometriosis associated to infertility in a Brazilian population. Seventy-seven women with endometriosis and pelvic pain, who desired to become pregnant, were selected from a tertiary care unit between those operated on between May 2007 and March 2017. All of them were submitted to laparoscopy for the surgical treatment of endometriosis and allowed to attempt natural conception for 36 months or immediately referred to in vitro fertilization (IVF). EFI was calculated according to surgical description and clinical information in medical records. Pregnancy rates and live birth rates after natural conception or IVF are reported and correlated to EFI. Fifty-three women tried natural conception and 24 were referred to IVF. Of the 53 who tried natural conception, 29 achieved pregnancy (54.7%) and 28 had live birth (52.8%). The majority of pregnancies (82.7%) occurred in the first 12 months after surgery and 75% of the patients who became spontaneously pregnant had EFI ≥ 7. Of the 24 patients referred to IVF, 13 became pregnant (54.1%) and 10 had live birth (41.7%). Infertility duration of 36 months or more and the presence of endometrioma increased the probability of having EFI ≤ 5. The overall live birth rate (LBR) for patients with low EFI scores (2-4) was 17% compared with 83.8% for those with higher EFI scores (6-9). EFI predicts pregnancy rates in patients operated on for moderate and severe endometriosis. Scores seem also to predict pregnancy rates after IVF.

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