BACKGROUND

Endometriosis is an inflammation-dependent condition characterized by the uncontrolled development of lesions resembling the endometrium. For the host tissue to maintain homeostasis throughout the active process of inflammation resolution, endogenous factors must be activated.

OBJECTIVE

To determine if using specialized pro-resolving mediators (SPM) to treat endometriosis patients’ persistent pelvic pain is safe and effective.

METHODS

A systematic review was performed to determine studies that determined the effect of Specialized Pro-resolving Mediators (SPM) on endometriosis control. A descriptive narrative approach was applied to synthesize the findings of this systematic review.

RESULTS

Three prospective case-control studies and three in vitro studies were included. All studies involved Lipoxin A4 as the specialized pro-resolving mediator assessed for benefit on endometriosis control. All studies consistently reported that SPM can be potentially effective in treating endometriosis. The search terms used were: “Specialized Pro-resolving Mediators,” “SPM,” “Chronic inflammatory agent,” pelvic pain, and endometriosis.

CONCLUSION

Despite the lack of trials on the use of Specialized Pro-resolving Mediators to manage chronic pelvic pain, case-control and in vitro studies are consistent in detailing the potential benefits of SPM for endometriosis control. Given the concrete pathophysiologic basis for the mechanism of action for SPM, it is highly recommended that future trials be made to determine its efficacy and safety.

Human ; Endometriosis ; Inflammation ; Specialized Pro-resolving Mediators

Primary amenorrhea is a symptom caused by different rare pathologic conditions. It is commonly seen during adolescence due to the absence of menses during this period. Presented here is a rare case of primary amenorrhea in an 18 year old girl with delayed pubertal growth and short stature which on series of investigations revealed hypergonadotropic hypogonadism, absence of the uterus and non-visualized bilateral ovaries on MRI. Karyotyping showed 45,X0. The coexistence of MRKH and gonadal dysgenesis was considered in this case and has been reported in only a few studies up to this date. Its association is uncommon, hence, a multidisciplinary approach is warranted for the management of her case. Further implications on menses and future fertility options are the main considerations, affecting the quality of life.

Turner Syndrome

Androgen Insensitivity Syndrome (AIS) is a disorder wherein a patient presents with a female phenotype but is actually genetically male with an XY karyotype. Typically, AIS is diagnosed at the beginning of second decade, when a phenotypically female patient complains of amenorrhea. It is extremely rare to make a first diagnosis of AIS after the fifth decade of life. This case report presents a 62-year old female who consulted because of primary amenorrhea and intraabdominal mass. Patient was diagnosed with Complete Androgen Insensitivity Syndrome based on physical exam findings, imaging studies, endocrine tests and karyotyping. She underwent exploratory laparotomy, adhesiolysis and bilateral orchiectomy. This report will discuss diagnosis and appropriate management of patients with Complete Androgen Insensitivity.
Androgen-Insensitivity Syndrome

Mullerian anomalies arise from the failure in the development of Mullerian ducts and their associated structures during organogenesis which confers adverse impact in fertility and reproductive health. Presented is a rare case of a 15 year old nulligravid, who presented with a chief complaint of severe cyclic hypogastric pain associated with primary amenorrhea. Complete clinical history, physical examination and sonographic findings pointed to a diagnosis of cervical hypoplasia associated with functioning uterine corpus and an absent vagina. Patient underwent total abdominal hysterectomy with left salpingectomy and bilateral oophorocystectomy, for hematometra, bilateral endometriotic cysts, and hematosalpinx. This case report discusses the management of cervicovaginal agenesis through a multidisciplinary approach by a team composed of an obstetrician-gynecologist, reproductive endocrinologist, pediatrician, and pediatric surgeon for proper evaluation, diagnosis, and management of this case.
Hematometra