BACKGROUNDEndometriosis is a controversial and enigmatic disease. Deep infiltrating endometriosis (DIE) is responsible for painful symptoms and is the least understood type of endometriosis. Little work has been devoted to define the location of DIE lesions and its relationships with pain. The aim of the study was to investigate the relationship between the anatomical distribution of DIE lesions and pain symptoms.

METHODSClinical data from 354 patients between May 2003 and December 2007 with laparoscopically diagnosed endometriosis were collected including 177 DIE patients and 177 non-DIE patients. The pain symptoms, including dysmenorrhea (DM), chronic pelvic pain (CPP, defined as intermittent or permanent pelvic pain, not related to the menstruation and longer than 6 months), deep dyspareunia (pelvic pain at intercourse) and dyschezia (pelvic pain with defecation), were recorded for every patient before operation. Endometriotic lesions were recorded by their anatomical distributions, the depth of infiltration and lesion colors. And the relationship between the anatomical distribution of DIE lesions and pain symptoms was analyzed. Pearson's chi-square test or Fisher's exact test, one-way analysis of variance (ANOVA) and linear regression and binary Logistic regression were used for statistical analysis.

RESULTSThe duration ((13.79 ± 3.94) years) of pain suffering in DIE patients was much longer than that of non-DIE patients (P < 0.01). In DIE patients, 60.7% of the uterosacral ligament (USL) nodules were bilateral (P < 0.01); 44.6% of the cul-de-sacs were completely blocked. Rectum invasion was observed in 19.9% of DIE patients (P = 0.03); pelvic adhesion was also more common. Up to 98.41% of the deep infiltrative lesions were located in the posterior pelvic compartment. DIE lesions were also found in bladder (1.58%), USL (67.08%), cul-de-sac (12.02%), recto-vaginal septum (12.66%), rectum and rectosigmoid junction (2.85%) and ureter (3.80%). The odds ratio of USL-DIE for CPP, deep dyspareunia, dyschezia were 2.52, 1.29 and 2.24 respectively. And the depth of infiltration correlated with the severity of dysmenorrhea.

CONCLUSIONSDIE lesions were associated with severe pain symptoms. The main distribution of DIE lesions was in the posterior pelvic compartment, and was more widespread and severe in DIE patients. Moreover, resection of these DIE lesions are very important to treat the pain symptoms.

Adult ; Constipation ; physiopathology ; Dysmenorrhea ; physiopathology ; Endometriosis ; pathology ; physiopathology ; Female ; Humans ; Pelvic Pain ; physiopathology ; Prospective Studies

In addition to regulating calcium and phosphorus metabolism to maintain strong bones, vitamin D also has immune regulating and anti-inflammatory effects. Moreover, it is related to chronic inflammatory diseases, autoimmune diseases and cancer. Many studies indicate the roles of vitamin D in the development and progression of endometriosis including the effects on modulation of immune responses, inflammation reactions, cell proliferation and apoptosis, angiogenesis, adhesion and invasion. Vitamin D supplementation can relieve pain and improve endometrial receptivity associated with endometriosis and play a preventive and therapeutic role. This paper summarizes the roles of vitamin D in endometriosis.
Autoimmune Diseases ; physiopathology ; Endometriosis ; physiopathology ; Endometrium ; physiopathology ; Female ; Humans ; Inflammation ; physiopathology ; Vitamin D ; immunology ; metabolism

BACKGROUNDEndometriosis affects natural fertility through various approaches, and in vitro fertilization (IVF) is a good treatment. But the IVF result of endometriosis patients is still under debate. We investigated the effect of endometriosis on IVF by analyzing the data from a single reproductive center.

METHODSA retrospective, database-searched cohort study was performed. Relevant information was collected from the electronic records of women who underwent IVF/intracytoplasmic sperm injection between January 2006 and December 2010 in the Assisted Reproductive Unit of Sir Run Run Shaw Hospital. Patients with endometriosis were enrolled the study group. The rest of the women formed the control group. The main outcome was the clinical pregnancy rate. Secondary outcomes were oocytes retrieved number, fertilization rate, high-quality embryo rate, number of high-quality embryo for embryo transplantation, and implantation embryo/high-quality embryo ratio (IE/HQE ratio). Comparisons were performed by the c(2)-test and independent t-test.

RESULTSThe endometriosis group (n = 177) had a markedly lower oocytes retrieved number, fertilization rate, implantation rate, and clinical pregnancy rate (7.6 ± 5.1, 63.6%, 27.7%, and 45.2%, respectively) compared with the non-endometriosis group (n = 4267; 11.8 ± 7.3, 68.4%, 36.2%, and 55.2%, respectively). Stratified analysis showed that this difference was found in the subgroup younger than 35-years old, while only fertilization rate and implantation rate were different in the elder subgroup. The ratio of high-quality embryos transferred is lower in endometriosis group (53.7% vs. 71.8%, P < 0.05), but there is no difference in IE/HQE ratio between two groups. There is no significant difference in fertilization rate, implantation rate, and clinical pregnancy rate between mild and severe endometriosis patients.

CONCLUSIONSEndometriosis patients suffer a decreasing IVF pregnancy rates mainly caused by reducing oocytes number and fertilization rate, regardless of the severity of the disease. Appropriate intracytoplasmic sperm injection manipulation might improve the outcomes of IVF.

Endometriosis ; physiopathology ; Female ; Fertilization in Vitro ; Humans ; Infertility, Female ; etiology ; therapy ; Pregnancy ; Pregnancy Rate ; Retrospective Studies

A large number of studies have shown that the oxidative imbalance is common in patients with endometriosis. Abnormal respiratory chain of mitochondrial, estrogen metabolism imbalance, iron overload, and ectopic foci may increase active oxygen, reduction of antioxidant enzyme and non-enzymatic substances may result in decreased antioxidant level, and the exposure to environmental hazards may further aggravate oxidative imbalance in patients with endometriosis. This article analyzes the oxidative imbalance and its role in the pathogenesis of endometriosis from the aspects of excessive oxide production and decreased antioxidant capacity.
Antioxidants ; metabolism ; Endometriosis ; physiopathology ; Female ; Humans ; Oxidative Stress ; Reactive Oxygen Species ; metabolism

OBJECTIVE: To observe the clinical therapeutic effect of herb-separated moxibustion on dysmenorrhea in ovarian endometriosis. METHODS: A total of 54 patients with ovarian endometriosis dysmenorrhea were randomized into a herb-separated moxibustion group and a waiting-list group, 27 cases in each one (3 cases dropped off in the herb-separated moxibustion group, 4 cases dropped off in the waiting-list group). Herb-separated moxibustion was applied at hypogastrium and lumbosacral area for 30 min in the herb-separated moxibustion group, once a week for 3 months, and oral ibuprofen sustained-release capsule was given to relieve pain when necessary. Excepting giving ibuprofen sustained-release capsule when necessary, no more intervention was adopted in the waiting-list group. Before and after treatment and in 3 months follow-up, visual analogue scale (VAS) score, days of dysmenorrhea, total dose of oral painkiller were observed. RESULTS: Compared before treatment, the VAS scores after tratment and in follow-up were decreased in the herb-separated moxibustion group (<0.05), and were less than those in the waiting-list group (<0.05); the days of dysmenorrhea and the total doses of oral painkiller after tratment and in follow-up were decreased in the herb-separated moxibustion group (<0.05), and were less than those in the waiting-list group (<0.05). CONCLUSION Herb-separated moxibustion can effectively improve dysmenorrhea symptom and shorten dysmenorrhea days in patients with ovarian endometriosis.
Acupuncture Points ; Dysmenorrhea ; therapy ; Endometriosis ; therapy ; Female ; Humans ; Ibuprofen ; therapeutic use ; Moxibustion ; Ovary ; physiopathology

INTRODUCTIONThis report describes a "parasitic" endometriotic cyst of the small bowel.

CLINICAL PICTUREA menopausal woman with a pelvic mass presenting years after commencing hormone therapy.

TREATMENTWe performed laparoscopic excision of a cystic tumour attached to the small bowel with a solitary vascular pedicle.

OUTCOMEHistology confirmed it to be an endometriotic cyst of ovarian origin, probably resulting from spillage during previous surgery and reactivation with hormone therapy.

CONCLUSIONSWe discuss the possible aetiology of this unusual presentation of endometriosis and review the literature on parasitic gynaecological tumours.

Cysts ; pathology ; Endometriosis ; diagnosis ; etiology ; Estrogen Replacement Therapy ; Female ; Genital Diseases, Female ; Humans ; Intestine, Small ; physiopathology ; Middle Aged

Epithelial-mesenchymal transition plays an important role in the development and progression of endometriosis. Mesenchymal-epithelial transition is involved in forming localized lesions of endometriosis, while EMT is involved in the injury, repair and fibrosis induced by local inflammation of endometriosis and the process of cell invasion and metastasis. The studies of signal transduction pathway and related proteins of epithelial-mesenchymal transition in the process of endometriosis may provide new targets for diagnosis and treatment of endometriosis.
Endometriosis ; complications ; etiology ; pathology ; physiopathology ; Epithelial-Mesenchymal Transition ; physiology ; Female ; Fibrosis ; complications ; Humans ; Inflammation ; complications ; Signal Transduction ; physiology

OBJECTIVETo compare the effect of abdominal acupuncture and Chinese medicine on pain relieving in pelvic cavity in patients with endometriosis.

METHODSFifty-eight cases were randomly divided into 2 groups. Thirty cases were in abdominal acupuncture group and 28 cases in Chinese medicine group. Abdominal acupuncture points such as Zhongwan (CV 12), Xiawan (CV 10) and Qihai (CV 6), etc. were adopted for the abdominal acupuncture group, and Tianqi Tongjing Capsule (radix notoginseng capsule for dysmenorrhea) was taken by the Chinese medicine group. After a 3-month treatment, the scores of McGill pain questionaire, level of serum CA125, average value of the radial line of endometrial cyst of ovary and the sum of 3 radial lines of the uterus of patients with adenomyosis as the complication of both groups were observed before and after treatment.

RESULTSThe McGill estimation of 6 items for both groups improved obviously after treatment (all P < 0.01, except numbers of selected deseriptors in Chinese medicine group). The differences of the result of McGill estimation of 6 items after treatment had statistical significance, the scores in the abdominal acupuncture group were obviously better than those in the Chinese medicine group (all P < 0.01). The differences of CA125 levels within one group or between 2 groups had statistical significance (P < 0.01, P < 0.05). The difference of the radial lines of patients with endometrial cyst of ovary within one group or between 2 groups after treatment had not statistical significance (all P > 0.05). For the value of 3 radial lines of the uterus of patients with adenomyosis within one group before and after treatment, only the difference in the abdominal acupuncture group had statistical significance (P < 0.01). The differences before and after treatment in the Chinese medicine group and the difference between 2 groups after treatment had no statistical significance (all P > 0.05).

CONCLUSIONEffect of abdominal acupuncture on relieving pain of pelvic cavity caused by endometriosis, reducing the level of serum CA125 is obverious than Tianqi Tongjing Capsule (radix notoginseng capsule for dysmenorrhea). However, the effects on reducing the size of the ovarian endometrial cyst and the size of uterus with adenomyosis are not significant. Therefore, it is concluded that abdominal acupuncture is a better choice for endometriosis with pain as the chief complaints.

Abdomen ; Acupuncture Therapy ; methods ; Adult ; Endometriosis ; physiopathology ; Female ; Humans ; Medicine, Chinese Traditional ; Middle Aged ; Pain Measurement ; Pelvic Pain ; therapy

BACKGROUNDThe effect of endometriosis on obstetric outcomes is still ambiguous. The aim of our study was to determine the association between endometriosis and adverse obstetric outcomes in a cohort of Chinese women.

METHODSA retrospective cohort study was undertaken to compare obstetric outcomes between 249 women with endometriosis and 249 women without endometriosis. All women were nulliparous and achieved singleton pregnancies naturally. Women with endometriosis were diagnosed during surgery and confirmed histologically. Odds ratios (ORs) and 95% confidence intervals (CIs) of measures of obstetric outcomes were calculated.

RESULTSWomen with endometriosis showed significantly increased risks of preterm labor (adjusted OR, 2.42; 95% CI, 1.05-5.57), placenta previa (adjusted OR, 4.51; 95% CI, 1.23-16.50), and cesarean section (adjusted OR, 1.93; 95% CI, 1.31-2.84). No significant differences were observed in the incidence of pregnancy-induced hypertension, fetal growth restriction, small for gestational age, placental abruption, or luteal support in the first trimester between the two groups.

CONCLUSIONSWomen with endometriosis are at a higher risk of preterm labor, placenta previa, and cesarean section during pregnancy and need additional care.

Adult ; Cesarean Section ; statistics & numerical data ; Endometriosis ; epidemiology ; physiopathology ; Female ; Humans ; Obstetric Labor, Premature ; epidemiology ; Placenta Previa ; epidemiology ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies

OBJECTIVETo investigate the effect of small interference RNA (siRNA) targeting nuclear factor-kappaB (NF-kappaB) on endometriosis.

METHODThe eutopic endometrium of women with endometriosis were transplanted into the nonvascular region of 8-day-old chicken embryo chorioallantocic membrane (CAM), and the effects of NF-kappaB p65 siRNA on the vascularization and endometriotic lesion formation were tested with proper controls.

RESULTSTransplantation of the endometrium onto the CAM resulted in a strong angiogenic response in the chicken tissue. The angiogenesis was significantly reduced and endometriotic lesion formation significantly suppressed with siRNA targeting NF-kappaB in comparison with the control group.

CONCLUSIONSThe NF-kappaB pathway is involved in the development of endometriotic lesions in vitro, and NF-kappaB gene silencing reduces endometriotic angiogenesis and promotes cell apoptosis in the endometriotic lesions, suggesting that NF-kappaB might be a good target for endometriosis treatment.

Animals ; Chick Embryo ; Chorioallantoic Membrane ; blood supply ; metabolism ; Endometriosis ; genetics ; physiopathology ; Female ; Humans ; NF-kappa B ; deficiency ; genetics ; Neovascularization, Pathologic ; genetics ; RNA Interference ; RNA, Small Interfering ; genetics